School of Medicine, Department of Palliative Care Policy and Rehabilitation, King's College London , London , UK .
Disabil Rehabil. 2014;36(1):23-31. doi: 10.3109/09638288.2013.775360. Epub 2013 May 30.
To examine the construct validity and inter-rater reliability of the Neurological Impairment Scale (NIS) and compare ratings by medical and multidisciplinary teams in a mixed neurorehabilitation sample. To assess its concurrent and predictive validity as a predictor of outcome and functional gains during inpatient rehabilitation.
The NIS was rated in a consecutive cohort of patients (n = 428) recruited from nine specialist neurorehabilitation units in London. Dimensionality and internal consistency were explored through principal components analysis with Varimax rotation. Inter-rater reliability and the relationship between NIS and functional outcome (UK Functional Assessment Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre.
Factor analysis identified two principal domains ("Physical" and "Cognitive") together accounting for 35% of the variance: their Cronbach's alpha values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95 (95% CI = 0.91-0.97)) and acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI = 0.88-0.95)). Change in NIS-physical score predicted 29% of the variance in functional gain (FIM + FAM change).
These findings provide the first formal evidence for the validity and reliability of the NIS as a measure of neurological impairment for use in general neuro-rehabilitation settings. Its further application and exploration are now warranted.
The extent of neurological recovery occurring during rehabilitation can make an important contribution to functional gains. In order to interpret measurement of functional outcome, we need to be able to identify changes at the level of impairment. Many of the available tools to measure severity of impairment are condition specific. The Neurological Impairment Scale (NIS) was developed for use across a broad range of disabling conditions alongside the UK FIM+FAM. This first formal examination of its psychometric properties provides evidence for its scalability, reliability and validity. The NIS has potential to provide useful information for case-mix adjustment and as a predictor of functional gain in general neurorehabilitation settings.
检验神经损伤量表（NIS）的结构效度和组内信度，并比较医学和多学科团队在混合神经康复样本中的评分。评估其作为住院康复期间结果和功能增益预测因子的同时和预测效度。
对来自伦敦 9 个神经康复专科的连续队列患者（n=428）进行 NIS 评分。通过主成分分析和 Varimax 旋转探索维度和内部一致性。在来自一个中心的亚组（n=94）中分析组内信度和 NIS 与功能结局（英国功能评估量表（FIM+FAM））之间的关系。
因素分析确定了两个主要领域（“物理”和“认知”），共占 35%的方差：其 Cronbach's alpha 值分别为 0.76 和 0.67。医生之间的总评分具有极好的组内信度（ICC=0.95（95%置信区间=0.91-0.97）），医学和多学科团队之间的信度可接受（ICC=0.92（95%置信区间=0.88-0.95））。NIS-物理评分的变化预测了功能增益（FIM+FAM 变化）的 29%方差。
这些发现首次提供了 NIS 作为一般神经康复环境中神经损伤测量工具的有效性和可靠性的正式证据。现在需要进一步应用和探索。
康复过程中发生的神经恢复程度可以对功能增益做出重要贡献。为了解释功能结局的测量，我们需要能够识别损伤水平的变化。许多用于测量严重程度的现有工具都是针对特定条件的。神经损伤量表（NIS）是为在广泛的残疾疾病中使用而开发的，同时还与英国 FIM+FAM 一起使用。对其心理测量特性的首次正式检查提供了其可扩展性、可靠性和有效性的证据。NIS 有可能为一般神经康复环境中的病例组合调整和功能增益预测提供有用信息。
