European journal of physical and rehabilitation medicine · 2026
Psychometric validation of domain-specific scores of the Oxford Cognitive Screen in patients with stroke.
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Iosa Marco, Morone Giovanni, Ciancarelli Irene, Demeyere Nele, Mancuso Mauro, Cogniremo Study Group
Аннотация
BACKGROUND: The Oxford Cognitive Screen (OCS) is a widely used tool for screening cognitive deficits in patients with stroke. It consists of 10 tests (yielding a total of 14 scores because two of the tests each generate three separate scores), covering six cognitive domains. However, using the OCS as an outcome measure requires standardized composite scores for each cognitive domain.
AIM: The aim of this study is to psychometrically validate domain-specific composite scores derived from the OCS that are usable as outcome measures.
DESIGN: Multicenter observational study.
SETTING: Inpatient and outpatient Rehabilitation Units.
POPULATION: Data from 1973 patients with stroke and those of 498 healthy participants were considered.
METHODS: We developed formulas for combining the 14 test scores and computing a percentage score for each one of the six domains covered by the OCS (Executive functions, Language and arithmetic, Memory, Orientation, Visuomotor control, Spatial exploration). The discriminant and convergent validity of the proposed scores were tested by comparing data from patients with stroke and those of healthy participants, and by correlating these scores with those of the relevant domains of other clinical scales (NIH-Stroke Severity scale and Functional Independence Measure, FIM), respectively. Cronbach's alpha was used to test the reliability of these scores. The sensitivity to change was assessed by comparing the scores before and after rehabilitation in a subgroup of 311 patients and computing Cohen's d as the effect size.
RESULTS: All six scores were significantly lower in patients (79.5±17.2%) than in healthy subjects (96.1±4.6%, P<0.001). All of them were significantly correlated with the relevant scores of other scales (r>0.59, P<0.001), with the exception of the score related to executive functions. The mean of these OCS scores significantly improved after rehabilitation (pre: 74.4±17.8% vs. post: 80.6±14.7%, P<0.001, Cohen's d=0.534).
CONCLUSIONS: The differences between patients and healthy subjects support the discriminant validity, whereas the correlations with other scale scores support the convergent validity. The latter was not significant only for the proposed score for executive functions, likely because it is the only score without a comparator based exactly on the same construct, but rather on a subdomain of it (FIM problem solving). Good reliability and sensitivity to change were also demonstrated.
CLINICAL REHABILITATION IMPACT: Our results showed that the developed percentage composite scores are valid and may be useful for clinical staff already using the OCS to also use it as an outcome score for assessing cognitive domain deficits.
AIM: The aim of this study is to psychometrically validate domain-specific composite scores derived from the OCS that are usable as outcome measures.
DESIGN: Multicenter observational study.
SETTING: Inpatient and outpatient Rehabilitation Units.
POPULATION: Data from 1973 patients with stroke and those of 498 healthy participants were considered.
METHODS: We developed formulas for combining the 14 test scores and computing a percentage score for each one of the six domains covered by the OCS (Executive functions, Language and arithmetic, Memory, Orientation, Visuomotor control, Spatial exploration). The discriminant and convergent validity of the proposed scores were tested by comparing data from patients with stroke and those of healthy participants, and by correlating these scores with those of the relevant domains of other clinical scales (NIH-Stroke Severity scale and Functional Independence Measure, FIM), respectively. Cronbach's alpha was used to test the reliability of these scores. The sensitivity to change was assessed by comparing the scores before and after rehabilitation in a subgroup of 311 patients and computing Cohen's d as the effect size.
RESULTS: All six scores were significantly lower in patients (79.5±17.2%) than in healthy subjects (96.1±4.6%, P<0.001). All of them were significantly correlated with the relevant scores of other scales (r>0.59, P<0.001), with the exception of the score related to executive functions. The mean of these OCS scores significantly improved after rehabilitation (pre: 74.4±17.8% vs. post: 80.6±14.7%, P<0.001, Cohen's d=0.534).
CONCLUSIONS: The differences between patients and healthy subjects support the discriminant validity, whereas the correlations with other scale scores support the convergent validity. The latter was not significant only for the proposed score for executive functions, likely because it is the only score without a comparator based exactly on the same construct, but rather on a subdomain of it (FIM problem solving). Good reliability and sensitivity to change were also demonstrated.
CLINICAL REHABILITATION IMPACT: Our results showed that the developed percentage composite scores are valid and may be useful for clinical staff already using the OCS to also use it as an outcome score for assessing cognitive domain deficits.