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<p>Hypotension is an under-recognized consequence of spinal cord injury (SCI). Clinical assessments, such as head-up tilt testing, are resource-intensive and carry safety risks. In this study, we evaluated the validity of the hypotension symptom domain of the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire as a patient-reported outcome measure for hypotension-related symptoms in individuals with SCI. Known-groups validity and convergent validity were supported by higher hypotension symptom scores in participants with physiologically defined orthostatic hypotension (OH). Discriminative performance for OH classification was acceptable, and symptom frequency, severity, and contextual triggers were each associated with greater physiological BP instability. Symptom-level analyses identified blurred vision, light-headedness, fatigue, weakness, and dizziness correlated with blood pressure declines. To assess real-world applicability, we also analyzed a global dataset of patient-reported ADFSCI responses from individuals with SCI, enabling population-scale characterization of hypotensive symptom burden. In this dataset, higher symptom scores were associated with female sex and higher neurological injury level. Together, these findings provide converging evidence of supporting the validity of the hypotension symptom domain as a scalable measure of hypotension symptom burden in SCI for use in remote assessment and screening.</p>

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Validating the ADFSCI hypotension symptom domain as a scalable patient reported outcome measure in spinal cord injury

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月1日

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  • Wenbin Yang,
  • Meagan N. Smith,
  • Julien Rimok,
  • Aasta P. Gandhi,
  • Nicolas Hankov,
  • Nicolò Macellari,
  • Anouk E. J. Nijland,
  • Ilse J. W. van Nes,
  • Léonie Asboth,
  • Jordan Squair,
  • Jocelyne Bloch,
  • Nelleke G. Langerak,
  • Noël L. W. Keijsers,
  • Erkan Kurt,
  • Sungchul Huh,
  • Kelly A. Larkin-Kaiser,
  • Jill M. Wecht,
  • Stephen L. McKenna,
  • Grégoire Courtine,
  • Aaron A. Phillips

摘要

Hypotension is an under-recognized consequence of spinal cord injury (SCI). Clinical assessments, such as head-up tilt testing, are resource-intensive and carry safety risks. In this study, we evaluated the validity of the hypotension symptom domain of the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire as a patient-reported outcome measure for hypotension-related symptoms in individuals with SCI. Known-groups validity and convergent validity were supported by higher hypotension symptom scores in participants with physiologically defined orthostatic hypotension (OH). Discriminative performance for OH classification was acceptable, and symptom frequency, severity, and contextual triggers were each associated with greater physiological BP instability. Symptom-level analyses identified blurred vision, light-headedness, fatigue, weakness, and dizziness correlated with blood pressure declines. To assess real-world applicability, we also analyzed a global dataset of patient-reported ADFSCI responses from individuals with SCI, enabling population-scale characterization of hypotensive symptom burden. In this dataset, higher symptom scores were associated with female sex and higher neurological injury level. Together, these findings provide converging evidence of supporting the validity of the hypotension symptom domain as a scalable measure of hypotension symptom burden in SCI for use in remote assessment and screening.