Abstract:Background: The National Institutes of Health Stroke Scale (NIHSS) is widely used to measure stroke deficits and is deemed to be reliable when used by a range of professionals. Aims: This study aimed to establish the inter-rater reliability of the NIHSS when completed via telemedicine. Secondary aims were to explore if professional group, length of time since training and/or re-certification, frequency of use and reason for using the NIHSS influenced the inter-rater reliability. Methods: A total of 30 video cl… Show more
“…n the more than 30 years since its debut, the National Institutes of Health Stroke Scale (NIHSS) 1,2 has grown to near universal use for structuring graded neurological examinations of stroke or suspected stroke in the hyperacute setting and become the gold standard for appraising poststroke function and change in neurological function. 3 It has demonstrated validity 4 and low-to-good reliability among providers, [5][6][7] which improves with training. 2,8 Importantly for research, acute NIHSS scores significantly predict both short-and long-term outcomes.…”
BACKGROUND:
The National Institutes of Health Stroke Scale is a widely accepted tool for structured graded neurological examination of stroke or suspected stroke in the hyperacute setting. Concerns have arisen about the use of its picture stimuli in a contemporary and global health context. Here, we present new stimuli prepared to serve the needs of stroke providers worldwide: the precarious painter image description and updated objects for naming.
METHODS:
This was a validation study of 101 healthy fluent English speakers. Participants were reached by the Johns Hopkins Outpatient Center, the University of South Carolina, and Prisma Health from 2022 to 2023 and included residents of the United States, Germany, Canada, the United Kingdom, Australia, and Zambia. Participants were recorded in person or via video conferencing when asked to describe the new picture, while a subset named seven illustrations. Multivariate analyses of variance were used for primary analyses. In a complementary investigation, 299 attendees of the 2023 International Stroke Conference were asked about their preference for the existing or new stimuli and why.
RESULTS:
Each of the 44 content units from the picture description was included by at least 5% of respondents in the demographically representative subsample. Performance was similar across healthy participants irrespective of age, sex, race, ethnicity, or education. Typical descriptions were characterized by an average of 23 content units (SD=5) conveyed with 167 syllables (SD=79). The new naming stimuli were recognized by 100% of participants from many countries as being familiar and identifiable, and names provided in response to the task were highly convergent. The majority of stroke health care providers preferred both the precarious painter and naming stimuli.
CONCLUSIONS:
The description of the new National Institutes of Health Stroke Scale picture, the precarious painter, results in rich samples among healthy speakers that will provide an appropriate basis for the detection of language deficits.
“…n the more than 30 years since its debut, the National Institutes of Health Stroke Scale (NIHSS) 1,2 has grown to near universal use for structuring graded neurological examinations of stroke or suspected stroke in the hyperacute setting and become the gold standard for appraising poststroke function and change in neurological function. 3 It has demonstrated validity 4 and low-to-good reliability among providers, [5][6][7] which improves with training. 2,8 Importantly for research, acute NIHSS scores significantly predict both short-and long-term outcomes.…”
BACKGROUND:
The National Institutes of Health Stroke Scale is a widely accepted tool for structured graded neurological examination of stroke or suspected stroke in the hyperacute setting. Concerns have arisen about the use of its picture stimuli in a contemporary and global health context. Here, we present new stimuli prepared to serve the needs of stroke providers worldwide: the precarious painter image description and updated objects for naming.
METHODS:
This was a validation study of 101 healthy fluent English speakers. Participants were reached by the Johns Hopkins Outpatient Center, the University of South Carolina, and Prisma Health from 2022 to 2023 and included residents of the United States, Germany, Canada, the United Kingdom, Australia, and Zambia. Participants were recorded in person or via video conferencing when asked to describe the new picture, while a subset named seven illustrations. Multivariate analyses of variance were used for primary analyses. In a complementary investigation, 299 attendees of the 2023 International Stroke Conference were asked about their preference for the existing or new stimuli and why.
RESULTS:
Each of the 44 content units from the picture description was included by at least 5% of respondents in the demographically representative subsample. Performance was similar across healthy participants irrespective of age, sex, race, ethnicity, or education. Typical descriptions were characterized by an average of 23 content units (SD=5) conveyed with 167 syllables (SD=79). The new naming stimuli were recognized by 100% of participants from many countries as being familiar and identifiable, and names provided in response to the task were highly convergent. The majority of stroke health care providers preferred both the precarious painter and naming stimuli.
CONCLUSIONS:
The description of the new National Institutes of Health Stroke Scale picture, the precarious painter, results in rich samples among healthy speakers that will provide an appropriate basis for the detection of language deficits.
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