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J Neurotrauma. 2016 Feb 1;33(3):307-14. doi: 10.1089/neu.2015.4217. Epub 2015 Dec 17.

Responsiveness, Sensitivity, and Minimally Detectable Difference of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, Version 1.0.

Kalsi-Ryan S1,2,3,4,5, Beaton D6,7,2,8, Ahn H9,2,8,5, Askes H5,10, Drew B5, Curt A11,5, Popovic MR7,12,2,4,5, Wang J3, Verrier MC1,7,2,4,5, Fehlings MG9,2,3,4,5.

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1 Department of Physical Therapy, Toronto Western Hospital , Toronto, Ontario, Canada .
6 University of Toronto , Toronto, Ontario, Canada .
7 Krembil Neuroscience Centre, Toronto Western Hospital , Toronto, Ontario, Canada .
8 University Health Network , Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada .
11 GRASSP Longitudinal Study Team .
2 Department of Occupational Therapy, St. Michaels Hospital , Toronto, Ontario, Canada .
3 Rehabilitation Science Institute, St. Michaels Hospital , Toronto, Ontario, Canada .
9 St. Michael's Hospital , Toronto, Ontario, Canada .
4 Department of Surgery, St. Michaels Hospital , Toronto, Ontario, Canada .
12 Spinal Cord Injury Research, St. Joseph's Health Care , London, Ontario, Canada .
10 Spinal Cord Injury Centre, University Hospital Balgrist , Zurich, Switzerland .
5 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada .


As spinal cord injury (SCI) trials begin to involve subjects with acute cervical SCI, establishing the property of an upper limb outcome measure to detect change over time is critical for its usefulness in clinical trials. The objectives of this study were to define responsiveness, sensitivity, and minimally detectable difference (MDD) of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP). An observational, longitudinal study was conducted. International Standards of Neurological Classification of SCI (ISNCSCI), GRASSP, Capabilities of Upper Extremity Questionnaire (CUE-Q), and Spinal Cord Independence Measure (SCIM) were administered 0-10 days, 1, 3, 6, and 12 months post-injury. Standardized Response Means (SRM) for GRASSP and ISNCSCI measures were calculated. Longitudinal construct validity was calculated using Pearson correlation coefficients. Smallest real difference for all subtests was calculated to define the MDD values for all GRASSP subtests. Longitudinal construct validity demonstrated GRASSP and all external measures to be responsive to neurological change for 1 year post-injury. SRM values for the GRASSP subtests ranged from 0.25 to 0.85 units greater than that for ISNCSCI strength and sensation, SCIM-SS, and CUE-Q. MDD values for GRASSP subtests ranged from 2-5 points. GRASSP demonstrates good responsiveness and excellent sensitivity that is superior to ISNCSCI and SCIM III. MDD values are useful in the evaluation of interventions in both clinical and research settings. The responsiveness and sensitivity of GRASSP make it a valuable condition-specific measure in tetraplegia, where changes in upper limb neurological and functional outcomes are essential for evaluating the efficacy of interventions.

[Indexed for MEDLINE]

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