Underlying structure of the National Institutes of Health Stroke Scale - Results of a factor analysis
Underlying structure of the National Institutes of Health Stroke Scale - Results of a factor analysis
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DOI：
10.1161/01.str.30.11.2347
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发表时间：
1999-11-01
期刊：
影响因子：
8.3
通讯作者：
Zivin, J
中科院分区：
文献类型：
--
作者：
Lyden, P;Lu, M;Zivin, J
背景和目的：没有卒中量表被证实是一种使用临床试验数据的结果测量方法，这些数据显示了积极的治疗效果。因此，我们认为，我们建议使用来自美国国立神经疾病和卒中研究所（NINDS）tPA卒中试验的数据来确定美国国立卫生研究院卒中量表（NIHSS）在接受组织纤溶酶原激活剂（tPA）治疗的患者中是否有效，并探索NIHSS的潜在临床结构。的NINDS tPA中风试验，推导出一个假设的潜在因素结构。然后，我们使用同一试验第2部分（n=333）的NIHSS数据对该结构进行了验证性因素分析。然后，我们测试了是否可以在tPA和安慰剂治疗的患者中发现这个最终的因素结构，在中风治疗后的一段时间内连续。使用3个月的结果数据，我们测试的NIHSS和其他措施之间的关联中风outcome.Results-The探索性分析表明，有2个因素的NIHSS，代表左右脑功能，确认内容效度的规模。由4个因子组成的替代结构可以得到更好的拟合优度：前2个因子可以分别代表左脑皮层和运动功能，后2个因子可以分别代表右脑皮层和运动功能。然后在tPA和安慰剂患者组中发现了相同的因素结构，证实了探索性分析。所有3个月的临床结果相互关联，在随后的时间点，确认预测validity. Conclusions，这是第一次研究有效的中风治疗患者的中风量表的有效性。NIHSS似乎在急性卒中患者中有效，并可用于发现治疗相关差异。该量表在卒中后3个月内连续使用时有效，并与其他结局指标表现出良好的一致性。
Background and Purpose-No stroke scale has been validated as an outcome measure using data from a clinical trial demonstrating a positive therapeutic effect. Therefore, we proposed to use data from the National Institute of Neurological Disorders and Stroke (NINDS) tPA Stroke Trial to determine whether the National Institutes of Health Stroke Scale (NIHSS) was valid in patients treated with tissue plasminogen activator (tPA) and to explore the underlying clinimetric structure of the NIHSS.Methods-We performed an exploratory factor analysis of NIHSS data from Part 1 (n=291) of the NINDS tPA Stroke Trial to derive a hypothesized underlying factor structure. We then performed a confirmatory factor analysis of this structure using NIHSS data from Part 2 of the same trial (n=333). We then tested whether this final factor structure could be found in tPA- and placebo-treated patients serially over time after stroke treatment. Using 3-month outcome data, we tested for an association between the NIHSS and other measures of stroke outcome.Results-The exploratory analysis suggested that there were 2 factors underlying the NIHSS, representing left and right brain function, confirming the content validity of the scale. An alternative structure composed of 4 factors could be derived, with a better goodness of fit: the first 2 factors could represent left brain cortical and motor function, respectively, and the second 2 factors could represent right brain cortical and motor function, respectively. The same factor structures were then found in tPA and placebo patient groups studied serially over time, confirming the exploratory analysis. All 3-month clinical outcomes were associated with each other at subsequent time points, confirming predictive validity.Conclusions-This is the first study of the validity of a stroke scale in patients treated with effective stroke therapy. The NIHSS appeared to be valid in patients with acute stroke and for finding treatment-related differences. The scale was valid when used serially over time after stroke, up to 3 months, and showed good agreement with other measures of outcome.