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The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment
  1. S R McCauleya,
  2. H S Levina,b,c,
  3. M Vanierd,
  4. J-M Mazauxe,
  5. C Boakef,
  6. P R Goldfaderh,
  7. D Rockersi,
  8. M Buttersk,
  9. D A Karekenj,
  10. J Lambertl,
  11. G L Cliftong
  1. aDepartment of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560 Fannin, Ste 1144, Houston, TX 77030, USA, bDepartment of Neurosurgery, cDepartment of Psychiatry, dEcole de Réadaptation, Université de Montréal, Montréal, Canada, eCentre Hospitalier Universitaire de Bordeaux, Bordeaux, France, fDepartment of Physical Medicine and Rehabilitation, The University of Texas Health Science Center, Houston, USA, gDepartment of Neurosurgery, hDepartments of Neurology and Neurosurgery, St Louis University School of Medicine, St Louis, USA, iDepartment of Neurological Surgery, University of California, Davis, Sacramento, USA, jDepartment of Neurology, Indiana University School of Medicine, Indianapolis, USA, kWestern Psychiatric Institute and Clinic, University of Pittsburgh Medical College, Pittsburgh, USA, lDepartment de Médecine Sociale et Preventive, Université de Montréal, Montréal, Canada
  1. Dr H S Levin hlevin{at}bcm.tmc.edu

Abstract

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.

  • outcome measures
  • head injury
  • randomised clinical trials
  • neurobehavioural sequelae

https://doi.org/10.1136/jnnp.71.5.643

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