OBJECTIVE: To determine the maximum permissible number of missed items on the 10-item Catherine Bergego Scale administered following the Kessler Foundation Neglect Assessment Process (KF-NAP®). Secondary objectives were to determine the frequency, characteristics, and most commonly cited reasons reported for missed items. DESIGN: Retrospective diagnostic accuracy study. SETTING: 16 inpatient rehabilitation facilities in the United States. PARTICIPANTS: A consecutive clinical sample of 4,256 patients with stroke or other neurological deficits who were assessed for spatial neglect with the KF-NAP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Catherine Bergego Scale via KF-NAP. RESULTS: The majority (69.7%) of patients had at least one missed item on their KF-NAP. Among those with missed items, it was most common to have two missed items (51.4%) and few had more than three missed items (11.3%). The most commonly missed items were Collisions (37.2%), Cleaning After Meals (36.1%), Meals (34.0%), and Navigation (19.7%). The most commonly reported reasons for missed items included time constraints, cognitive or communication deficits, and behavior or refusal of the therapy session. These reasons were reported for nearly all item types. Item-specific reasons were also commonly reported, such as a lack of a needed resource for task completion or low functional status of the patient. Prorated scoring of measures with up to three missed items maintained an acceptable level of concordance with complete measures (Lin's Concordance Correlation Coefficientâ¯=â¯0.96, 95% CIâ¯=â¯0.9478-0.9626) for the combination of three missed items with lowest concordance. CONCLUSIONS: Clinicians should make every effort to capture all items on the KF-NAP. However, missed items occur in the majority of cases due to patient factors and barriers inherent to the inpatient hospital setting. When missed items are necessary, clinicians can confidently interpret a prorated score when seven or more items are scored.
The Effect of Missed Items on the Reliability of the Kessler Foundation Neglect Assessment Process