Abstract WMP35: Assessment Of Spatial Neglect In Acute Stroke Patients: Results Of A Cross-country Pilot Study To Validate A Simplified Version Of The Catherine Bergego Scale

Abstract

Background: Spatial neglect (SN) is present in about 20% patients in acute stroke units. If left unidentified SN may obstruct rehabilitation. The 10-item Catherine Bergego Scale (CBS) is increasingly recommended for SN assessment and has excellent psychometric properties. However, a standardized assessment with the CBS takes around 30-40 minutes to complete, making it rather unrealistic for nurses and physicians to use in the fast pace of the stroke unit. Objectives: To test a revised protocol for the CBS to make its routine use feasible in acute stroke units. We will: a). Compare the time used to administer the original version of the CBS with the simplified version of the CBS (sCBS), b). evaluate the agreement between the results of the CBS and sCBS, c). establish the interrater agreement between two rates, R1+R2, when scoring the sCBS, and d). correlate the sCBS with stroke severity and disability. Methods: Out of 98 consecutive stroke patients from the stroke units in Kaunas and Reykjavik, 15 with right-sided SN were included within five days following stroke. A structured assessment with the CBS established the presence and severity of SN. Patients identified with SN using the original structured assessment underwent a replicated evaluation with a simplified version of the sCBS. Two raters assessed the participants with the sCBS while they were blinded to the other rater’s scores. Stroke severity was assessed with NIHSS and disability with smRS. Results: There was a positive correlation between the NIHSS and the severity of SN r(13) = .78, p = .001. and the smRS and SN r(13) = .72, p =.002. On average it took 42 minutes to assess patients with mild/moderate SN with the CBS versus 14 minutes with the sCBS. Patients with very severe SN took <10 minutes to assess, both with the CBS and sCBS, because many scale items were impossible to score. A total of 54 items were impossible to score across patients with the CBS. Significantly more items could be scored using the sCBS (p< .05; 39 items, r1 and 40 items, r2). Conclusions: In contrast to the original CBS, the sCBS is more assessment-friendly for application in bedridden acute SN patients. We expect that the shortening of the assessment time may enhance SN screening in stroke units.