Introduction: GRASSP was developed to capture subtle changes in neurological impairment of the upper extremity after cervical spinal cord injury (SCI) during the acute, sub-acute, and chronic phases. Psychometric properties of reliability, validity and responsiveness have been established. Establishing uptake and promoting application of the GRASSP in clinical trials and interventional studies will enable SCI researchers to study efficacy more readily. Scientific Aims: 1) To develop responsiveness, establish the sensitivity and minimally detectable differences (MDD) of the GRASSP 2) To establish how the measure can be applied in clinical trials and interventional studies.
Methods: A prospective longitudinal study including individuals with acute tetraplegia is currently being conducted as a multi-centre/multi-national study. Serial testing consists of GRASSP, International Standards for Neurological Classification for Spinal Cord Injury (ISNCSCI), Spinal Cord Independence Measure (SCIM), Capabilities of Upper Extremity Questionnaire (CUE), Questionnaires and Life Satisfaction Survey (LISAT-11) administered 0 to 10 days, 1, 3, 6, and 12 months post injury. Analysis: A comparison of the standardized changes from baseline to each time point for GRASSP and ISNCSCI using the Freidman and Wilcoxin signed rank test determine responsiveness and sensitivity, calculations of MDD define scores ranges that define true clinical difference. Sample:127 patients have been enrolled, enrollment is closed and follow-up assessments will continue until December 2013.
Results: GRASSP is 69% to 31% more sensitive to impairment change than the ISNCSCI, MDD ranges between 5pts for strength and 2pts for sensory scores.
Conclusions: GRASSP Version 1.0 is a sensitive upper limb impairment measure which will be useful in clinical and research settings to assess the sensory, motor and functional changes occurring after injury. The subtleties that the measure characterizes are valuable in elucidating the underlying approaches to improve concomitant hand function and define efficacy of new interventions.
Patient Care: Improved and more sensitive outcomes will enable the SCI field to conduct successful clinical trials by establishing efficacy through use of sensitive outcomes.
Learning Objectives: 1)To understand what the GRASSP Version 1.0 is and how it can be implemented in clinical settings, clinical trials and studies.
2) To understand how the measures scoring system can elucidate a change in impairment.