Assessing reliability and validity of the Chinese version of the stroke scale: Scale development
Section snippets
‘What is already known about the topic?’
NIHSS is a fast, effective, accurate, and systemic assessment tool for stroke patients, widely used in the English speaking environments to evaluate their treatment, plan hospital care, create rehabilitation programmes, and monitor patient progress.
‘What this paper adds’
The Chinese version of the National Institutes of Health Stroke Scale (C-NIHSS) was found to be reliably and validly used both by Chinese medical personnel to assess the level of neurological deficit in acute stroke patients, and also by researchers to evaluate opportunities for research.
Literature review
Ischemic strokes account for approximately 75% of all strokes (Adams et al., 1996). Because there is no surgical treatment, close and consistent monitoring of the stroke patient is important (Ingram and Sedlak, 2002). In 1983, the US NIH developed the NIHSS as a standardized, easily used, and effective means of assessing neurological deficit in acute stroke patients (Goldstein et al., 1989). It is one of four neurological scales used to measure outcomes of fibrinolytic therapy (Ingram and
Methods
This methodological study developed, then examined the reliability and validity of C-NIHSS. This research was approved by the Institutional Review Board of Chang Gung Memorial Hospital. In all, 48 acute ischemic stroke patients were selected based on availability and/or accessibility (convenience sampling) from admitted patients. Informed consent was obtained from each subject or their next of kin. Medical experts translated the NIHSS into C-NIHSS. We examined the reliability and validity of
Characteristics of subjects
We studied 48 hospitalized ischemic stroke patients in total: 31 men (64.6%) and 17 women (35.4%). Most (36.75%) were aged between 60 and 79 years; 19 had a history of stroke (39.6%); 32 had a history of hypertension (66.7%); 34 smoked (70.8%); 26 had a history of diabetes (54.2%) and 10 a history of heart disease (20.8%). Categorized according to stroke type, 33 patients had atherosclerosis of carotid arteries (68.8%) and 15 atherosclerosis of vertebrobasilar arteries (31.2%). Categorized
Discussion
In support of the rising spirit of scientific quantitation within nursing, we here aimed to develop a Chinese version of an internationally applicable, reliable, and valid C-NIHSS for Taiwan. This scale is for use by neurologists and is expected to be employed by any member of a medical care team caring for acute stroke patients. It becomes the team's common language. In Taiwan, the first step was to translate E-NIHSS into C-NIHSS and ensure consistency. A number of criteria for successful
Conclusions
Through testing the content reliability, criterion-related validity, internal consistency reliability and inter-rater reliability, C-NIHSS was found to be a reliable and valid assessment tool. It can be used clinically by neurology medical personnel to assess the level of neurological deficit for acute stroke patients.
Limitations and recommendations
Ideally, the six raters would have been gathered together to conduct the assessment, and as we were limited by the raters’ schedules, this research was unable to employ random pairing method to the raters for assessing subjects. Furthermore, we were unable to assess subjects within 24 h of stroke onset. Future research can work on group sampling, invite and train raters from related fields, including physical medicine and rehabilitation, emergency, general medicine, and nursing departments. This
Acknowledgements
We wish to thank all the subjects, physicians, and nurses who participated in this study. This research was supported by a grant (CMRPG83041) from Chang Gung Memorial Hospital, Kaohsiung.
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