400 Section - Inter-Rater Reliability of the German Version of ISAFSCI (2nd Ed.) in Subacute Spinal Cord Injury and Disease

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

Anke Scheel-sailer, MD (she/her/hers)

Chief Physician Musculoskeletal Rehabilitation / PD Dr. med.
Center for Rehabilitation & Sports Medicine Inselspital and Berner Reha Zentrum, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland

Co-Author/Coautor(s)

EH

Elena Henes, MD

Resident
Swiss Paraplegic Center
Nottwil, Luzern, Switzerland
AK

Andrei Krassioukov, MD

Professor
ICORD
Vancouver, British Columbia, Canada

Corresponding Author/Autor a quien dirigir la corr(s)

MW

Matthias Walter, MD

Lecturer
University of Basel
BINNINGEN, Basel-Landschaft, Switzerland

Objectives :

To evaluate the inter-rater reliability (IRR) of the German Version of ISAFSCI (2nd Ed.) in patients with subacute Spinal Cord Injury and Disease.

Design:

The ISAFSCI 2021 include 22 items on bronchopulmonary (BPF) and sudomotor function (SMF), core body temperature (CBT), heart rate (HR), diastolic (DBP) and systolic (SBP) blood pressure as well as patient-reported and anticipated results on urinary bladder, bowel and sexual function (UBBSF). Two ISAFSCI assessments were conducted within 14 days. The agreement (IRR) was calculated using Cohen's Kappa (categories are < 0.20 = poor; 0.21-0.40 = fair; 0.41-0.60 = moderate; 0.61-0.80 = good; 0.81-1.00 = almost perfect).

Results:

30 participants (5 female [17%], median age 49 years) were included (i.e., American Spinal Injury Association Impairment Scale [AIS] A=16, B=4, C=5, D=5; tetraplegia=15, paraplegia=15). Moderate to almost perfect IRR were observed in 83% of all items (18/22), i.e. BPF (0.91), SMF (0.85), UBBSF (patient-reported 0.49-0.69; anticipated 0.69-1.0), CBT (0.34), HR (0.31), SBP (0.294) and DBP (0.13). Certain limitations must be considered regarding poor (i.e. 1/22, 5%) and fair IRRs (i.e. 3/22, 14%). For example, a difference in CBT as little as 0.1°C can shift the score from normal to sub-normal between assessments. With respect to the cardiovascular parameters, we observed within-patient changes from normotensive to hypotensive BP as well as presence of orthostatic hypotension, bradycardia or tachycardia that led to scoring differences between assessments.

Conclusion:

The German 2021 ISAFSCI version demonstrated predominantly moderate to almost perfect inter-rater reliability in the sub-acute SCI setting. Lower agreement in selected items, particularly core body temperature and cardiovascular parameters, likely reflects the sensitivity of these measures to small physiological fluctuations. Overall, the findings support the tool’s reliability while underscoring the need for careful interpretation of inherently variable autonomic indicators.