title: Arabic cross cultural adaptation and validation of the National Institutes of Health Stroke Scale.
abstract: BACKGROUND
  The National Institutes of Health Stroke Scale (NIHSS), the most commonly used tool to quantify neurological deficit in acute stroke, was initially developed in English. We present our experience in developing and validating an Arabic version of the NIHSS (arNIHSS).
  
  
  METHODS
  
  
  
  RESULTS
  In 6months, 137 patients were recruited (mean age±standard deviation 62±12years; 48 women). For interrater agreement, weighted kappa value ranged from 0.36 to 0.66 and intraclass correlation coefficient (ICC) for the whole scale was excellent at 0.95 (95% confidence interval [CI] 0.94-0.97). For intrarater agreement, weighted kappa ranged from 0.52 to 1.0 and the ICC was 0.94 (95% CI 0.87-0.98). The construct validity of the arNIHSS is demonstrated by its correlation with the DWI-ASPECT and the 3months mRS score (Spearman correlation -0.46 and 0.58 respectively; P<0.001 for both).
  
  
  CONCLUSIONS
  We developed and validated a culturally adapted Arabic version of the NIHSS. Further validation in other Arab countries is recommended.
authors.affiliation: HealthPartners Clinics and Services Department of Neurosciences, St Paul, MN, United States. Electronic address: Haitham.M.Hussein@healthpartners.com.
authors.forename: Haitham M
authors.initials: HM
authors.lastname: Hussein
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Abdel Moneim
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Tamer
authors.initials: T
authors.lastname: Emara
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Yousry A
authors.initials: YA
authors.lastname: Abd-Elhamid
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Haitham H
authors.initials: HH
authors.lastname: Salem
authors.affiliation: Cairo University, Kasralainy School of Medicine, Neurology Department, Cairo, Egypt.
authors.forename: Foad
authors.initials: F
authors.lastname: Abd-Allah
authors.affiliation: Cairo University, Kasralainy School of Medicine, Neurology Department, Cairo, Egypt.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Farrag
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: M Amir
authors.initials: MA
authors.lastname: Tork
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Shalash
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Khaled H
authors.initials: KH
authors.lastname: Ezz El Dein
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Gamaleldin
authors.initials: G
authors.lastname: Osman
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Shady S
authors.initials: SS
authors.lastname: Georgy
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Ghali
authors.affiliation: Cedars-Sinai Department of Neurology, Los Angeles, CA, United States.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
authors.affiliation: Ain Shams University Department of Neurology, Cairo, Egypt.
authors.forename: Ramez R
authors.initials: RR
authors.lastname: Moustafa
mesh_terms: D000368:Aged; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000208:ethnology; D009316:National Institutes of Health (U.S.) / Q000592:standards*; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology*; D014481:United States / Q000208:ethnology
keywords: Arabic; Cross-cultural; Ischemic stroke; NIHSS; Neurological examination; Stroke scale; Stroke severity; Translation