Roesner Katrin, Brodowski Hanna, Strutz Nicole
Department of Physiotherapy, Pain and Exercise Research Luebeck, Institute of Health Sciences, Universität zu Lübeck, Lübeck, Germany.
International Graduate Academy, Institute of Health and Nursing Sciences, Medical Faculty of Martin Luther University Halle-Wittenberg, University Medicine Halle, Halle (Saale), Germany.
Front Neurol. 2025 Jul 30;16:1631275. doi: 10.3389/fneur.2025.1631275. eCollection 2025.
Stroke severity affects length of hospital stay and functional recovery in rehabilitation. Therefore, establishing baseline data of stroke severity is a crucial step. In 2017, neurorehabilitation researchers met at the Stroke Recovery and Rehabilitation Roundtable (SRRR) to build a consensus on new standards for stroke recovery research. Core outcomes for measurement in stroke trials resulted in the recommendation that severe stroke should be assessed using the NIHSS. This scoping review aims to provide an overview of the variety of measurements used in clinical research to assess severe stroke.
RCTs and CCTs were identified by searching PubMed, CENTRAL, SSCI, and ICTRP, covering articles published between January 2018 and September 2024. Peer-reviewed articles in English focusing on rehabilitative interventions and patients aged 18 years or older who have been classified with a severe stroke. The articles included were analyzed according to used measurements and cut-off scores.
The initial search yielded 1,004 publications, of which 35 (3.6%) studies were deemed eligible. In total, 11 different measures were used to assess severe stroke. Most studies used the NIHSS ( = 14), followed by mRS ( = 6), the FMA upper extremity ( = 4), the original FMA ( = 4) and the (modified) BI ( = 3). Seven different cut-off scores for the NIHSS were identified, with the scale being most frequently used in clinical settings.
This review indicates substantial variability in measurements and a diverse range of cut-off scores. Consequently, comparability of patients' baseline stroke severity across studies is limited. Given the fact that the NIHSS is only partially used, future efforts should focus on barriers and challenges using the NIHSS.
中风严重程度会影响住院时间和康复中的功能恢复。因此，建立中风严重程度的基线数据是关键一步。2017年，神经康复研究人员在中风恢复与康复圆桌会议（SRRR）上会面，就中风恢复研究的新标准达成共识。中风试验的核心测量结果建议，应使用美国国立卫生研究院卒中量表（NIHSS）评估严重中风。本综述旨在概述临床研究中用于评估严重中风的各种测量方法。
通过检索PubMed、CENTRAL、SSCI和ICTRP识别随机对照试验（RCT）和非随机对照试验（CCT），涵盖2018年1月至2024年9月发表的文章。以英文发表的、专注于康复干预且年龄在18岁及以上被归类为严重中风患者的同行评审文章。根据所使用的测量方法和临界值对纳入的文章进行分析。
初步检索得到1004篇出版物，其中35项研究（3.6%）被认为符合条件。总共使用了11种不同的测量方法来评估严重中风。大多数研究使用NIHSS（n = 14），其次是改良Rankin量表（mRS，n = 6）、Fugl-Meyer评估上肢部分（FMA上肢，n = 4）、原始Fugl-Meyer评估量表（原始FMA，n = 4）和（改良）Barthel指数（（改良）BI，n = 3）。确定了NIHSS的7种不同临界值，该量表在临床环境中使用最为频繁。
本综述表明测量方法存在很大差异，临界值范围也各不相同。因此，不同研究中患者基线中风严重程度的可比性有限。鉴于NIHSS仅部分被使用，未来的工作应聚焦于使用NIHSS时的障碍和挑战。
