Original research| Volume 96, ISSUE 8, P1385-1396, August 2015

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Validity of the Neuromuscular Recovery Scale: A Measurement Model Approach

Published:April 22, 2015DOI:



      To determine how well the Neuromuscular Recovery Scale (NRS) items fit the Rasch, 1-parameter, partial-credit measurement model.


      Confirmatory factor analysis (CFA) and principal components analysis (PCA) of residuals were used to determine dimensionality. The Rasch, 1-parameter, partial-credit rating scale model was used to determine rating scale structure, person/item fit, point-measure item correlations, item discrimination, and measurement precision.


      Seven NeuroRecovery Network clinical sites.


      Outpatients (N=188) with spinal cord injury.


      Not applicable.

      Main Outcome Measure



      While the NRS met 1 of 3 CFA criteria, the PCA revealed that the Rasch measurement dimension explained 76.9% of the variance. Ten of 11 items and 91% of the patients fit the Rasch model, with 9 of 11 items showing high discrimination. Sixty-nine percent of the ratings met criteria. The items showed a logical item-difficulty order, with Stand retraining as the easiest item and Walking as the most challenging item. The NRS showed no ceiling or floor effects and separated the sample into almost 5 statistically distinct strata; individuals with an American Spinal Injury Association Impairment Scale (AIS) D classification showed the most ability, and those with an AIS A classification showed the least ability. Items not meeting the rating scale criteria appear to be related to the low frequency counts.


      The NRS met many of the Rasch model criteria for construct validity.


      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), CFA (confirmatory factor analysis), NRN (NeuroRecovery Network), NRS (Neuromuscular Recovery Scale), PCA (principal components analysis), SCI (spinal cord injury)
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      Linked Article

      • Interrater Reliability of the Neuromuscular Recovery Scale for Spinal Cord Injury
        Archives of Physical Medicine and RehabilitationVol. 96Issue 8
        • Preview
          To determine the interrater reliability of the Neuromuscular Recovery Scale (NRS), an outcome measure designed to classify people with complete or incomplete spinal cord injury (SCI) into 4 phase-of-injury groups by assessing motor performance based on normal preinjury function and disallowing use of compensation for 4 treadmill-based items and 6 overground/mat items.
        • Full-Text
        • PDF
      • Test-Retest Reliability of the Neuromuscular Recovery Scale
        Archives of Physical Medicine and RehabilitationVol. 96Issue 8
        • Preview
          To determine the test-retest reliability of the Neuromuscular Recovery Scale (NRS), a measure to classify lower extremity and trunk recovery of individuals with spinal cord injury (SCI) to typical preinjury performance of functional tasks without use of external and behavioral compensation.
        • Full-Text
        • PDF