Life expectancy of persons in the acute phase after a spinal cord injury (SCI) dramatically increased in the second half of the last century. The long-term mortality (more than two years post-injury) is still an issue and a strong contributing risk factor are secondary health conditions also including spasticity. Spasticity has been reported to be present in 74% of people in a recent cross-sectional study investigating a cohort including Swiss residents. There are many different forms of spasticity seen in patients as well as varying definitions found in the literature. Furthermore it is recognized that spasticity may have both negative as well as positive impacts on daily life.
Spasticity should not solely be assessed with objective measures and the inclusion of the patient's perspective and personal perception is crucial to completely address and trace out spasticity in each individual. The patient reported impact of spasticity measure (PRISM) as well as the spinal cord injury spasticity evaluation tool (SCI-SET), both established in 2007, are validated and recommended to apply in routine practice. Unfortunately, the SCI-SET is only available in English, Persian and Turkish which hinders the implementation in other language regions.
Therefore the investigators decided to translate and cross-culturally adapt the SCI-SET and create a German version of that questionnaire (SCI-SETde). This finally helps to assess the usefulness of therapeutic interventions and to monitor the course of spasticity in patients. The SCI-SETde will be checked for comprehensibility and tested for cultural aspects in advance to its validation. These are prerequisites that it can later be used in daily routine.
The expected risk and burden for participants is very small because they only have to fill in questionnaires.
The primary objective is to establish the SCI-SETde and to cross-culturally adapt and validate it in a small cohort of patients. The translation and back-translation already happened and the authors of the initial SCI-SET are informed and gave their consent that a German version of this questionnaire may be established.
It is very important that the questionnaire is understandable and well-suited to ask patients about the influence of their spasticity on several areas of daily life. It is necessary to receive feedback on how patients understand each single question and also if any questions are somehow unclear or not enough accurate or specific. To test the validity and reliability of the questionnaire is necessary to evidence its usefulness for assessment.
Test-retest reliability will be assessed by administering the questionnaires two times at the same day and time one week apart. Construct validity will be assessed by comparing the SCI-SETde with scores from additional questionnaires namely, an adapted form of the Penn Spasm Frequency Scale (PSFS) and the self-reported version of the Spinal Cord Independence Measure (SCIM-SR) as well as self-reported impact and severity of spasticity.
There are possible confounders that may interfere with the results. These confounding factors will be assessed on both time points through an additional checklist that asks patients if they suffered from any kind of fracture, decubitus ulcer, any sort of infection, new arisen pain due to any condition as well as any psychogenic trauma.
People within the SCI community of Switzerland will be taken into consideration to participate in this study. The recruitment of the participants will be either a consecutive ongoing recruitment during daily clinical practice or direct contacting of known SCI patients with stated spasticity symptoms. Patients will be informed in detail about the project if they meet all the inclusion criteria and no exclusion criteria is found in routine practice. Participants are not receiving any compensation for their participation in the study. For each patient the project duration is roughly two weeks.
All the data will be stored safely with only authorized people having access to the data corresponding to their duties to manage or analyze the data. The physical data will be entered into the secure databank for final analysis. All data is encoded by giving each participant a unique patient ID that doesn't allow any inference on the identity of the person. The key document with the link between the patient ID and the person behind it will be stored in a secured desk separately from the remaining study documents.
