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.
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.
Cincura
Carolina
C
Stroke Clinic, Federal University of Bahia, Salvador, Brazil.
Pontes-Neto
Octavio M
OM
Neville
Iuri S
IS
Mendes
Henrique F
HF
Menezes
Daniela F
DF
Mariano
Débora C
DC
Pereira
Issana F
IF
Teixeira
Larissa A
LA
Jesus
Pedro A P
PA
de Queiroz
Danilo C L
DC
Pereira
Davidson F
DF
Pinto
Elen
E
Leite
João P
JP
Lopes
Antonio A
AA
Oliveira-Filho
Jamary
J
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