Article

PURPOSE: To examine the construct validity and inter-rater reliability of the
Neurological Impairment Scale (NIS) and compare ratings by medical and
multidisciplinary teams in a mixed neurorehabilitation sample. To assess its
concurrent and predictive validity as a predictor of outcome and functional gains
during inpatient rehabilitation.
The NIS was rated in a consecutive
cohort of patients (n = 428) recruited from nine specialist neurorehabilitation
units in London. Dimensionality and internal consistency were explored through
principal components analysis with Varimax rotation. Inter-rater reliability and
the relationship between NIS and functional outcome (UK Functional Assessment
Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre.
RESULTS: Factor analysis identified two principal domains ("Physical" and
"Cognitive") together accounting for 35% of the variance: their Cronbach's alpha
values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent
for overall scores between doctors (ICC = 0.95 (95% CI = 0.91-0.97)) and
acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI =
0.88-0.95)). Change in NIS-physical score predicted 29% of the variance in
functional gain (FIM + FAM change). CONCLUSION: These findings provide the first
formal evidence for the validity and reliability of the NIS as a measure of
neurological impairment for use in general neuro-rehabilitation settings. Its
further application and exploration are now warranted. IMPLICATIONS FOR
REHABILITATION: The extent of neurological recovery occurring during
rehabilitation can make an important contribution to functional gains. In order
to interpret measurement of functional outcome, we need to be able to identify
changes at the level of impairment. Many of the available tools to measure
severity of impairment are condition specific. The Neurological Impairment Scale
(NIS) was developed for use across a broad range of disabling conditions
alongside the UK FIM+FAM. This first formal examination of its psychometric
properties provides evidence for its scalability, reliability and validity. The
NIS has potential to provide useful information for case-mix adjustment and as a
predictor of functional gain in general neurorehabilitation settings.

Langue : ANGLAIS