Faculty Collaboration Database

Measurement properties of the NIH Stroke Scale during acute rehabilitation. Stroke 1997 Jun;28(6):1174-80

Date

06/01/1997

Pubmed ID

9183346

DOI

10.1161/01.str.28.6.1174

Scopus ID

2-s2.0-0030914503 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

BACKGROUND AND PURPOSE: The scale of stroke impairment characteristics by Brott and associates, the National Institutes of Health (NIH) Stroke Scale, has been used widely in various studies of stroke outcome; however, the measurement properties of the items applied to patients during medical rehabilitation have not been evaluated thoroughly. This study evaluated the extent to which scale items cohere to define a unidimensional construct and have a useful range for application to patients during medical rehabilitation.

METHODS: Rating scale (or Rasch) analysis of the 15 NIH Stroke Scale items was conducted using the BIGSTEPS computer program to evaluate (1) the range of impairment assessed by the items, (2) the items' coherence with an underlying construct of impairment, and (3) range of impairment measured in rehabilitation patients. We sought to maximize the range of impairment measured by conducting analyses recursively; at each subsequent step, the worst fitting item was deleted or rescored. The sample comprised 1291 admission and discharge records from 693 rehabilitation inpatients with stroke.

RESULTS: Thirteen items arrayed the sample across a sufficient range of impairment. The limb ataxia item fit poorly and was deleted; lower ratings for this item were associated with higher scores on the total scale. Pupillary response was also deleted because ratings reflected poor congruence with the total score. Best language was rescored because intermediate ratings were inconsistently related to the total score. Patients with hemorrhagic strokes had poorer fitting measures than did patients with ischemic strokes.

CONCLUSIONS: The items in a revised NIH Stroke Scale worked well together to define the severity of impairment resulting from stroke that is observed during medical rehabilitation. Directions regarding limb ataxia should be modified to indicate untestability due to hemiplegia.

Author List

Heinemann AW, Harvey RL, McGuire JR, Ingberman D, Lovell L, Semik P, Roth EJ

Author

John R. McGuire MD Professor in the Physical Medicine and Rehabilitation department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cerebrovascular Disorders
Disability Evaluation
Female
Humans
Male
National Institutes of Health (U.S.)
United States