Abstract
Background and Purpose: There is a growing interest in therapies that may augment motor recovery that could be initiated in the acute stroke unit and maintained through the rehabilitation period. Homogenization of the currently fragmented stroke clinicometrics is necessary before such multidisciplinary trials can be conducted. The supplementary motor scale of the NIH stroke scale (SMS-NIHSS) is a simple and reliable scale for assessing proximal and distal motor function in the upper and lower extremities. We hypothesized that the SMS-NIHSS is a valid tool for assessing motor recovery with prognosticative value. Methods: We performed an analysis of SMS-NIHSS scores recorded in 1281 patients enrolled in trial of ORG 10172 in Acute Stroke Treatment (TOAST). Results: The mean SMS-NIHSS scores were 8.18 at baseline, and 4.68 at 3 months. The SMS-NIHSS baseline score was an independent predictor of favorable outcome at 3 months (OR=0.86; 95% CI 0.84-0.87; p<0.0001) after adjusting for confounders. The degree of improvement in the SMS-NIHSS scores from baseline to three months (ΔSMS-NIHSS) was also independently associated with a favorable outcome (p<0.0001). At three months, SMS-NIHSS scores showed a strong correlation with Barthel Index (r=-0.70, p<0.0001) and Glasgow Outcome Score (r=+0.73, p<0.0001). Conclusion: The SMS-NIHSS is a valid scale for assessing recovery with prognosticative value, and may be sensitive to changes during recovery. Given that the SMS-NIHSS is an extension of the widely accepted NIHSS, it could be easily implemented in trials conducted in a variety of clinical research settings including acute stroke hospitals and rehabilitation units.
Published Version
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