A Simple Post Hoc Transformation that Improves the Metric Properties of the BBB Scale for Rats with Moderate to Severe Spinal Cord Injury

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Abstract
The Basso, Beattie, Bresnahan (BBB) open field locomotor scale is a popular measure of functional recovery following spinal cord injury (SCI). To examine the metric properties of the scale, we performed detailed analyses of BBB scores from 643 rats with moderate and severe SCI (12.5, 25, or 50 mm MASCIS) from two different laboratories. The analyses revealed that the BBB scale is ordinal in the most frequently used portion of the scale. Higher scores (14 and greater) were not frequently assigned in the dataset as animals with mild injuries were not sampled, making the ordinal nature of the upper end of the scale difficult to assess. The rare scores assigned in this range disproportionately increased variance. Under these conditions collapsing scores above 14 into one category increased effect size. Analysis of the lower region of the scale revealed that some scores (2 and 3) were rarely assigned, implying a discontinuity in the scale. The discontinuous nature of the lower portion of the scale presents a problem for both parametric and nonparametric statistical analyses. Pooling scores 2/3/4 eliminated the gap, enhancing the metric properties of the scale. Under the injury conditions evaluated, the transformation helped assure that the data were continuous and ordered. Further, interval durations were comparable across the entire range of the transformed scale, allowing application of parametric statistical techniques. The transformation should be applied in a post hoc fashion to reduce variability and increase power in cases where few scores fall in upper portion of the scale.