Stroke, Vol 25, 2220-2226, Copyright © 1994 by American Heart Association
P Lyden, T Brott, B Tilley, KM Welch, EJ Mascha, S Levine, EC Haley, J Grotta and J Marler
BACKGROUND AND PURPOSE: Despite the frequent use of clinical rating scales
in multicenter therapeutic stroke trials, no generally acceptable method
exists to train and certify investigators to use the instrument
consistently. We desired to train investigators to use the National
Institutes of Health Stroke Scale in a study of acute stroke therapy so
that all examiners rated patients comparably. METHODS: We devised a
two-camera videotape method that optimizes the visual presentation of
examination findings. We then measured the effectiveness of the training by
asking each investigator to evaluate a set of 11 patients, also on
videotape. We tabulated the evaluations, devised a scoring system, and
calculated measures of interobserver agreement among the participants in
this study. RESULTS: We trained and certified 162 investigators. We found
moderate to excellent agreement on most Stroke Scale items (unweighted
kappa > 0.60). Two items, facial paresis and ataxia, exhibited poor
agreement (unweighted kappa < 0.40) and should be revised in future
editions of the scale. Performance improved with video training compared
with previous studies. Inclusion of the motor rating of the unaffected
limbs in the total score did not affect reliability. CONCLUSIONS: Video
training and certification is a practical and effective method to
standardize the use of examination scales. Two cameras must be used during
the taping of patients to accurately present the clinical findings. This
method is easily adapted to any study in which a large number of
investigators will be enrolling patients at multiple clinical centers.
ARTICLES
Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group
University of California, San Diego.
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K. C. Johnston, A. F. Connors Jr, D. P. Wagner, and E. C. Haley Jr Risk Adjustment Effect on Stroke Clinical Trials Stroke, February 1, 2004; 35 (2): e43 - e45. [Abstract] [Full Text] [PDF]
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C Terborg, S Bramer, S Harscher, M Simon, and O W Witte Bedside assessment of cerebral perfusion reductions in patients with acute ischaemic stroke by near-infrared spectroscopy and indocyanine green J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 38 - 42. [Abstract] [Full Text] [PDF]
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B Cucchiara, S E Kasner, D A Wolk, P D Lyden, V A Knappertz, T Ashwood, T Odergren, and A Nordlund Lack of hemispheric dominance for consciousness in acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, July 1, 2003; 74(7): 889 - 892. [Abstract] [Full Text] [PDF]
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