Spanish Cross-Cultural Adaptation and Validation of the National Institutes of Health Stroke Scale

Domínguez, Raúl; Vila, José F.; Augustovski, Federico; Irazola, Vilma; Castillo, Pablo R.; Escalante, Roberto Rotta; Brott, Thomas G.; Meschia, James F.
April 2006
Mayo Clinic Proceedings;Apr2006, Vol. 81 Issue 4, p476
Academic Journal
OBJECTIVES: To adapt and validate a Spanish-language version (SV) of the National institutes of Health Stroke Scale (NIHSS) to facilitate its use in Spanish-speaking contexts. PATIENTS AND METHODS: The methods recommended by the international Quality of Life Assessment Project were followed Two forward translations and 1 back translation of the NIHSS were developed to ensure lingual and cultural equivalence. A final revised SV-NIHSS was administered by 8 physicians to patients with stroke in 3 clinics in Buenos Aires, Argentina, from September 2003 to December 2003. RESULTS: The study included 102 patients (mean ± SD age, 73.3±6.5 years; 56% women) with stroke (86% ischemic). The SV-NIHSS mean baseline score was 9.78±704 interrater reliability was independently evaluated for 98 patients, showing a high agreement: κ, 0.77 to 0.99 for the 15 items; interrater correlation coefficient, 0.991 (95% confidence interval, 0.987-0.994). intrarater reliability was excellent: κ, 0.86 to 1.00 for the 15 items; mean Intrarater correlation coefficient, 0.994 (95% confidence interval, 0.991-0.996). Construct validity was also adequate; the SV-NIHSS had a negative correlation with baseline Glasgow Coma Scale (Spearman coefficient = -.0574, P < .001) and with Barthel index at 3 months (Spearman coefficient = -0.658, P < 001). Patients with different Rankin scores at 3 months also had significantly different baseline SV-NIHSS scores, from a mean of 4.29 ± 2.21 for Rankin score of 0 to a mean of 2940± 3.97 for Rankin score of 6 (P < .001). CONCLUSION: This study shows that a Spanish-language version of the NIHSS developed with internationally recommended methods is reliable and valid when applied in a Spanish-speaking setting.


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