Reliability of a United States Version of the Nottingham Sensory Assessment

Many stroke survivors experience somatosensory deficits and there is currently no “gold standard” reliable standardized assessment commonly used by clinicians in the United States. In the present study, the authors modified the Nottingham Sensory Assessment (NSA) into a U.S. version to provide therapists with a standardized multimodal sensory assessment for use with clients post-stroke. Six licensed rehabilitation practitioners and one occupational therapy student administered the United States-NSA (US-NSA) on 17 older adults with chronic stroke (i.e., at least six months post-stroke) to evaluate its inter-rater reliability. The authors used an intraclass correlation coefficient (ICC) to analyze the inter-rater reliability of the data. The findings indicate strong agreement for all test items, except for the Sharp-Dull Discrimination item when tested on the lower extremity. The US-NSA is a promising sensory impairment assessment available for use by U.S. occupational therapists and other rehabilitation professionals to use in intervention planning, measuring outcomes, and quality of care. RELIABILITY OF THE US-NSA 3 Reliability of a United States Version of the Nottingham Sensory Assessment Somatic sensation enables humans to engage with the world in a safe and meaningful way. It supports a spectrum of skills that underlie participation in numerous areas of occupation, from detecting dangerous levels of heat to knowing where one’s body is in space. Nearly 800,000 Americans suffer a new or recurrent stroke every year (American Heart Association, 2013), and more than half of all stroke survivors experience sensory dysfunction (Carey, 1995). These sensory deficits can dramatically impact a person’s ability to function and live safely and independently. Studies suggest that sensory impairment is both related to motor impairment (Tyson, Hanley, Chillala, Selley, & Tallis, 2008) and predictive of motor recovery after stroke (Feys et al., 2000). There is potential that addressing sensation in the intervention process may improve mobility, motor abilities, and functional independence in stroke survivors. Clinicians working with stroke survivors report that they use sensory assessments on a regular basis and find them important for clinical practice (Doyle, Bennett, Gustafsson, 2013b; Winward, Halligan, & Wade, 1999). Information gained from sensory assessments is important for the entire therapeutic process: diagnosis, prognosis, client and caregiver education, and intervention planning (Winward et al., 1999). It follows that being able to determine the extent and severity of sensory deficits in stroke survivors allows for more informed treatment and may potentially lead to better client outcomes (Winward et al., 1999). The American Occupational Therapy Association (AOTA) (2010) strongly recommends that occupational therapists use appropriate, evidence-based measures during the evaluation and intervention processes as much as possible in order to guide effective clinical decision-making. There are a limited number of standardized sensory measures available, however, and most possess low clinical utility and have not been found to be reliable or valid (Connell & Tyson, 2012). The Nottingham Sensory Assessment (NSA) (Lincoln et al., 1991), originally developed in Europe, is a standardized multimodal sensory assessment that has been revised for use in many countries. Subsequent revisions of the NSA are currently available across Europe (Lincoln, Jackson, & Adams, 1998; Stolk-Hornsveld, Crow, Hendriks, Van Der Baan, & Harmeling-Van Der Wel, 2006) and in Brazil RELIABILITY OF THE US-NSA 4 (Lima et al., 2010). The Erasmus MC modifications to the Nottingham Sensory Assessment (EmNSA) has demonstrated strong clinical utility and high psychometric values compared to other standardized sensory assessments currently available to occupational therapists (Connell & Tyson, 2012). The EmNSA assesses a wide range of sensory modalities, tactile detection and discrimination as well as proprioception, on both the upper and lower limbs (Stolk-Hornsveld et al., 2006). It offers ease of use in a clinical setting because it is fast to administer, requiring between 10 and 15 minutes, and involves inexpensive and readily available testing materials (Stolk-Hornsveld et al., 2006). Stolk-Hornsveld et al. (2006) has found that the inter-rater and intra-rater reliability for the EmNSA ranges from good to excellent across different components of the assessment. Although this assessment was found to have one of the best balances between reliability and clinical utility (Connell & Tyson, 2012), the EmNSA is rarely used by U.S. occupational therapists (Doyle, Bennett, & Gustafsson, 2013b). U.S. clinicians choose to make use of less reliable and less comprehensive assessments (Doyle et al., 2013b), which provides therapists with unreliable information for intervention planning and clinical decision-making. One potential reason for the limited use of the NSA in the United States could be that there are unique differences in language and culture between Europe and the United States. These dissimilarities are significant enough to potentially cause U.S. occupational therapists and patients to misunderstand some of the test items, which may reduce the reliability of the NSA when used in the United States.