J Neurol
Neurosurg Psychiatry 2001 Nov;71(5):643-51 The neurobehavioural rating scale-revised:
sensitivity and validity in closed head injury
assessment.
McCauley SR, Levin HS,
Vanier M, Mazaux JM, Boake C, Goldfader PR, Rockers D, Butters M, Kareken
DA, Lambert J, Clifton GL.
Department
of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560
Fannin, Ste 1144, Houston, TX 77030, USA.
OBJECTIVES: To
investigate the factor structure and psychometric properties of the
neurobehavioural rating scale-revised (NRS-R) and to determine its
usefulness in clinical trials. METHODS: A consecutive series of patients
sustaining severe closed head injury were evacuated to one of 11 large
regional North American trauma centres and entered into a randomised,
phase III, multicentre clinical trial investigating the therapeutic use of
moderate hypothermia. Acute care personnel were blinded to outcome and
outcome personnel were blinded to treatment condition. The Glasgow outcome
scale (GOS) was the primary outcome measure. Secondary outcome measures
included the disability rating scale (DRS) and the NRS-R. RESULTS:
Exploratory factor analysis of NRS-R data collected at 6 months after
injury (n=210) resulted in a five factor model including: (1) executive/cognition,
(2) positive symptoms, (3)
negative symptoms, (4) mood/affect, and (5) oral/motor. These factors
showed acceptable internal consistency (0.62 to 0.88), low to moderate
interfactor correlations (0.19 to 0.61), and discriminated well between
GOS defined groups. Factor validity was demonstrated by significant
correlations with specific neuropsychological domains. Significant change
was measured from 3 to 6 months after injury for the total score (sum of
all 29 item ratings) and all factor scores except mood/affect and positive
symptoms. The total score and all factor scores correlated significantly
with concurrent GOS and DRS scores. CONCLUSIONS: The NRS-R is well suited
as a secondary outcome measure for clinical trials as its completion rate
exceeds that of neuropsychological assessment and it provides important
neurobehavioural information complementary to that provided by global
outcome and neuropsychological measures.
|