The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment

Abstract

Objectives-To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. Methods-A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. Results-Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/aVect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/aVect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. Conclusions-The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures. (J Neurol Neurosurg Psychiatry 2001;71:643-651)

The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): II. Reliability and Convergent Validity

“…A similar validation technique was successfully used, in which the DRS was graded against the Glasgow Outcome Scale (GOS; Hall et al, 1985), and to determine the sensitivity to change of the Neurobehavioral Rating Scale-Revised (McCauley et al, 2001b); a similar procedure is planned for a future study by the authors of this article. Further work is required to determine how the NOS-TBI should be implemented when assigning a patient's GOS score, and more fundamentally, how NOS-TBI scores relate to GOS outcome categories.…”

BCL2Genotypes: Functional and Neurobehavioral Outcomes after Severe Traumatic Brain Injury

“…There are eight items in the measurement tool, which assess four areas: awareness/ arousal, cognitive ability for self-care, level of physical dependence on others, and estimated ability for employment, school, or homemaking. This scale has been shown to be a useful predictor of outcome following TBI (McCauley et al, 2001). …”

Cognitive and functional status after vein of Galen aneurysmal malformation endovascular occlusion

“…The executive/cognitive items from the Neurobehavioral Rating Scale-Revised (NRS-R) [15,16] , the Bicêtre outcome score [8] , and the Barthel index [17] were used in the evaluation of each patient. Factors loading under executive/cognitive in the NRS-R included patient difficulties with planning, mental flexibility, memory, disorientation, initiative or motivation, self-appraisal, conceptual disorganization, and oral comprehension [15] . As is standard for the NRS-R, each patient was graded on a four-tier scale including absent, mild, moderate, or severe difficulty for each item evaluated.…”