Validity and reliability study of the Turkish version of Spinal Cord Independence Measure-III.

STUDY DESIGN: This is a multicenter, prospective study. OBJECTIVES: The objective of this study was to assess the validity and reliability of the Turkish version of Spinal Cord Independence Measure-III (SCIM-III). SETTING: This study was conducted in rehabilitation centers of three hospitals in Turkey. METHODS: Two-hundred and four (n=204) consecutive patients with spinal cord injury (SCI) were included in the study. Each patient was examined by two physicians. Neurologic impairment was measured according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria. Backward and forward translation of SCIM-III was performed by native speakers in both languages. To measure the validity of SCIM-III, the scores were compared with patients' AIS grades, total motor scores and the Health Survey Short Form-36 (SF-36) subscale scores. SCIM-III was analyzed for test-retest reliability by the same rater on 49 patients during the follow-up evaluations. RESULTS: Total agreement values between raters changed between 75.9 and 100%. Kappa values were all above 0.6, and they were statistically significant. The Pearson's correlation values between the raters were very high and statistically significant. The Cronbach's α-values for the two consecutive raters were 0.865 and 0.896. Test-retest reliability was assessed by paired samples t-test, and no significant difference was observed. SCIM-III and SF-36 physical (r=0.339, P<0.005) and general health scores (r=0.200, P<0.005) showed correlation. All subscales of the SCIM-III, with the exception of self-care, had significant differences in comparison with the AIS grades. SCIM-III total and total motor scores showed correlation (r=0.585, P<0.001). CONCLUSION: The Turkish version of SCIM-III was found to be valid and reliable.

Spinal accessory nerve injury: eight cases and review of the literature.

The spinal accessory nerve (SAN) is the major motor supply to the trapezius and sternocleidomastoid muscles. The superficial course of the SAN in the posterior cervical triangle makes it vulnerable to injuries. The most common reason is an iatrogenic injury during surgery but other causes such as stretch or traction injury have also been reported. Five iatrogenic SAN injuries were occurred after radical neck dissection (RND) for laryngeal carcinoma in two patients, lymphadenectomy for oral mucosal tumor in one patient, surgery for lipoma in one patient, and lymph node biopsy for tuberculosis in one patient, traumatic SAN injuries were occurred after the carrying and lifting in three patients. Our eight patients were followed conservatively and 6 of them had significant improvement of pain and function of the shoulder. However, the remaining two patients with radical neck dissection showed moderate improvement in both pain and function including shoulder range of motion and activities of daily living. We report the eight cases with SAN injury that had admitted to our outpatient clinic in the last one year with neck, back and shoulder pain as well as limitation in the shoulder range of motion and difficulty in the activities of daily living.

Traumatic spinal cord injuries in southeast Turkey: an epidemiological study.

In 1994, a retrospective study of new cases of traumatic Spinal Cord Injury (SCI) was conducted in all the hospitals in Southeast Turkey: 75 new traumatic SCI were identified. The estimated annual incidence was 16.9 per million population. The male/female ratio was 5.8/1. The mean age was 31.3, being 31.25 for male patients and 31.36 for female patients. 70.7% of all patients were under the age of 40. The major causes of SCI were falls (37.3%) and gunshot wounds (29.3%), followed by car accidents (25.3%), and stab wounds (1.3%). Thirty one patients (41.3%) were tetraplegic and 44 (58.7%) paraplegic. In tetraplegic patients the commonest level was C5, in those with paraplegia L1. The commonest associated injury was head trauma followed by fractures of the extremity(ies). Severe head trauma, being a major cause of death, may have obscured the actual incidence of SCI. Most of gunshot injured SCI patients were young soldiers fighting against the rebels. As there was no available data for the rebels with SCI, the actual incidence of SCI in Southeast (SE) Turkey should be higher than that found in this study.

The functional independence measure in spinal cord injured patients: comparison of questioning with observational rating.

Functional independence measure (FIM) is becoming widely used for all aspects of disabling diseases including spinal cord injury (SCI). It is recommended that it is rated by trained clinicians familiar with the patients. We aimed to compare the ratings of those patients who were questioned with those who were observed in a simulated environment. Fifty patients with SCI were included in the study. They were all FIM rated by the same clinician, first by questioning and then by observation. Although observational rating took much more time than questioning there was a very strong correlation between these two different rating methods. We can conclude that questioning SCI patients could be used as a valuable and quick way to assess the functional level of such patients. Although this does not exclude observational scoring that was generally higher and more motivational for the patient.

Traumatic spinal cord injuries in Istanbul, Turkey. An epidemiological study.

This is a retrospective study conducted in all of the hospitals of Istanbul to survey new patients with a traumatic spinal cord injury (SCI) in 1992. In that year 152 new traumatic SCI were identified. The estimated annual incidence was 21 per million population. The male/female ratio was 3/1. The mean age was 33, being 34 for male patients and 31 for female patients. 72% of all patients were under the age of forty. The major causes of SCI were falls (43%) and car accidents (41%), followed by being struck by an object (7%), gunshot injury (5%), stab injury (2%). Fifty patients (33%) were tetraplegic and 102 (67%) paraplegic. Regarding the tetraplegic patients the commonest level was C5, in those who were paraplegic L1. There were no cases at levels C1, T1 or T2. The commonest associated injury was head trauma, followed by fractures of an extremity (or extremities). Severe head trauma, as a major cause of death, may obscure the actual incidence of SCI in this study. Accidental falls (exceeding road accidents) were mostly due to falls from buildings and accidents on work premises.