Inter-rater reliability of the 1992 international standards for neurological and functional classification of incomplete spinal cord injury

Aims: To determine the inter-rater reliability in scoring sensory and motor function and in defining sensory and motor levels in incomplete spinal cord injury, using the revised 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury (ISCSCI-92) and to determine the effect on raters agreement of one standardising assessment. Methods: Two physicians and two physiotherapists at the Spinal Cord Injury Unit, Karolinska Hospital, classified 23 patients according to the ISCSCI-92. Kappa values were calculated. Results: Kappa values varied from 0 to 0.83 (poor to very good) for the pin-prick scores, from 0 to 1 for the light touch scores and from 0 to 0.89 for motor function after the standardising assessment. Kappa values for sensory and motor levels were fair to poor after the standardising assessment. The results showed improvement in degree of agreement in 35/46 dermatomes for scoring pin-prick, in 15/42 for light touch, in 14/19 segments for motor function and for three out of four sensory and motor levels. Conclusion: This study indicates a weak inter-rater reliability for scoring incomplete SCI lesions using the ISCSCI-92.