Test-retest reliability of the Valsalva maneuver in spinal cord injury

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1798134 · Published: March 1, 2022

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

Autonomic dysfunction, including impaired cardiovascular control, is a common consequence of spinal cord injury (SCI). This can lead to issues like orthostatic hypotension. The Valsalva maneuver (VM) is a simple, non-invasive test to assess baroreflex sensitivity (BRS), which reflects the function of the autonomic nervous system in regulating blood pressure. This study examines how consistently the VM measures BRS in individuals with traumatic cervical SCI, assessing whether it's a reliable tool for bedside autonomic assessment.

Study Duration

Not specified

Participants

14 participants with cervical SCI (ranging from C3-C8 neurological level)

Evidence Level

Test-retest reliability study

Key Findings

1
Valsalva Ratio (VR), a measure of cardiovagal function, showed good test-retest reliability in participants with SCI.
2
Total Recovery (TR), a measure of sympathetic adrenergic function, also demonstrated good reliability.
3
Qualitative waveform analysis of the VM was reproducible in the majority of participants, suggesting it can be a valuable tool.

Research Summary

The study assessed the test-retest reliability of quantitative and qualitative baroreflex sensitivity (BRS) parameters derived from the Valsalva maneuver (VM) in individuals with traumatic cervical SCI. The results showed that Valsalva Ratio (VR) and Total Recovery (TR) demonstrated good reliability, and qualitative assessment of the VM waveform showed a high degree of reproducibility. The findings suggest that certain aspects of the VM can be used as a reliable, non-invasive tool for assessing BRS and autonomic function in individuals with SCI.

Practical Implications

Clinical Assessment Tool

The Valsalva maneuver could potentially be used as a bedside tool for assessing autonomic dysfunction in individuals with SCI.

Understanding Autonomic Dysfunction

Using the VM may enhance understanding regarding the completeness of injury to autonomic circuits within the spinal cord following SCI.

Future Research

Further studies are needed to refine and characterize the qualitative waveform analysis in multiple contexts.

Study Limitations

1
The study was conducted with a relatively small sample size, leading to large standard deviations in quantitative BRS parameters.
2
The sample was biased toward male sex, and it is unknown whether sex differences exist in response to VM in SCI.
3
The consistency of pressure generation during the forced expiration could have influenced the reliability of some parameters.

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