Assessing reliability and validity of the Chinese version of the stroke scale: Scale development

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Abstract

Background: The National Institutes of Health Stroke Scale (NIHSS) is a systematic, 15-point evaluation tool, designed to assess neurological deficit in acute stroke patients and written in English. It is used to support important medical and nursing decisions.

Objectives: To translate the NIHSS into Chinese and establish its psychometric properties using Chinese evaluators.

Design: Methodological research design.

Setting: One medical centre.

Participants: Using convenience sampling, 48 subjects admitted with acute ischemic stroke were selected.

Methods: In this study, six clinicians from the Department of Neurology (3 nurses, 3 doctors) assessed the 48 patients using the C-NIHSS, the Glasgow Coma Scale and the Barthel index.

Results: The C-NIHSS content validity index reached 1.00, and the Cronbach's α coefficient for internal consistency was 0.92. Of the 15 scale items, two (facial palsy and limb ataxia) had low inter-rater values (k values below 0.39). Kappa (κ) values were substantial (over 0.60) for all other items. The C-NIHSS has a significantly negative correlation with both Glasgow Coma Scale (r=-0.824, p<0.01), and Barthel index (r=-0.683, p<0.01) scores.

Conclusions: The C-NIHSS is a reliable and valid scale for the clinical assessment of neurological deficit in acute stroke patients.

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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