Assessment scales in stroke: clinimetric and clinical considerations

Abstract

As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of “clinimetric” analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.

Derivation and Validation of a Modified Short Form of the Stroke Impact Scale

“…A primary limitation of SIS concerns feasibility and acceptability. Other commonly used scales in stroke are limited by imperfect reliability (mRS), floor and ceiling effects (BI), and poor validity for certain stroke syndromes (NIHSS) 21, 22, 23. The context of testing is also important.…”

Endovascular Therapy Demonstrates Benefit over Intravenous Recombinant Tissue Plasminogen Activator Based on Repeatedly Measured National Institutes of Health Stroke Scale

“…The NIHSS, which has been shown to predict outcome well after stroke [3,4,5,6,7,8], was a prespecified secondary outcome of the trial. In addition to the baseline measurement used to define severity, the NIHSS evaluation was repeated at 40 min after i.v.…”

Assessing Cognition Post-Stroke using Virtual Reality Technology

“…Given the high incidence of post-stroke cognitive impairments (Lindén et al, 2004) and communication deficits (Engelter et al, 2006), major barriers exist for meeting these guidelines in clinical practice. Properties of reliability, validity and feasibility for cognitive assessments need to be evaluated in all patient groups to guide the selection of appropriate tools (Dekker, Dallmeijer, & Lankhorst;Harrison, McArthur, & Quinn, 2013).…”

“…Evaluating the clinimetric properties for cognitive assessments is necessary to determine validity and feasibility, including user experience (Harrison et al, 2013). C3A…”

“…Evaluating the clinimetric properties for cognitive assessments is necessary to determine validity, feasibility, including acceptability for users and examiners (Harrison et al, 2013). This paper will report on key feasibility factors associated with the C3A with respect to the selected hardware and design of the apparatus, time-taken to complete the C3A, missing data compared to pen-and-paper methods, and user acceptance.…”