Upper Extremity Measures in Spinal Cord Injury: Convergent Validity and Prediction of Functional Independence

To examine associations between 3 standardized upper extremity (UE) measures-the Capabilities of Upper Extremity Test (CUE-T), Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), and the International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score (ISNCSCI-UEMS)-and functional independence at discharge, measured by the Continuity Assessment Record and Evaluation (CARE) Tool, and their predictive value for discharge outcomes.

This was a secondary analysis of a randomized controlled trial in cervical spinal cord injury (SCI) conducted at an inpatient rehabilitation facility specializing in SCI. Participants were 75 adults with traumatic cervical SCI (C1-C8, AIS B-D) within 5 months post injury undergoing inpatient rehabilitation. Baseline UE measures (CUE-T, GRASSP total and subscales, UEMS) were administered early during rehabilitation. CARE tool total and self-care scores were extracted from records at baseline and discharge. Pearson correlations and linear regression models assessed relationships between UE measures and CARE outcomes.

Baseline CARE total and self-care scores showed moderate to strong correlations with CUE-T (r = 0.72, 0.57), GRASSP total (r = 0.75, 0.60), and GRASSP prehension performance (r = 0.76, -0.59), respectively. CUE-T demonstrated the strongest predictive value for self-care outcomes at discharge (r = 0.62). Each 1-unit increase in CUE-T predicted a 0.75-unit increase in CARE total and 0.33-unit increase in CARE self-care.

This study supports the convergent validity of the CARE tool with established UE outcome measures in SCI rehabilitation. Baseline CUE-T scores show the strongest predictive value for self-care independence at inpatient rehabilitation discharge.