Stroke outcome assessment: optimizing cutoff scores for the Longshi Scale, modified Rankin Scale and Barthel Index

PONE-D-21-04938

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Reviewer #2: Yes

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Reviewer #1: With great pleasure and interest I have reviewed the titled work “Stroke outcome assessment: optimizing cutoff scores for the Longshi Scale, modified Rankin Scale and Barthel Index” of the authors Zhou M et al.

The Longshi Scale, a visual-based scale, is reliable and valid in activity ssessment.

Authors aimed to investigate the relationships of the Longshi Scale with the modified Rankin Scale and Barthel Index and optimize cutoff scores of these scales in stroke outcomes assessment.

With a large sample of patients and with an adequate statistical analysis, the authors specify these cutoffs transversely.

This is an important study. In the real world, many healthcare professionals are unfamiliar with the modified Rankin scale or the Barthel index. Furthermore, many patients cannot be scored due to inconsistencies in the definition of the categories for each of these scales. The Longshi visual scale could provide this information and / or complement the others.

The only observation would be the poor definition of figure 1. No more comments.

Reviewer #2: I appreciate the opportunity to read by first-hand the article submitted by Dr. Zhou and colleagues. I would like to highlight the interest in improving the quality of the neurological and disability evaluation of patients after a stroke. Is known to all, that the wide variety of sequelae and levels of disability that these patients develop makes it complicated to objectify the degree of functionality. Considering the above, the reliability of widely used scales such as the modified Rankin scale (mRS) has been raised (Cerebrovasc Dis. 2010 Jan; 29 (2): 188-93). The effort to develop a larger scale, validate it and compare it to demonstrate its usefulness is valuable. This article seeks to define the relationship between the mRS scale and the Barthel index (BI) with the Longshi Scale. Previously, other authors (J Int Med Res. 2020; 48 (7)) have shown a good correlation of LS with BI, but not with mRS.

As part of the review, I have no further observations to make to the abstract or introduction. In the method segment, patients with aphasia or who do not cooperate with the evaluation are specified as exclusion criteria, this could translate into a selection bias by leaving out usual scenarios for the application of the scales. The large number of bedridden patients classified within low mRS levels stands out, which is why the correction made by the authors is very appropriate, which in turn translates into more appropriate results for the purpose of the publication.

Regarding the results and discussion, I believe they are adequately informed and supported. In the same way, the authors manage to define their objective with a good statistical basis, to establish a cut-off for what would be a good outcome after a stroke.

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Reviewer #1: No

Reviewer #2: Yes: Alvaro Hernández-Guillén