The Relevance of Neurological and Functional Outcome Scales for Acute Stroke Trials

  • A. Ferbert
  • K. Willmes
Conference paper

Abstract

Research in the field of medical treatment is based on the assessment of variables that are aimed at by the therapy under question. Even if it is tempting and easy to choose a single laboratory parameter for measurement, it is the improvement of the patient’s general clinical status that is of utmost importance before introducing a new therapy. The assessment of a stroke patient seems to be particularly difficult, as a stroke commonly leads to a variety of more or less independent signs that may or may not be improved by a drug in different ways. Is the treatment of benefit to the patient or not if his or her moderate paresis completely resolves but at the same time Broca’s aphasia deteriorates to global aphasia? In the following we will try to analyze how different stroke scales have dealt with this problem. We will focus on scales that attempt to quantify deficit or residual abilities once stroke has occurred. We will not touch on the methodological problems that one has to face in a stroke prevention trial when an ischemic event or death occurs in a previously healthy or at-risk patient.

Keywords

Placebo Glycerol Depression Neurol Atenolol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adams RJ, Meador KJ, Sethi KD, Grotta JC, Thompson DS (1987) Graded neurological scale for use in acute hemispheric stroke treatment protocols. Stroke 18:665–669PubMedCrossRefGoogle Scholar
  2. 2.
    Brott T, Adams HP, Olinger CP, et al (1989) Measurements of acute cerebral infarction: A clinical examination scale. Stroke 20:864–870PubMedCrossRefGoogle Scholar
  3. 3.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Measur 20:34–46CrossRefGoogle Scholar
  4. 4.
    Cote R, Battista RN, Wolfson C, Boucher J, Adams J, Hachinski VC (1989) The Canadian Neurological Scale: Validation and reliability assessment. Neurology 39:638–643PubMedGoogle Scholar
  5. 5.
    Cote R, Hachinski VC, Shurtell BL, Norris JW, Wolfson C (1986) The Canadian Neurological Scale: A preliminary study in acute stroke. Stroke 17:731–737PubMedCrossRefGoogle Scholar
  6. 6.
    European Carotid Surgery Trialist’s Collaborative Group (1991) MRC European carotid surgery trial: Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243CrossRefGoogle Scholar
  7. 7.
    Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S (1975) I. A method for evaluation of physical performance. Scand J Rehabil Med 7:13–31PubMedGoogle Scholar
  8. 8.
    Gelmers HJ, Gorter K, de Weerdt CJ, Wiezer HJA (1988) Assessment of interobserver variability in a Dutch multicenter study on acute ischemic stroke. Stroke 19:709–711PubMedCrossRefGoogle Scholar
  9. 9.
    Gelmers HJ, Hennerici M (1990) Effect of nimodipine on acute ischemic stroke pooled results from five randomized trials. Stroke 21(Suppl IV):IV-81–IV-84Google Scholar
  10. 10.
    Goldstein LB, Bertels C, Davis JN (1989) Interrater reliability of the NIH Stroke Scale. Arch Neurol 46:660–662PubMedCrossRefGoogle Scholar
  11. 11.
    Koziol JA, Hacke W (1990) Multivariate data reduction by principal components, with application to neurological scoring instruments. J Neurol 237:461–464PubMedCrossRefGoogle Scholar
  12. 12.
    Krauth J (1984) A modification of kappa for intraobserver bias. Biom J 26:435–445CrossRefGoogle Scholar
  13. 13.
    Loewen SC, Anderson BA (1988) Reliability of the modified motor assessment scale and the Barthel index. Phys Ther 68:1077–1081PubMedGoogle Scholar
  14. 14.
    Mahoney FJ, Barthel DW (1965) Functional evaluation. The Barthel index. Md Med J 14:61–65Google Scholar
  15. 15.
    Mathew NT, Rivera VM, Meyer JS, Charney JZ, Hartmann A (1972) Double-blind evaluation of glycerol therapy in acute cerebral infarction. Lancet December 23:7791–7793Google Scholar
  16. 16.
    Rankin J (1957) Cerebral vascular accident in patients over the age of 60. II. Prognosis. Scott Med J 2:200–215PubMedGoogle Scholar
  17. 17.
    Scandinavian Stroke Study Group (1985) Multicenter trial of hemodilution in ischemic stroke — background and study protocol. Stroke 16:885–890CrossRefGoogle Scholar
  18. 18.
    Shinar D, Gross CR, Mohr JP, et al (1985) Interobserver variability in the assessment of neurologic history and examination in the Stroke Data Bank. Arch Neurol 42:557–565PubMedCrossRefGoogle Scholar
  19. 19.
    Sisk C, Ziegler DK, Zileli T (1970) Discrepancies in recorded results from duplicate neurological history and examination in patients studied for prognosis in cerebrovascular disease. Stroke 1:14–18PubMedCrossRefGoogle Scholar
  20. 20.
    Skyhoj-Olsen T (1990) Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 21:247–251CrossRefGoogle Scholar
  21. 21.
    The Dutch TIA Study Group. (1988) The Dutch TIA Trial: Protective effects of low-dose aspirin and atenolol in patients with transient ischemic attacks or nondisability stroke. Stroke 19:512–517CrossRefGoogle Scholar
  22. 22.
    UK TPA Study Group (1988) The UK-TPA aspurin trial. Interim results. Br Med J 296:316–320CrossRefGoogle Scholar
  23. 23.
    van Gijn J (1992) Measurement of outcome in stroke prevention trials. Cerebrovasc Dis 2(Suppl 1):23–34CrossRefGoogle Scholar
  24. 24.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJA, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMedCrossRefGoogle Scholar
  25. 25.
    Wade DT, Hewer RL (1987) Functional abilities after stroke: Measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry 50:177–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • A. Ferbert
    • 1
  • K. Willmes
    • 1
  1. 1.Department of NeurologyRWTH AachenAachenFederal Republic of Germany

Personalised recommendations