The NIHSS Supplementary Motor Scale: A Valid Tool for Multidisciplinary Recovery Trials

被引:5
作者
Leira, Enrique C. [1 ]
Coffey, Christopher S. [4 ]
Jorge, Ricardo E. [2 ]
Morton, Susanne M. [3 ]
Froehler, Michael T. [1 ]
Davis, Patricia H. [1 ]
Adams, Harold P., Jr. [1 ]
机构
[1] Univ Iowa, Dept Neurol, Carver Coll Med, Iowa City, IA 52242 USA
[2] Univ Iowa, Dept Psychiat, Carver Coll Med, Iowa City, IA 52242 USA
[3] Univ Iowa, Carver Coll Med, Dept Phys Therapy & Rehabil Sci, Iowa City, IA USA
[4] Univ Iowa, Coll Publ Hlth, Dept Biostat, Iowa City, IA USA
关键词
Ischemic stroke; Clinical trials; Clinicometrics; Research methodology; Motor recovery; Scales; NIH Stroke Scale; NIHSS supplementary motor scale; ACUTE ISCHEMIC-STROKE; FUGL-MEYER ASSESSMENT; OUTCOME MEASURES; TREATMENT TOAST; CLINICAL-TRIALS; ORG; 10172; NIMODIPINE; ORG-10172;
D O I
10.1159/000351514
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: There is a growing interest in therapies that may augment motor recovery that could be initiated in the acute stroke unit and maintained through the rehabilitation period. Homogenization of the currently fragmented stroke clinicometrics is necessary before such multidisciplinary trials can be conducted. The supplementary motor scale of the NIH Stroke Scale (SMS-NIHSS) is a simple and reliable scale for assessing proximal and distal motor function in the upper and lower extremities. We hypothesized that the currently underutilized SMS-NIHSS is a valid tool for assessing motor recovery with prognosticative value. Methods: We performed an analysis of SMS-NIHSS scores recorded in 1,281 patients enrolled in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). We plotted the probability of a favorable outcome (FO) and very favorable outcome (VFO) at 3 months based on the baseline SMS-NIHSS scores. In order to better study the relationship between SMS-NIHSS and 3-month functional outcome, we performed multivariate logistic regression analyses using both FO and VFO as outcome measures. Analyses were adjusted for potential confounders such as age, sex, side of the lesion, time from symptom onset to emergency room arrival, temperature, systolic blood pressure, blood glucose level and treatment group assignment (ORG 10172 vs. placebo). We also calculated the Spearman correlation coefficient between the SMS-NIHSS, Barthel Index (BI) and Glasgow Outcome Score (GOS) obtained at the 3-month visit. Results: The mean SMS-NIHSS scores were 8.18 at baseline and 4.68 at 3 months. The SMS-NIHSS scores showed a gradual improvement during the first 3 months after stroke. There was a linear relationship between the baseline SMS-NIHSS scores and the probability of an FO or VFO at 3 months. The SMS-NIHSS baseline score was an independent predictor of FO (OR = 0.86; 95% CI 0.84-0.87; p < 0.0001) and VFO (OR = 0.85; 95% CI 0.84-0.87; p < 0.0001) at 3 months after adjusting for confounders. The degree of improvement in the SMS-NIHSS scores from baseline to 3 months was also independently associated with FO and VFO (p < 0.0001). At 3 months, SMS-NIHSS scores showed a strong correlation with the BI (r = -0.70; p < 0.0001) and GOS (r = 0.73; p < 0.0001). Conclusions: The SMS-NIHSS is a valid scale for assessing motor recovery with prognosticative value, and may be sensitive to changes during recovery. Given that the SMS-NIHSS is an extension of the widely accepted NIHSS, it could be easily implemented in trials conducted in a variety of clinical research settings, including acute stroke hospitals and rehabilitation units. Copyright (c) 2013 S. Karger AG, Basel
引用
收藏
页码:69 / 73
页数:5
相关论文
共 14 条
[1]   Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) [J].
Adams, HP ;
Davis, PH ;
Leira, EC ;
Chang, KC ;
Bendixen, BH ;
Clarke, WR ;
Woolson, RF ;
Hansen, MD .
NEUROLOGY, 1999, 53 (01) :126-131
[2]   Low molecular weight heparinoid, ORG 10172 (Danaparoid), and outcome after acute ischemic stroke - A randomized controlled trial [J].
Adams, HP ;
Woolson, RF ;
Helgason, C ;
Karanjia, PN ;
Gordon, DL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 279 (16) :1265-1272
[3]   ENSURING RELIABILITY OF OUTCOME MEASURES IN MULTICENTER CLINICAL-TRIALS OF TREATMENTS FOR ACUTE ISCHEMIC STROKE - THE PROGRAM DEVELOPED FOR THE TRIAL OF ORG-10172 IN ACUTE STROKE TREATMENT (TOAST) [J].
ALBANESE, MA ;
CLARKE, WR ;
ADAMS, HP ;
WOOLSON, RF ;
BENDIXEN, BH ;
DAVIS, PH ;
JACOBY, MR ;
GOMEZ, FJ ;
DYKEN, ME ;
UC, EY ;
WOJCIESZEK, JM ;
KAPPELLE, LJ ;
TANNA, AB ;
MITCHELL, VL ;
GOMEZ, CR ;
MALKOFF, MD ;
TULYAPRONCHOTE, R ;
SAUER, CM ;
RIAZ, G ;
SCHMIDT, JG ;
MALIK, MM ;
BANET, GA ;
KARANJIA, PN ;
MADDEN, KP ;
RUGGLES, KH ;
MICKEL, SF ;
GOTTSCHALK, PG ;
HANSOTIA, PL ;
SORENSON, RW ;
JACOBSON, DM ;
HINER, BC ;
MANCL, K ;
LUKASIK, E ;
BRUNO, A ;
LAKIND, ED ;
JEFFREY, DR ;
MLADINICH, EK ;
IQBAL, J ;
REINERS, M ;
BARRETT, DW ;
SHIBUYA, D ;
WILLIAMS, JK ;
RUSSELL, P ;
KING, MK ;
CHAPIN, JE ;
CARTER, S ;
JEFFRIES, L ;
HIER, DB ;
SHAPIRO, RA ;
BRINT, SU .
STROKE, 1994, 25 (09) :1746-1751
[4]   The case for modality-specific outcome measures in clinical trials of stroke recovery-promoting agents [J].
Cramer, Steven C. ;
Koroshetz, Walter J. ;
Finklestein, Seth P. .
STROKE, 2007, 38 (04) :1393-1395
[5]   Post-stroke motor and functional evaluations - A clinical correlation using Fugl-Meyer assessment scale, Berg balance scale and Barthel index [J].
de Oliveira, Roberta ;
Cacho, Enio Walker Azevedo ;
Borges, Guilherme .
ARQUIVOS DE NEURO-PSIQUIATRIA, 2006, 64 (3B) :731-735
[6]   BARRIERS TO THE USE OF HEALTH-STATUS MEASURES IN CLINICAL INVESTIGATION, PATIENT-CARE, AND POLICY RESEARCH [J].
DEYO, RA ;
PATRICK, DL .
MEDICAL CARE, 1989, 27 (03) :S254-S268
[7]   Defining post-stroke recovery: implications for design and interpretation of drug trials [J].
Duncan, PW ;
Lai, SM ;
Keighley, J .
NEUROPHARMACOLOGY, 2000, 39 (05) :835-841
[8]   The Fugl-Meyer Assessment of motor recovery after stroke: A critical review of its measurement properties [J].
Gladstone, DJ ;
Danells, CJ ;
Black, SE .
NEUROREHABILITATION AND NEURAL REPAIR, 2002, 16 (03) :232-240
[9]   Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation [J].
Hsieh, Yu-wei ;
Wu, Ching-yi ;
Lin, Keh-chung ;
Chang, Ya-fen ;
Chen, Chia-ling ;
Liu, Jung-sen .
STROKE, 2009, 40 (04) :1386-1391
[10]   Current trends in stroke rehabilitation. A review with focus on brain plasticity [J].
Johansson, B. B. .
ACTA NEUROLOGICA SCANDINAVICA, 2011, 123 (03) :147-159