Measuring severe stroke: a scoping review of RCTs

None of these tools are objective. No one is determining the exact location and number of neurons(both gray and white matter) affected. 

I consider the NIHSS subjective stroke scale as worthless.

The first thing needed is an OBJECTIVE DAMAGE DIAGNOSIS. The National Institutes of Health Stroke Scale(NIHSS) is not objective.With no objective damage diagnosis you can't even do any decent research because you don't have a valid starting point for comparison purposes. Do you KNOW ANYTHING ABOUT RESEARCH AT ALL?

Fugl-Meyer Assessment-Upper Extremity may be the gold standard in assessing something, but it is completely subjective so completely useless in validating how well interventions work. With no objective starting point you can't make any research on that repeatable. 

The 20 tasks in the UEFI include: 20 questions on a 5- point rating scale

Measuring severe stroke: a scoping review of RCTs

Katrin Roesner^1,2Hanna Brodowski¹Nicole Strutz^3*

• ¹Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany, Lübeck, Germany
• ²Institute of Health and Nursing Sciences, Medical Faculty of Martin Luther University Halle-Wittenberg, University Medicine Halle, Magdeburger Straße 8, 06112 Halle (Saale), Germany, Halle (Saale), Germany
• ³Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany, Halle (Saale), Germany

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Background: Stroke severity affects length of hospital stay and functional recovery in rehabilitation. Therefore, establishing baseline data of stroke severity is a crucial step. In 2017, neurorehabilitation researchers met at the Stroke Recovery and Rehabilitation Roundtable (SRRR) to build a consensus on new standards for stroke recovery research. Core outcomes for measurement in stroke trials resulted in the recommendation that severe stroke should be assessed using the NIHSS. This scoping review aims to provide an overview of the variety of measurements used in clinical research to assess severe stroke.Methods: RCTs and CCTs were identified by searching PubMed, CENTRAL, SSCI, and ICTRP, covering articles published between January 2018 and September 2024. Peer-reviewed articles in English focusing on rehabilitative interventions and patients aged 18 years or older who have been classified with a severe stroke. The articles included were analyzed according to used measurements and cut-off scores.The initial search yielded 1004 publications, of which 35 (3.6 %) studies were deemed eligible. In total, eleven different measures were used to assess severe stroke. Most studies used the NIHSS (n=14), followed by mRS (n=6), the FMA upper extremity (n=4), the original FMA (n=4) and the (modified) BI (n=3). Seven different cut-off scores for the NIHSS were identified, with the scale being most frequently used in clinical settings. Conclusions: This review indicates substantial variability in measurements and a diverse range of cutoff scores. Consequently, comparability of patients' baseline stroke severity across studies is limited. Given the fact that the NIHSS is only partially used, future efforts should focus on barriers and challenges using the NIHSS.

Keywords: stroke severity, Outcome measure, Cut-off scores, neurological rehabilitation, stroke phase, NIHSS

Received: 19 May 2025; Accepted: 07 Jul 2025.

Copyright: © 2025 Roesner, Brodowski and Strutz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Nicole Strutz, Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany, Halle (Saale), Germany

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.