German Transcreation of the International Standards to Document Remaining Autonomic Function After Spinal Cord Injury (Second Edition): A Feasibility Study in Individuals With Subacute Phase Spinal Cord Injury/Disease (SCI/D).

Background: In May 2021, the second edition of International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) was published.

Objectives: To transcreate the 2021 ISAFSCI (2nd ed.) to German and to assess its feasibility in the subacute phase following spinal cord injury/disease (SCI/D).

Methods: Transcreation to German was performed by an interdisciplinary team of native English and German speakers. We screened individuals with SCI/D for eligibility (i.e., age ≥18 years; >3 months following SCI/D) between August 2021 and January 2022. To minimize the time for the assessment, we first interviewed participants in a supine position before conducting the clinical examination. We assessed participants thrice within 14 days using a randomized sequence of assessors, and we assessed SCI/D according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) grading of the SCI/D, including the American Spinal Injury Association Impairment Scale (AIS). Time of ISAFSCI assessments (median and quartiles) and its completeness (%) were calculated.

Results: Twelve participants (3 females; median age 42 years [Q1: 31, Q3: 54]) were enrolled and assessed thrice. Severity and level of injury were either sensorimotor complete (AIS A, 9) or incomplete (AIS C, 3) SCI/D and tetraplegia (n = 5) or paraplegia (n = 7), respectively. Median time to complete an assessment was 39 minutes (Q1: 32, Q3: 46).

Conclusion: The German version of the ISAFSCI second edition is feasible to perform in a subacute cohort. However, given the subacute stage following SCI, certain limitations must be acknowledged. Many participants have not yet engaged in sexual activity, which limits the evaluation of sexual function.