Abstract TP152: Correlation of NIH Stroke Scale and Fugl-Meyer Motor Scales in a Longitudinal Stroke Recovery Study: Implication for Feasibility Survey for Stroke Rehabilitation Trial

Abstract

Introduction: Recruitments of stroke recovery trials have been challenging. NIH stroke scale (NIHSS) has been universally collected in the acute stroke phase, but stroke recovery trials generally use Fugl-Meyer Motor Scale (FMMS) for outcome measure as well as patient selection criteria. The knowledge gap on the relationship between the two scales potentially jeopardize the accuracy of clinical trial recruitment feasibility survey that is based on NIHSS in the acute phase. We aimed to investigate the correlation between the two scales in a longitudinal stroke recovery study. Methods: This is a prospective cohort study (Prediction and Imaging biomarker of Post-stroke Motor Recovery) that enrolled patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIHSS and FMMS were assessed 2-7 days after onset of stroke symptoms as well as at 90 days (± 15 days) post-stroke. Modified Rankin Scale (mRS), Stroke Impact Scale-16 (SIS-16) and Personal Health Questionnaire-9 (PHQ-9) were collected at 90 days (±15 days). Correlation analysis were conducted with Pearson Correlation coefficient. Results: 119 patients met the inclusion criteria and were included in the analysis. NIH Arm scales of 0, 1, 2, 3 and 4 correspond to FM-UE scales at 3 months of 61.1, 59.8, 58.0, 47.3 and 17.0. NIH leg scales of 1, 2, 3 and 4 correspond to FM_LE scales at 3 months of 32.4, 29.8, 27.8, 21.0 and 17.2. The correlation coefficient between of two leg scales is not as good as the two arm scales. (0.76 vs. 0.83). Similarly, mRS of 0, 1, 2, 3, 4 and 5 correspond to FMMS of 99.0, 91.6, 85.5, 51.6, 41.5, 21.6 and SIS-16 of 73.7, 69.6, 64.7, 55.1, 42.8, 25.3. Conclusions: Our data suggest that there is a strong correlation pattern between the NIH arm scale and FM-UE scale, NIH leg scale and FM-LE scale as well as mRS, FMMS, NIHSS and SIS-16. This information is potentially useful to inform the feasibility assessment for future stroke rehabilitation trials done through the NIH Stroke Trials Network.

Association between Baseline NIHSS Limb Motor Score and Functional Recovery after Stroke: Analysis Based on a Multicountry Dataset

“…Our analysis performed in a population of patients with AIS of intermediate severity (b-NIHSS [8][9][10][11][12][13][14] shows that long-term functional outcome is specifically associated with the level of their baseline limb motor score of the NI-HSS (b-NIHSS-LMS), in addition to their level of b-NI-HSS. Nested logistic regression analysis showed that b-NI-HSS and b-NIHSS-LMS were independently associated with functional independence (mRS 0-1).…”

“…Data from a large clinical trial, the CHInese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES) and its extension (CHIMES-E) study, was used for this analysis [8, 9]. CHIMES is an international, multicentre, randomised, double-blind study comparing a 3-month course of MLC601 (NeuroAiD TM ) to placebo on poststroke recovery assessed with mRS at month 3 and up to month 24 [9, 10].…”

“…By contrast, the 15-item NIH Stroke Scale (NIHSS) has become the standard for assessing stroke severity [6] as it can be administered rapidly following acute admission, even by non-neurologist physicians and nurses [7]. Moreover, a prospective cohort study of 119 patients reported strong associations between FMA, NIHSS arm and leg scores, and modified Rankin Score (mRS) [8]. Thus, an amended NIHSS with greater weighting to limb impairment may be an alternative to the FMA for assessing motor function and may potentially be used as a selection criterion to stratify patients with motor deficits.…”

“…A secondary objective was to apply this new tool in the context of a clinical trial. Methods: The analysed population considered for this research included subjects from a large published, double-blind, multicentre trial, randomised to receive either a combination of various herbal and non-herbal components (MLC601) or placebo, administered within 72 h after an acute ischaemic stroke of intermediate severity (defined by baseline NIH Stroke Scale [b-NIHSS] score of [8][9][10][11][12][13][14]. Associations between b-NIHSS-LMS and favourable outcome, i.e., mRS 0-1 at month 3, were evaluated using logistic regression adjusted for baseline covariates and study treatment.…”

“…Baseline characteristics of overall analysis population (b-NIHSS[8][9][10][11][12][13][14] with mRS assessed at month 3 NIHSS, baseline NIH stroke scale; b-NIHSS-LMS, b-NIHSS limb motor score; SD, Standard deviation; mRS, modified Rankin Scale. p values were obtained to compare two treatments groups (MLC601 vs.…”