Date Presented 4/8/2016
We studied the American version of the Nottingham Sensory Assessment and found strong concurrent validity with the Fugl–Meyer Assessment Sensory scale and moderate relationships with functional use of the upper extremity. This assessment will be useful for clinicians working with stroke survivors.
Primary Author and Speaker: Sue Doyle
Additional Authors and Speakers: Domonique Herrin, Alina Muller
RESEARCH QUESTION: The purpose of this study was to evaluate the concurrent validity of the U.S. version of the Nottingham Sensory Assessment (US–NSA) in persons with chronic stroke.
RATIONALE: Currently, the most frequently used assessment of sensation after stroke is unstandardized and has poor reliability (Doyle, Bennett, & Gustafsson, 2013). The Nottingham Sensory Assessment (NSA) was developed in Europe and is a multimodal sensory assessment with strong parametric properties and good clinical utility and is recommended for use after stroke. The NSA has been modified for use in the United States but further testing to demonstrate the validity of this revised measure is needed.
DESIGN: We recruited a convenience sample of 12 adults with chronic stroke from a pro bono outpatient clinic.
METHOD: The US–NSA consists of five sensory modalities that are tested in four locations in both upper and lower limbs and scored on a 3-point ordinal scale. There is also a six-item stereognosis subscale. Total score possible for each side of the body is 92, with higher scores indicating less impairment. The Fugl-Meyer Assessment Sensory subscale (FMA–S) consists of six items for each of the upper and lower limbs that are scored on a similar 3-point ordinal scale for a total possible score of 24 points. The Chedoke Arm Hand Activity Inventory (CAHAI 9) is a nine-item measure that assesses functional recovery of the arm and hand using a 7-point quantitative scale for a possible total score of 63 points. Participants were evaluated on all measures within a 3-wk time period over two sessions.
ANALYSIS: The concurrent validity of the US–NSA was evaluated using Pearson’s product–moment correlation with the FMA–S. The relationship between functional use of the upper limb (CAHAI) and sensory abilities (US–NSA and FMA-S) after stroke was also evaluated using Pearson’s product–moment correlation. Significance level was chosen to be .05, and the correlation strengths were interpreted as follows: .90–1.00, very high; .70–.90, high; .50–.70, moderate; .30–.50, low; and .00–.30, little if any correlation (Hinkle, Wiersma, & Jurs, 1998).
RESULTS: Results indicated very high concurrent validity between the US–NSA and the FMA–S (r = .911). Moderate relationships between upper-extremity sensory (US–NSA UE (r = .676) and FMA–S (r = .577) and functional hand and arm use (CAHAI) were found.
DISCUSSION: This study supports the validity of the US–NSA. Although further studies with larger sample sizes and higher power are warranted to evaluate the parametric properties of the US–NSA, based on the current results, and previous studies on prior versions of the NSA, therapists could use the US–NSA in clinical practice.
IMPACT STATEMENT: Using a reliable and valid measure of sensory impairments will provide practitioners with accurate data on which to plan intervention strategies. The US–NSA demonstrates potential to be a measure with good parametric characteristics and clinical utility for use with clients after stroke.
References
Doyle, S. D., Bennett, S., & Gustafsson, L. G. (2013). Occupational therapy for upper limb post-stroke sensory impairments: A survey. British Journal of Occupational Therapy, 76, 434–442. http://dx.doi.org/10.4276/030802213X13807217284143
Hinkle, D. E., Wiersma, W., & Jurs, S. G. (1998). Applied statistics for the behavioural sciences (4th ed.). Boston: Houghton Mifflin.
