Challenging comparison of stroke scales

Area of Science:

• Neurology
• Clinical Assessment
• Rehabilitation Medicine

Background:

• Stroke scales are crucial for assessing patient recovery and guiding treatment.
• Existing scales include clinicometric and functional impairment/disability measures.
• Commonly used scales are the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI).

Purpose of the Study:

• To review and analyze existing stroke scales.
• To compare the utility and adoption of various stroke assessment tools.
• To highlight the continued reliance on traditional scales despite newer alternatives.

Main Methods:

• A comprehensive internet search was conducted for studies on stroke scales.
• Keywords used included: stroke, scale, score, and disability.
• The search was finalized on January 1, 2013.

Main Results:

• Modified NIHSS and Scandinavian stroke scale offer improvements over the standard NIHSS but are not widely adopted.
• The modified Rankin Scale (mRS) and Barthel Index (BI) are standard for functional assessment, though mRS distinctions are unclear.
• The Asian stroke disability scale is a valid, simplified alternative to mRS and BI.
• NIHSS, mRS, and BI remain routine due to clinician familiarity and their use in pivotal stroke trials.

Conclusions:

• Clinician familiarity and historical use in trials perpetuate the use of NIHSS, mRS, and BI.
• Despite potential benefits of newer scales, established tools dominate clinical practice and research.
• Further evaluation and promotion of validated, simplified scales may be warranted.