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The approval of tissue plasminogen activator to treat acute ischemic stroke and the
continuing need to evaluate new neuroprotective drugs and thrombolytic agents in clinical
trials have focused interest on the quantitative evaluation of stroke patients. Emphasizing
outcomes management in clinical practice has also heightened the importance of quantitative
evaluation using assessment scales. Investigators who evaluate, revise, and use assessment
scales for the measurement of stroke impairment, disabilites, and handicaps face many
challenges. These problems include the heterogeneity of stroke and the need to determine
appropriate outcome measures, to use neurological deficit scales that can accurately
predict disability, to ensure adequate follow-up, and to use scales that can be used
outside of clinical trials by all health care professionals. Such scales should be
easily and quickly administered, responsive, valid, and reliable. The most important
categories of stroke scales are neurological deficit scales (e.g., Canadian Neurological
Scale, European Stroke Scale, and National Institutes of Health [NIH] Stroke Scale),
functional outcome scales (e.g., Barthel Index), and global outcome scales (e.g.,
Modified Rankin Scale). Although stroke-specific, health-related quality-of-life (HRQL)
scales have yet to be developed and validated, general HRQL scales such as the Nottingham
Health Profile, the Medical Outcomes Study Short Form-36, the Sickness Impact Profile,
and the Health Utilities Index may be used to assess stroke patients. Lacking the
ideal single stroke outcome scale, we continue to recomend a combination of scales:
the NIH Stroke Scale (or similar deficit scale), the Barthel Index, and the Rankin
Scale.
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References
- Clinimetrics in stroke research.Stroke. 1987; 18: 528-530
- The European Stroke Scale.Stroke. 1994; 25: 2215-2219
- Evolving toward effective therapy for acute ischemic stroke.JAMA. 1993; 270: 360-364
- Acute stroke trials: From morass to nirvana?.Cerebrovas Dis. 1995; 5: 3-6
- aForces motivating the use of health status assessment measures in clinical settings and related clinical research.Med Care. 1992; 30 (suppl): MS15-MS22
- Stroke scores and scales.Cerebrovasc Dis. 1992; 2: 239-247
- Trials of trials in acute ischemic stroke: The Humana Lecture.Stroke. 1993; 24: 1410-1415
- A critical appraisal of stroke evaluation and rating scales.Stroke. 1991; 11: 1345-1352
- Scientific and clinical problems in indexes of functional disability.Ann Intern Med. 1986; 105: 413-420
- Towards a model stroke trial: The single-centre naftidrofuryl study.Neuroepidemiology. 1986; 5: 121-147
- International classification of impairments, disabilities, and handicaps.in: World Health Organization, Geneva1993
- The concepts of impairment, disability, and handicap.Cerebrovasc Dis. 1994; 4: 2-6
- Rehabilitation of the stroke survivor.in: Barnett HJM Mohr JP Stein BM Stroke: Pathophysiology, diagnosis, and management. 2nd Ed. Churchill Livingstone, New York1992: 1189-1201
- Classification of subtype of acute ischemic stroke: Definitions for use in a multicenter clinical trial.Stroke. 1993; 24: 35-41
- Epidemiologic profile of long-term stroke disability: The Framingham study.Arch Phys Med Rehabil. 1979; 60: 487-491
- Problems in design of stroke treatment trials.Stroke. 1982; 13: 94-99
- Tissue plasminogen activator for acute ischemic stroke.N Engl J Med. 1995; 333: 1581-1587
- Assessment of outcome after severe brain damage: A practical scale.Lancet. 1975; 7905: 480-484
- Observer variability in assessing impaired consciousness and coma.J Neurol Neurosurg Psychiatry. 1978; 41: 603-610
- A comparison of five stroke scales with measures of disability, handicap, and quality of life.Stroke. 1993; 24: 1178-1181
- Neurological scales in the assessment of cerebral infarction.Cerebrovasc Dis. 1994; 4: 7-14
- Clinical trials in acute brain infarction: The question of assessment criteria.in: Battistini N Acute brain ischemia: Medical and surgical therapy. Raven, New York1985: 201-208
- Methodology of clinical trials in acute cerebral ischemia: Survival, functional, and neurological outcome measures.Cerebrovasc Dis. 1991; 1: 100-111
- How to assess acute cerebral ischemia.Cerebrovasc Brain Metab Rev. 1991; 3: 179-212
- Acute recovery patterns in stroke patients.Med J Aust. 1980; 2: 663-666
- Recovery after stroke.J Neurol Neurosurg Psychiatry. 1983; 46: 5-8
- The rate of recovery from stroke and its measurement.Int Rehabil Med. 1981; 3: 155-161
- Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients.Am J Phys Med Rehabil. 1996; 75: 114-120
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Functional evaluation: The Barthel Index.MD State Med J. 1965; 14: 61-65
- Reproducibility and utility of a simple neurological scoring system for stroke patients (Copenhagen Stroke Scale).J Neurol Rehabil. 1988; 2: 59-63
- A comparative contrast of clinimetric and psychometric methods for constructing indexes and rating scales.J Clin Epidemiol. 1992; 45: 1201-1218
- Responsiveness of the rehabilitation activities profile and the Barthel Index.J Clin Epidemiol. 1996; 49: 39-44
- Improved reliability of the NIH Stroke Scale using video training.Stroke. 1994; 25 (In: Haley EC, Grotta J, Marler J, et al.): 2220-2226
- 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).Stroke. 1994; 25: 1746-1751
- The Canadian Neurological Scale: A preliminary study in acute stroke.Stroke. 1986; 17: 731-737
- The Canadian Neurological Scale: Validation and reliability assessment.Neurology. 1989; 39: 638-643
- The post-stroke hemiplegic patient. I: A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Post-stroke hemiplegia and ADL performance.Scand J Rehabil Med. 1980; 7 (suppl): 140-152
- Evaluation of functional capacity after stroke as a basis for active intervention: Validation of a modified chart for motor capacity assessment.Scand J Rehabil Med. 1988; 20: 111-115
- 2nd Ed. Psychometric Theory. McGraw-Hill, New York1978
- Graded neurologic scale for use in acute hemispheric stroke treatment protocols.Stroke. 1987; 18: 665-669
- Clinical stroke scales: An intra- and inter-scale evaluation.Neurology. 1990; 40 ([poster]): 352
- Double-blind evaluation of glycerol therapy in acute cerebral infarction.Lancet. 1972; ii: 1327-1329
- Studies on cerebrovascular strokes. II: Clinical findings and short-term prognosis in a stroke material.Acta Med Scand. 1976; 199: 133-140
- Assessment of interobserver variability in a Dutch, multicenter study on acute ischemic stroke.Stroke. 1988; 19: 709-711
- Adjusted hypervolemic hemodilution in acute ischemic stroke.Stroke. 1990; 21: 1429-1434
- Measurements of acute cerebral infarction: A clinical examination scale.Stroke. 1989; 20: 864-870
- Interrater reliability of the NIH stroke scale.Arch Neurol. 1989; 46: 660-662
- Multicenter trial of hemodilution in ischemic stroke: Background and study protocol.Stroke. 1985; 16: 885-890
- Multicenter trial of hemodilution in ischemic stroke. I: Results in the total patient population.Stroke. 1987; 18: 691-699
- Multicenter trial of hemodilution in acute ischemic stroke: Results of subgroup analyses.Stroke. 1988; 19: 464-471
- Reliability of Scandinavian Neurological Stroke Scale.Cerebrovasc Dis. 1991; 1: 103-107
- Steroid therapy in acute cerebral infarction.Arch Neurol. 1976; 33: 69-71
- Comment on “Study design of stroke treatments”.Stroke. 1982; 13: 527-528
- Prediction of long-term outcome in the early ours following acute ischemic stroke.Arch Neurol. 1995; 52: 250-255
- Lubeluzole in acute ischemic stroke: A double-blind, placebo-controlled phase II trial.Stroke. 1996; 27: 76-81
- Urgent therapy for stroke. Part II. Pilot study of tissue plasminogen activator administered 91–180 minutes from onset.Stroke. 1992; 23: 641-645
- ADL status in stroke: Relative merits of three standard indexes.Arch Phys Med Rehabil. 1980; 61: 355-358
- A unified ADL evaluation form.Arch Phys Med Rehabil. 1973; 54: 175-179
- Reliability of the Barthel Index outcome measure selected for the NINDS t-PA Stroke Trial.in: Yamaguchi T Mori E Minematsu K Thrombolytic therapy in acute stroke III. Springer-Verlag, Tokyo, Japan1996
- Predicting Barthel ADL score at 6 months after an acute stroke.Arch Phys Med Rehabil. 1983; 64: 24-28
- Stroke rehabilitation: Analysis of repeated Barthel index measures.Arch Phys Med Rehabil. 1979; 60: 14-17
- The Barthel ADL Index: A standard measure of physical disability?.Int Disabil Stud. 1988; 10: 64-67
- Performance profiles of the Functional Independence Measure.Am J Phys Med Rehabil. 1993; 72: 84-89
- Quantification of disability after stroke.Cerebrovasc Dis. 1994; 4: 15-18
- The uniform data system for medical rehabilitation report of first admissions for 1992.Am J Phys Med Rehabil. 1994; 73: 51-55
- Evaluation of the functional capacity of stroke patients through an activity index.Scand J Rehabil Med. 1982; 14: 93-100
- Studies of illness in the aged. The Index of ADL: A standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Numerical scoring of self-care status of patients.Arch Phys Med Rehabil. 1965; 46: 689-697
- Outcome of comprehensive medical rehabilitation: Measurement by PULSES profile and the Barthel Index.Arch Phys Med Rehabil. 1979; 60: 145-154
- Rehabilitation Activities Profile, the ICIDH as a framework for a problem-oriented assessment method in rehabilitation medicine.Disabil Rehabil. 1995; 17: 169-175
- The Stroke Rehabilitation Outcome Study: Part II. Relative merits of the total Barthel Index score and a four-item subscore in predicting patient outcomes.Arch Phys Med Rehabil. 1989; 70: 100-103
- Cerebral vascular accidents in patients over the age of 60: II. Prognosis.Scot Med J. 1957; 2: 200-215
- Assessment of quality-of-life outcomes.N Engl J Med. 1996; 334: 835-840
- Quality of life and clinical trials.Lancet. 1995; 346 (Anonymous): 1-2
- User's guides to the medical literature: XII. How to use articles about health-related quality of life.JAMA. 1997; 277: 1232-1237
- Quality of life, health status, and clinical research.Med Care. 1989; 27 (suppl): S148-S156
- Interpreting pharmacoeconomic and quality-of-life clinical trial data for use in therapeutics.Pharmaco Economics. 1992; 2: 107-117
- Methods for quality-of-life studies.Annu Rev Public Health. 1994; 15: 535-559
- Outcome measures in quality of life.Top Stroke Rehabil. 1996; 2: 1-17
- A critical appraisal of the quality of quality-of-life measurements.JAMA. 1994; 272: 619-626
- Quality of life bibliography and lindexes: 1993 update.Qual Life Res. 1995; 4: 53-74
- Health status, quality of life, and the individual.JAMA. 1994; 272 ([editorial]): 630-631
- Trial design issues: End points and sample size.Cerebrovasc Dis. 1995; 5: 3-11
- A pilot study of rehabilitation at home after stroke: A health-economic appraisal.Scand J Rehabil Med. 1996; 28: 9-18
- The Nottingham Health Profile user's manual.Galen Research & Consultancy, Manchester1981
- Critical review of the international assessments of health-related quality of life.Qual Life Res. 1993; 2: 369-395
- Measuring health in injured workers: A cross-sectional comparison of five generic health status instruments in workers with musculoskeletal injuries.Am J Ind Med. 1996; 29: 618-631
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- The Sickness Impact Profile: Conceptual formulation and methodology for the development of a health status measure.Int J Health Serv. 1976; 6: 393-415
- The Sickness Impact Profile: Development and final revision of a health status measure.Med Care. 1981; 19: 787-805
- The SIP68: A measure of health-related functional status in rehabilitation medicine.Arch Phys Med Rehabil. 1996; 77: 440-445
- (Anonymous)Multi-attribute health status classification questionnaire.Technology Assessment Group, San Francisco1994
- A comprehensive multiattribute system for calssifying the health status of survivors of childhood cancer.J Clin Oncol. 1992; 10: 923-928
- Scaling the Spanish version of the Nottingham Health Profile: Evidence of limited value of item weights.J Clin Epidemiol. 1996; 49: 31-38
- NHP or SIP: A comparative study in renal insufficiency associated anemia.Qual Life Res. 1996; 5: 91-100
- Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study.JAMA. 1989; 262: 907-913
- Comparative measurement sensitivity of short and longer health status instruments.Med Care. 1992; 30: 917-925
- A comparison of two multidimensional measures of health status: The Nottingham Health Profile and the RNAD 36-Item Health Survey 1.0.Qual Life Res. 1996; 5: 165-174
- The Sickness Impact Profile as a measure of the health status of noncognitively impaired nursing home residents.Med Care. 1989; 27: 157-167
- Validation of the Sickness Impact Profile and Psoriasis Disability Index in Psoriasis.Br J Dermatol. 1990; 123: 751-756
- Relationships between general health measured with the Sickness Impact Profile and respiratory symptoms, physiological measures and mood in patients with chronic airflow limitation.Am Rev Respir Dis. 1989; 140: 1538-1543
- Measuring functional outcomes in chronic disease: A comparison of traditional scales and a self-administered health status questionnaire in patients with rheumatoid arthritis.Med Care. 1983; 21: 180-192
- The Sickness Impact Profile: Reliability of a health status measure.Med Care. 1983; 14: 146-155
- Toward clinical applications of health status measures: Sensitivity of scales to clinically important changes.Health Serv Res. 1984; 19: 277-289
- Can the Sickness Impact Profile measure change? An example of scale assessment.J Chronic Dis. 1986; 39: 429-438
- Stability and responsiveness of utility measures.Med Care. 1994; 32: 183-188
- A health status index and its application to health services outcomes.Oper Res. 1970; 186: 1021-1066
Article info
Publication history
Accepted:
October 21,
1997
Received:
June 13,
1997
Identification
Copyright
© 1998 National Stroke Association. Published by Elsevier Inc.
