title: Measured neurological improvements correlate with self-perceived improvements after stroke.
abstract: BACKGROUND
  Important advantages of neurologic impairment scales after stroke include measurements of within-subject changes over time starting at baseline. We compared percent improvement on the National Institutes of Health stroke scale (NIHSS) to stroke outcome that seems tangible to patients and caregivers: their perceived percent improvement.
  
  
  METHODS
  We prospectively measured improvement on the NIHSS between baseline and 3 to 6 months in consecutive patients with acute stroke presenting within 48 hours after onset. Unaware of the measured result, patients and caregivers were asked to estimate their perceived overall improvement since baseline assessment at the time of enrollment. We excluded patients with baseline NIHSS <3, clear improvement before screening, coma, brain herniation, or intraventricular hemorrhage.
  
  
  RESULTS
  Of 40 enrolled patients, 9 died, 5 could not return for reevaluation, and the remaining 26 were reevaluated and analyzed. Median time from stroke onset to enrollment was 19.5 hours (range 2-45) and the median baseline NIHSS score was 8 (range 3-31). The measured improvements on the NIHSS ranged between 12.5% and 100% and correlated moderately (Spearman rank coefficient 0.54) and significantly (P = .005) with the patient- and caregiver-perceived percent improvement.
  
  
  CONCLUSIONS
  Percent improvement on the NIHSS after stroke correlates moderately and significantly with patient and caregiver perceived overall improvement and appears to be a useful addition to the current functional outcome measures.
authors: Department of Neurology, Georgia Health Sciences University School of Medicine, Augusta, Georgia 30912, USA. abruno@georgiahealth.edu
authors: Askiel
authors: A
authors: Bruno
authors: Chen
authors: C
authors: Lin
authors: Neel
authors: N
authors: Shah
authors: Jeffrey A
authors: JA
authors: Switzer
authors: Abiodun E
authors: AE
authors: Akinwuntan
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology*; D009460:Neurologic Examination; D010361:Patients / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012649:Self Concept; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013997:Time Factors