Assessment Scales Article Flashcards
Clinimetrics
Study of properties of clinical assessment tools
Derived from theory of psychometrics
NIHSS - how many items
15 item scale - standardizes and quantifies a neuro exam
NIHSS - what type of measure
ordinal, nonlinear measure - assigns numerical value to aspects of neuro function
NIHSS assesses what
Language, motor function, sensory loss, consciousness, visual fields, extraocular movements, coordination, neglects, speech
NIHSS - scored from
0 to 42
0 = no impairment
21+ = severe impairment
NIHSS - Commonly used how clinically
in clinical acute stroke practice
Modified NIHSS
11 point scale
improved reliability - not used often though
Also a pediatric one
Advantages of NIHSS
straightforward 6 min to perform No equipment Scores reliable across observers - non specialists can use it too Reliable with telemedicine High content validity
NIHSS clinically relevant - score change of what
more than 2 points is clinically relevant
Criticism of NIHSS
Validity in non dominant hemisphere stroke has been questioned
Barthel Index - adapted from what
maryland disability index
Barthel index - used for what in studies
studies looking at basic ADLs
Barthel index - developed wh
to assist in discharge planning from longterm care wards
Barthel index - most commonly used functional measure in what
stroke rehab settings and 2nd most used functional outcome measure across stroke trials
Barthel index - assesses what
10 functional tasks (ADLs)
Scoring the individual based on independence in each task
Barthel index - scores range from
0 to 100
Higher score = greater independence
Barthel index - common interpretation
Over 80 = ind and should be able to return home
less than 40 = very dependent
Barthel index - common interpretation of score for outcome
95 - excellent outcome
75 - poor outcome
Barthel index - valid prognositc tool following stroke for predicting what
recovery, level of care needed, and duration of rehab needed after stroke
Barthel index - strengths
Interobserver reliability
Barthel index - limitations
Does not reflect burden of communication and cognitive deficits
Lacks a result to represent stroke mortality
Responsiveness to change - floor and ceiling effects!
Barthel index - best suited for who
stroke survivors requiring inpatient rehab
Barthel index - considered a measure of
basic ADLs (self care and mobility)
Modified Rankin Scale (mRS) - how many points
6 point
0 to 5
Modified rankin scale - what type of scale
ordinal, hierarchical scale
Modified rankin scale describes what
global disability with a focus on mobility
Modified rankin scale - most commonly used functional measure in what
stroke trials
AND the primary or coprimary outcome in large scale stroke trials
Modified rankin scale - used to measure
premorbid ability to assist in selection of patients and as a final outcome measure (for stroke trials)
Used for global disability
Strengths of modified rankin scale
5 min to complete
Modified rankin scale - score of 6
denotes death
Modified rankin scale - limitations
reliability - potential for substantial interobserver variability
Modified rankin scale - clinically relevant change
Less responsive to change than some scales but a single point change on mRS will always be clinically relevant
QOL measure - short form 36
Geriatric scale that assesses 8 domains of health
Validated for stroke pts, noncompletion bias and floor/ceiling effects
QOL measure - EuroQOL
Self completed questionairre
Assess 5 domains with visual analog scale
Validated for use in stroke populations
Noncompletion bias present
QOL measure - Stroke specific QOL scale
Developed based on interviews with stroke survivors
Validated for use in stroke pts
Values for minimal detectable change and clinical important differences are established
