Comparison Between the Original and Shortened Versions of the National Institutes of Health Stroke Scale in Ischemic Stroke Patients of Intermediate Severity

Abstract

Analyses were performed using data from the Chinese Medicine Neuroaid Efficacy on Stroke recovery (CHIMES) study, an international, randomized, placebo-controlled, double-blind trial investigating the efficacy of MLC601 on stroke recovery in patients with ischemic stroke of intermediate severity in the preceding 72 hours (clinicaltrials.gov NCT00554723). 10,11 Patients were randomly allocated to either MLC601 or placebo for 3 months as add-on to standard stroke care.Patients were assessed at baseline, day 10 (±2 days), or discharge, whichever was earlier, and month 3 (±1 week). At baseline, demographic and clinical information, as well as prestroke modified Rankin Scale (mRS) score, were ascertained. NIHSS and mini-mental status examination (MMSE) were also performed. At day 10 (or discharge, if earlier) and month 3 visits, NIHSS, mRS, and MMSE were assessed again. In addition, month 3 assessment included the Barthel index (BI).Background and Purpose-The 15-item National Institutes of Health Stroke Scale (NIHSS) has been critiqued for its complexity and variability, and shortened versions have been proposed. This study aimed to compare the measurement properties of the original version with 3 shortened versions with 11, 8, and 5 items, respectively. Methods-Analyses were performed using data from an international, double-blind randomized controlled trial investigating the efficacy of MLC601 on stroke recovery in patients with ischemic stroke of intermediate severity (Chinese Medicine Neuroaid Efficacy on Stroke recovery [CHIMES]). To compare discriminative ability and responsiveness to change, the effect sizes of the NIHSS scores in relation to modified Rankin Scale, mini-mental status examination, and Barthel index were estimated using regression analysis. Results-For both discriminative ability and responsiveness to change, the original version exhibited a larger effect size (0.55 and 0.84) in relation to modified Rankin Scale than the other 3 shortened versions (0.35-0.46 and 0.74-0.78). Conclusions-The original 15-item NIHSS retained information that made it more discriminative and responsive to change than the shortened versions. We recommend future clinical researchers to use the full version NIHSS to evaluate patients' stroke severity. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00554723.

Effect of Early Rehabilitation and Nursing Intervention on the Rehabilitation Prognosis of Elderly Stroke Hemiplegia Patients in the Department of Neurology

“…The NIHSS score [ 4 ] includes language, facial paralysis, consciousness level, and gaze function, with the total score of 45 points; the higher the score indicates the worse the degree of nerve defect.…”

Functional Dynamics of Neutrophils After Ischemic Stroke

“…S1. Age (mean 64.87 ± 0.60 and 95% CI 63.69 -66.05), gender (female : male = 68 : 157), and score of National Institute stroke scale [12,13] (NIHSS) of patients were recorded. Neutrophil count, neutrophil to lymphocyte ratio (NLR) in the peripheral blood and the infarct sizes within 24h after symptom onset were analyzed.…”

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).…”

“…In a previous study comparing the 15-item and shortened versions of the NIHSS, we showed that the original 15-item NIHSS displayed the largest effect size for discriminant ability and responsiveness to change on mRS compared to its shortened versions [14]. On the other hand, to measure the broader disability that can result from stroke in later post-acute stages, it is preferable to use other rating scales measuring functional outcomes which are widely used in RCTs and requested by regulatory bodies [15].…”

“…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.…”