COSMIN database

A reappraisal of reliability and validity studies in stroke

D'Olhaberriague, L., Litvan, I., Mitsias, P., and Mansbach, H. H.
BACKGROUND: The emergence of prophylactic and therapeutic interventions in stroke has been accompanied by the widespread use of stroke classifications and scales that measure deficit (stroke scales) or resulting long-term handicap (handicap and disability scales). Although the accuracy of some scales and classifications has been studied, there is no updated systematic review appraising all of them.

REVIEW: We reviewed the literature and selected 21 studies on classifications and scales. The International Classification of Diseases, 10th revision, achieved the highest interobserver agreement among seven stroke classifications. The National Institutes of Health Stroke Scale, the Canadian Neurological Scale, and the European Stroke Scale had the highest reliability across items among nine stroke scales. The Barthel Index was the most reliable disability scale.

CONCLUSIONS: The identification of the most reliable stroke classifications and scales should encourage their use in selection of homogeneous populations of patients for clinical research studies and to improve communication among scientists. Further research is needed to investigate neglected aspects of the neurological examination and the validity of stroke classifications.
0039-2499 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Functional status:
Physical functioning
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
BI - Barthel Index   
CNS - Canadian Neurological Scale
ESS - European Stroke Scale
FMA - Fugl-Meyer Motor Assessment   
HSS - Hemispheric Stroke Scale
Mathew Scale
NIHSS - National Institutes of Health Stroke Scale   
SSS - Scandinavian Stroke Scale
Stroke Severity Scale
Toronto Scale
UNSS - Unified Neurological Stroke Scale