Stroke Assessment Scales: The Dilemma Validity or Reliability

Marco Aurelio Gralha de Caneda

Neurology Department of GHC, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.

DOI: 10.4236/oalib.1101067                

Abstract

The author discusses the conceptual bases related to general and clinimetric properties of stroke scales, relating them to its application in research and clinical practice. This paper briefly presents the definitions of reliability and validity and its usage in clinical studies, and didactically demonstrates statistical approaches for obtaining agreement and correlation coefficients. Finally, it proposed to criticize the most common bias in the literature on the use of these concepts and forwards suggestions for its appropriate guidance to studies formulation.

Keywords

Reliability, Validity, Stroke Scales, Neurological Scales

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kasner, S. (2006) Clinical Interpretation and Use of Stroke Scales. The Lancet Neurology, 5, 603-612.
[2]	Lai, S.M., Duncan, P.W. and Keighley, J. (1998) Prediction of Functional Outcome after Stroke. Stroke, 29, 1838-1842. http://dx.doi.org/10.1161/01.STR.29.9.1838
[3]	de Caneda, M.A.G., Fernandes, J.G., Almeida, A.G. and Mugnol, F.E. (2006) Reliability of Neurological Assessment Scales in Patients with Stroke. Arquivos de Neuropsiquiatria, 64, 690-697.
[4]	Meyer, B.C., Hemmen, T.M., Jackson, C.M. and Lyden, P.D. (2002) Modified NIHSS for Use in Stroke Clinical Trials. Prospective Reliability and Validity. Stroke, 33, 1261-1266. http://dx.doi.org/10.1161/01.STR.0000015625.87603.A7
[5]	Haan, D.R., Horn, J. and Limburg, M. (1993) A Comparison of Five Stroke Scales with Measures of Disability, Handicap and Quality of Life. Stroke, 24, 1178-1181. http://dx.doi.org/10.1161/01.STR.24.8.1178
[6]	Kay, R., Wong, K.S. and Perez, G. (1997) Dichotomizing Stroke Outcomes Based on Self-reported Dependency. Neurology, 49, 1694-1696. http://dx.doi.org/10.1212/WNL.49.6.1694
[7]	Wilson, J.T., Hareendran, A. and Grant, M. (2002) Improving the Assessment of Outcome in Stroke. Stroke, 33, 2243-2246. http://dx.doi.org/10.1161/01.STR.0000027437.22450.BD
[8]	Orgogozo, J.M. (1994) The Concepts of Impairment, Disability and Handicap. Cerebrovascular Disease, 4, 2-6. http://dx.doi.org/10.1159/000108531
[9]	Orgogozo, J.M. (1998) Advantage and Disadvantage of Neurological Scales. Cerebrovascular Disease, 8, 2-7. http://dx.doi.org/10.1159/000047505
[10]	Asplund, K. (1987) Clinimetricsin Stroke Research. Stroke, 18, 528-530.
[11]	Duffy, L., Gajree, S., Langhorne, P., Stott, D. and Quinn, T.J. (2013) Reliability (Inter-Rater Agreement) of the Barthel Index for Assessment of Stroke Survivors. Systematic Review and Meta-Analysis. Stroke, 44, 462-468. http://dx.doi.org/10.1161/STROKEAHA.112.678615
[12]	Hantson, L. and De Keyser, J. (1994) Neurologic Scales in the Assessment of Cerebral Infarction. Cerebrovascular Diseases, 4, 7-14. http://dx.doi.org/10.1159/000108532
[13]	Banks, J.L. and Marotta, C.A. (2007) Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials. Stroke, 38, 1091-1096. http://dx.doi.org/10.1161/01.STR.0000258355.23810.c6
[14]	Côté, R., Batista, R.N., Wolfson, C.M. and Hachinski, V. (1988) Stroke Assessment Scales: Guidelines for Development, Validation and Reliability Assessment. Canadian Journal of Neurological Sciences, 15, 261-265.
[15]	Quinn, T.J., Dawson, J., Walters, M.R. and Lees, K.R. (2009) Reliability of the Rankin Scale. A Systematic Review. Stroke, 40, 3393-3395. http://dx.doi.org/10.1161/STROKEAHA.109.557256
[16]	Lyden, P.D. and Lau, G.T. (1991) A Critical Appraisal of Stroke Evaluation and Rating Scales. Stroke, 22, 1345-1352. http://dx.doi.org/10.1161/01.STR.22.11.1345
[17]	Streiner, D.L. and Norman, G.R. (1995) Health Measurements Scales: A Practical Guide to Their Development and Use. 2a Edition, Oxford University Press, Oxford, 104-127.
[18]	Koran, L.M. (1975) The Reliability of Clinical Methods, Data and Judgments. The New England Journal of Medicine, 293, 642-646. http://dx.doi.org/10.1056/NEJM197509252931307
[19]	Everitt, B.S. (1989) Measurements in Medicine and Statistical Methods for Medical Investigations. Oxford University Press, London, 16-28.
[20]	Altmann, D.G. (1990) Practical Statistics for Medical Research. 1st Edition, CRC Press, London, 396-409.
[21]	Koran, L.M. (1975) The Reliability of Clinical Method, Data and Judgments II. The New England Journal of Medicine, 293, 695-701. http://dx.doi.org/10.1056/NEJM197510022931405
[22]	Berger, K., Kase, C.S. and Buring, J.E. (1996) Interobserver Agreement in the Classification of Stroke in the Physician’s Health Study. Stroke, 27, 238-242. http://dx.doi.org/10.1161/01.STR.27.2.238
[23]	Johnson, C.J., Kittner, S.J., McCarter, R.J., Sloan, M.A., Stern, B.J., Buchholz, D. and Price, T.R. (1995) Interrater Reliability of an Etiologic Classification of Ischemic Stroke. Stroke, 26, 46-51. http://dx.doi.org/10.1161/01.STR.26.1.46
[24]	Shinar, D., Gross, C.R., Mohr, J.P., Caplan, L.R., Price, T.R., Wolf, P.A., et al. (1985) Interobserver Variability in the Assessment of Neurologic History and Examination in the Stroke Data Bank. JAMA Neurology, 42, 557-565. http://dx.doi.org/10.1001/archneur.1985.04060060059010
[25]	Fleiss, J.L. (1981) Statistical Methods for Rates and Proportions. 1st Edition, John Wiley & Sons, London, 218.
[26]	Harrison, J.K., McArthur, K.S. and Quinn, T.L. (2013) Assessment Scales in Stroke: Clinimetric and Clinical Considerations. Clinical Interventions in Aging, 8, 201-211.