title: Production and validation of Putonghua- and Cantonese-Chinese language National Institutes of Health Stroke Scale training and certification videos.
abstract: OBJECTIVE
  The National Institutes of Health Stroke Scale (NIHSS) is an integral part of acute stroke assessment. We report our experience with new Putonghua- and Cantonese-Chinese language NIHSS (PC-NIHSS and CC-NIHSS) training and certification videos.
  
  
  METHODS
  A professional video production company was hired to create the training and certification videos for both PC-NIHSS and CC-NIHSS. Two training and certification workshops were held in Chengdu and Beijing, and two workshops in Hong Kong. The instruction, training and group A certification videos were presented to workshop attendees. Unweighted kappa statistics were used to measure the agreement among raters, and the inter-rater agreements for PC-NIHSS and CC-NIHSS videos were compared with those of original English language NIHSS (E-NIHSS) videos.
  
  
  RESULTS
  The pass rates using PC-NIHSS and CC-NIHSS videos were 79% and 82%, respectively. All possible responses on individual scale items were included. Facial palsy and limb ataxia (13%) showed poor agreement, nine (60%) to 10 (67%) items showed moderate agreement (0.4<kappa<0.75), and three (20%) to four (27%) items showed excellent agreement. When compared with E-NIHSS videos, the agreements on best gaze, visual fields, facial weakness and aphasia were less for PC-NIHSS videos, and the agreements on commands for level of consciousness and visual fields were less for CC-NIHSS videos. Nevertheless, there was no difference between PC-NIHSS or CC-NIHSS and E-NIHSS videos in the agreement on total score.
  
  
  CONCLUSIONS
  Compared with E-NIHSS videos, PC-NIHSS and CC-NIHSS videos show good content validity and inter-rater reliability. Availability of these videos may facilitate the proper use of NIHSS among physicians and nurses in Putonghua- or Cantonese-speaking communities.
authors.affiliation: Department of Medicine (Neurology), and Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong. rtcheung@hkucc.hku.hk
authors.forename: R T F
authors.initials: RT
authors.lastname: Cheung
authors.forename: P D
authors.initials: PD
authors.lastname: Lyden
authors.forename: T H
authors.initials: TH
authors.lastname: Tsoi
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.forename: M
authors.initials: M
authors.lastname: Liu
authors.forename: S F K
authors.initials: SF
authors.lastname: Hon
authors.forename: R
authors.initials: R
authors.lastname: Raman
authors.forename: L
authors.initials: L
authors.lastname: Liu
mesh_terms: D002568:Certification; D002681:China; D006801:Humans; D007802:Language; D009316:National Institutes of Health (U.S.); D020521:Stroke / Q000628:therapy*; D014481:United States; D014743:Videotape Recording / Q000592:standards*
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