title: The National Institutes of Health Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke.
abstract: BACKGROUND
  The National Institutes of Health Stroke Scale (NIHSS) is purported to be associated with long-term outcomes. This study determined the concurrent validity of the NIHSS with the Stroke Impact Scale (SIS), a previously validated measure of health status in chronic stroke survivors.
  
  
  METHODS
  The NIHSS and the SIS were administered to 147 subjects before participation in a multicenter, randomized, controlled trial. A Spearman's rho was used to determine correlations between NIHSS total score and (1) SIS physical dimension scores, (2) SIS overall perception of recovery scores, and (3) the SIS activities and independent activities of daily living (ADL/IADL) scores. SIS score variation and medians between subjects who scored a zero versus a nonzero on the NIHSS was also assessed.
  
  
  RESULTS
  There was no association between total NIHSS scores and SIS physical dimension scores, SIS overall perception of recovery scores, and SIS ADL/IADL scores (P = -.036, P = .782; P = -.039, P = .640; P = -.054, P = .520; respectively). Lastly, significant variation and similar median scores on the SIS were found between those scoring a zero on the NIHSS versus those who did not score a zero.
  
  
  CONCLUSIONS
  The NIHSS has no association with health status in chronic stroke and lacks association with measures of impairment and functional limitation. From these findings, we conclude that the NIHSS has poor validity to discern long-term poststroke outcomes and is not associated with health status. Because of possible limitation in the NIHSS's ability to accurately determine outcomes in this population, we recommend restriction of its use to the acute stage of recovery.
authors.affiliation: Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio; B.R.A.I.N. (Better Rehabilitation and Assessment for Improved Neuro-recovery) Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio. Electronic address: heather.tanksley@osumc.edu.
authors.forename: Heather T
authors.initials: HT
authors.lastname: Peters
authors.affiliation: Health Information Management and Systems Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.
authors.forename: Susan E
authors.initials: SE
authors.lastname: White
authors.affiliation: Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio; B.R.A.I.N. (Better Rehabilitation and Assessment for Improved Neuro-recovery) Laboratory, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.) / Q000592:standards; D010291:Paresis / Q000175:diagnosis / Q000209:etiology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis*; D014481:United States
keywords: Stroke; hemiparesis; measurement; outcomes; rehabilitation