ArticleStroke2025
New Animated Training and Certification Application for NIHSS.
Article in Stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Covert macrovascular disease and early outcome after ischemic cerebrovascular events.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Observational
- Infarction volume modulates and corrects left hemisphere bias in the NIHSS for middle cerebral artery stroke.Frontiers in neuroscience · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundThe National Institutes of Health Stroke Scale is used globally to rate neurological deficits in patients with acute stroke. Originally designed for research use, the scale uses idiosyncratic scoring rules and requires thorough training for proper use. Currently available training and certification systems are timeworn and limited in the range of demonstrated neurological findings. We aimed to develop a new training and certification method to address the limitations of the prior system.
methodsWe describe a new animated system that uses state-of-the-art digital motion capture, avatar rendering, and digital animation that enables illustration of all possible scale item responses within a training module. For certification, we created 20 unique case vignettes, which can be viewed from many angles allowing better scoring scenario presentation. Training to use the scale via telemedicine was added. Alpha and beta testing was completed to enhance iterative development. From a penultimate version, we measured interrater agreement among 42 pilot users who each viewed 6 cases. After further improvement, we finalized the application and confirmed interrater agreement in a second sample of 365 consecutive, unselected users viewing 3 cases. Clinometric analysis methods followed our prior studies of the scale.
resultsUsers agreed the new, animated training module is more engaging and informative than legacy training videos. We compared the new system to the legacy live-video certification system for clinometric reliability. In the confirmatory sample, the intraclass correlation coefficient was 0.979 (97.5% CI, 0.919-0.99). Kappa scores ranged from 0.25 to 0.90 across all 15 scale items. These results are comparable to previous studies.
conclusionsA new, animated training and certification system showed equivalent clinometric properties to legacy systems, providing a reliable method for National Institutes of Health Stroke Scale training and certification. The new system allows modification and reconfiguration if needed to maintain user interest and case novelty.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.