Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia
Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia
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DOI：
10.3171/2012.6.aospine1258
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发表时间：
2012-09-01
影响因子：
2.8
通讯作者：
Fehlings, Michael G.
中科院分区：
文献类型：
--
作者：
Kalsi-Ryan, Sukhvinder;Curt, Armin;Fehlings, Michael G.
Object.在有关人类脊髓损伤（SCI）的试验中，上肢的主要结局指标需要区分功能和神经变化，并需要满足临床应用的心理测量学特性。力量、感觉和知觉的分级重新定义评估（GRASSP）由国际GRASSP研究和设计团队开发，作为完全和不完全四肢瘫痪（即瘫痪或轻瘫）个体上肢的特定临床结局指标。它可以在急性颈脊髓损伤后的恢复过程中使用。一项国际多中心研究（包括北美和欧洲的中心）进行了国际应用该措施，并检查其适用性。GRASSP是一种多模式测试，包括每个上肢的5个子测试：背侧感觉、手掌感觉（用Semmes-Weinstein单丝测试）、力量（用10块肌肉的运动分级测试）和抓握（区分定性和定量抓握的评分）。因此，GRASSP的管理导致5个数字评分，提供了上肢功能的综合概况。GRASSP中所有子测验的评分者间信度和重测信度分别为0.84 ~ 0.96和0.86 ~ 0.98。在定义上肢感觉和运动完整性方面，GRASSP比SCI神经学分类国际标准（ISNCSCI）敏感约50%（结构效度）。子测验显示与脊髓独立性测量（SCIM）、SCIM自我护理子量表和上肢能力问卷（CUE）的一致性（与功能自我感知[CUE]的一致性最强，0.57-0.83，p < 0.0001）。GRASSP被认为是一个标准化的上肢功能障碍的措施，完全或不完全的四肢瘫痪的个人使用的可靠性，结构效度和并发效度。反应性（从发病到受伤后一年的随访）目前正在国际研究（北美和欧洲）中进行测试。GRASSP可以在受伤后早期给药，因此使其成为可以在急性护理（ICU），康复和门诊诊所中给药的工具。(http：//thejns.org/doi/abs/10.3171/2012.6.AOSPINE1258）
Object. Primary outcome measures for the upper limb in trials concerning human spinal cord injury (SCI) need to distinguish between functional and neurological changes and require satisfying psychometric properties for clinical application.Methods. The Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) was developed by the International GRASSP Research and Design Team as a clinical outcome measure specific to the upper limbs for individuals with complete and incomplete tetraplegia (that is, paralysis or paresis). It can be administered across the continuum of recovery after acute cervical SCI. An international multicenter study (involving centers in North America and Europe) was conducted to apply the measure internationally and examine its applicability.Results. The GRASSP is a multimodal test comprising 5 subtests for each upper limb: dorsal sensation, palmar sensation (tested with Semmes-Weinstein monofilaments), strength (tested with motor grading of 10 muscles), and prehension (distinguishes scores for qualitative and quantitative grasping). Thus, administration of the GRASSP results in 5 numerical scores that provide a comprehensive profile of upper-limb function. The established interrater and test-retest reliability for all subtests within the GRASSP range from 0.84 to 0.96 and from 0.86 to 0.98, respectively. The GRASSP is approximately 50% more sensitive (construct validity) than the International Standards of Neurological Classification of SCI (ISNCSCI) in defining sensory and motor integrity of the upper limb. The subtests show concurrence with the Spinal Cord Independence Measure (SCIM), SCIM self-care subscales, and Capabilities of Upper Extremity Questionnaire (CUE) (the strongest concurrence to impairment is with self-perception of function [CUE], 0.57-0.83, p < 0.0001).Conclusions. The GRASSP was found to demonstrate reliability, construct validity, and concurrent validity for use as a standardized upper-limb impairment measure for individuals with complete or incomplete tetraplegia. Responsiveness (follow-up from onset to I year postinjury) is currently being tested in international studies (in North America and Europe). The GRASSP can be administered early after injury, thus making it a tool that can be administered in acute care (in the ICU), rehabilitation, and outpatient clinics. (http://thejns.org/doi/abs/10.3171/2012.6.AOSPINE1258)