title: Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing.
abstract: BACKGROUND
  We aimed to validate three widely used scales in stroke research in a multiethnic Brazilian population.
  
  
  METHODS
  The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were translated, culturally adapted and applied by two independent investigators. The mRS was applied with or without a previously validated structured interview. Interobserver agreement (kappa statistics) and intraclass correlation coefficients were calculated.
  
  
  RESULTS
  84 patients underwent mRS (56 with and 28 without a structured interview), 57 BI and 62 NIHSS scoring. Intraclass correlation coefficient was 0.902 for NIHSS and 0.967 for BI. For BI, interobserver agreement was good (kappa = 0.70). For mRS, the structured interview improved interobserver agreement (kappa = 0.34 without a structured interview; 0.75 with a structured interview).
  
  
  CONCLUSIONS
  The NIHSS, BI and mRS show good validity when translated and culturally adapted. Using a structured interview for the mRS improves interobserver concordance rates.
authors.affiliation: Stroke Clinic, Federal University of Bahia, Salvador, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Cincura
authors.forename: Octavio M
authors.initials: OM
authors.lastname: Pontes-Neto
authors.forename: Iuri S
authors.initials: IS
authors.lastname: Neville
authors.forename: Henrique F
authors.initials: HF
authors.lastname: Mendes
authors.forename: Daniela F
authors.initials: DF
authors.lastname: Menezes
authors.forename: Débora C
authors.initials: DC
authors.lastname: Mariano
authors.forename: Issana F
authors.initials: IF
authors.lastname: Pereira
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Teixeira
authors.forename: Pedro A P
authors.initials: PA
authors.lastname: Jesus
authors.forename: Danilo C L
authors.initials: DC
authors.lastname: de Queiroz
authors.forename: Davidson F
authors.initials: DF
authors.lastname: Pereira
authors.forename: Elen
authors.initials: E
authors.lastname: Pinto
authors.forename: João P
authors.initials: JP
authors.lastname: Leite
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Lopes
authors.forename: Jamary
authors.initials: J
authors.lastname: Oliveira-Filho
mesh_terms: D000368:Aged; D001938:Brazil; D003469:Culture; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D007802:Language; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D015588:Observer Variation; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology; D014481:United States