A critical appraisal of stroke evaluation and rating scales.

Abstract

Background:To judge the efficacy of new, putative stroke therapies, we need a method to measure neurological deficit accurately in groups of patients before and after treatment. No single measurement technique has yet proven to be universally acceptable, but one approach is the use of rating instruments that summarize the neurological deficit found on clinical examination. Currently, stroke assessment scales may be based on the examination of physical deficits, an inventory of activities of daily living, or a global evaluation of functional outcome.Summary of Review: Scientific methods for authenticating stroke scales are available in the psychometric and statistical literature. We review currently available stroke scales for their validity and reliability and propose investigations needed to refine further the standardized measurement of neurological deficit following stroke.Conclusions: We suggest that clinical stroke trials include a physical deficit scale and a global rating during the acute phase and that an activities of daily living scale be added at later points in recovery. (Stroke 1991;22:1345-1352)

Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials

“…If so, highly sensitive scales will be needed to assess treatment efficacy. Thus, a better understanding of the relative sensitivities of specific scales might lead to improvements in stroke rehabilitation trial methodology and facilitate the search for new treatments [14,[17][18][19][20][21].…”

“…The scales examined in our study fall into two of the categories described by Lyden and Lau, global scales and activities of daily living (ADL) scales [18]. The MRS and the ISTM are global scales that attempt to quickly group patients into a few very large categories; any change in category must therefore be clinically significant.…”

Confiabilidade, compreensão e aceitação da versão em português da Motor Assessment Scale em pacientes com acidente vascular encefálico

“…To achieve that, it is necessary to study the reliability, because if it is poor, the error between different raters or between consecutive tests will increase 24 . Assessment instruments must have suitable levels of reliability 2,6,17,25 to justify its clinical and research use 10 .…”

Stroke Assessment Scales: The Dilemma Validity or Reliability

“…Reliability is defined as the quality of a particular method to reproduce its results on repeated applications with the least possible variability [12]- [16]. The reliability cannot be conceived as a property that a method has or not, every instrument shows some degree of reliability when applied to certain populations and under certain conditions, however should respect a plausibility and clinical adequacy [2] [3] [17].…”

“…So, is convenient, where there're more than two classificatory categories, to weight these degrees of variance, in order to more accurately measure the amounts of it between examiners. This is the weighted kappa coefficient ( ) k ρ [16] [17] [20]. This coefficient can be mathematically expressed by:…”