Stroke Outcome Measures Overview

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Type	Name	Approx time to administer	Strengths	Weaknesses
Level of consciousness	Glasgow Coma Scale	2 minutes	Simple, valid, reliable.	None observed.
Stroke deficit scales	NIH Stroke Scale	2 minutes	Brief, reliable, can be administered by non-neurologists.	Low sensitivity.
	Canadian Neurological Scale	5 minutes	Brief, valid, reliable.
Global disability scale	Rankin Scale	5 minutes	Good for overall assessment of disability.	Walking is the only explicit assessment criterion. Low sensitivity.
Measures of disability/activities of daily living (ADL)	Barthel Index	5-10 minutes	Widely used for stroke. Excellent validity and reliability.	Low sensitivity for high-level functioning.
	Functional Independence Measure (FIM)	40 minutes	Widely used for stroke.	Measures mobility, ADL, cognition, functional communication.	“Ceiling” and “floor” effects.
Mental status screening	Folstein Mini-Mental State Examination	10 minutes	Widely used for screening.	Several functions with summed score. May misclassify patients with aphasia.
	Neurobehavioral Cognition Status Exam (NCSE)	10 minutes	Predicts gain in Barthel Index scores. Unrelated to age.	Does not distinguish right from left hemisphere. No reliability studies in stroke. No studies of factorial structure. Correlates with education.
Assessment of motor function	Fugl-Meyer	30-40 minutes Extensively evaluated measure.	Good validity and reliability for assessing sensorimotor function and balance.	Considered too complex and time-consuming by many.
	Motor Assessment Scale	15 minutes	Good, brief assessment of movement and physical mobility.	Reliability assessed only in stable patients. Sensitivity not tested.
	Motricity Index	5 minutes	Brief assessment of motor function of arm, leg, and trunk.	Sensitivity not tested.
Balance assessment	Berg Balance Assessment	10 minutes	Simple, well established with stroke patients, sensitive to change.	None observed.
	Rivermead Mobility Index	5 minutes	Valid, brief, reliable test of physical mobility.	Sensitivity not tested.
Assessment of speech and language functions	Boston Diagnostic & Aphasia Examination	1-4 hours	Widely used, comprehensive, good standardisation data, sound theoretical rationale.	Time to administer long; half of patients cannot be classified.
	Porch Index of Communicative Ability (PICA)	1/2-2 hours	Widely used, comprehensive, careful test development and standardisation.	Time to administer long. Special training required to administer. Inadequate sampling of language other than one word and single sentences.
	Western Aphasia Battery	1-4 hours	Widely used, comprehensive.	Time to administer long. “Aphasia quotients” and “taxonomy” of aphasia not well validated.
Depression scales	Beck Depression Inventory (BDI)	10 minutes	Widely used, easily administered. Norms available. Good with somatic symptoms.	Less useful in elderly and in patients with aphasia or neglect.High rate of false positives. Somatic items may not be due to depression.
	Center for Epidemiologic Studies Depression (CES-D)	< 15 minutes	Brief, easily administered, useful in elderly, effective for screening in stroke population.	Not appropriate for aphasic patients.
	Geriatric Depression Scale (GDS)	10 minutes	Brief, easy to use with elderly, cognitively impaired, and those with visual or physical problems or low motivation.	High false negative rates in minor depression.

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