Spanish cross-cultural adaptation and validation of the National Institutes of Health Stroke Scale.
OBJECTIVE
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.


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+/-7.04. Interrater reliability was Independently evaluated for 98 patients, showing a high agreement: kappa, 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: kappa, 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 = -0.574, 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 29.40+/-3.97 for Rankin score of 6 (P < .001).


CONCLUSIONS
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.
Domínguez
Raúl
R
University of Buenos Aires Hospital Sirio Libanés, Instituto Médico ENERI, Ciudad Autónoma de Buenos Aire, Argentina.
Vila
José F
JF
Augustovski
Federico
F
Irazola
Vilma
V
Castillo
Pablo R
PR
Rotta Escalante
Roberto
R
Brott
Thomas G
TG
Meschia
James F
JF
D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D015203:Reproducibility of Results; D012189:Retrospective Studies; D013030:Spain; D020521:Stroke / Q000145:classification*; D009626:Terminology as Topic; D014177:Translations; D014481:United States