- •A culturally adapted Arabic version of the NIHSS is developed: arNIHSS.
- •arNIHSS has similar psychometric characteristics to the original NIHSS.
- •arNIHSS was validated in 2 academic institutions in Egypt.
- •Further validation in other Arab countries is recommended.
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).
- A)Scale development phase: 6 bilingual neurologists translated the scale to Arabic. Items 9 and 10 were modified to suit the Arabic language and culture. A panel of 11 Arab neurologists reviewed the final product and an Arabic language expert did final editing.
- B)Scale validation phase: 10 examiners (four neurology residents and six nurses), who had no experience with the NIHSS, were trained to use the arNIHSS. Patients with acute stroke were recruited at two academic institutions in Egypt. Each patient was examined on admission by 3 examiners using the arNIHSS and at 24 hours by one of the three examiners. The agreement between the first three examinations was used to calculate the interrater agreement. The agreement between the admission and the 24-hour arNIHSS performed by the same examiner was used to calculate the intrarater agreement. Construct validity was evaluated by correlating the arNIHSS on admission with the infarct volume on initial the diffusion weighted imaging (DWI) using the Alberta Stroke Program Early CT score (DWI-ASPECTS) and the functional outcome at 3 months assessed by the modified Rankin Scale (mRS).
In 6 months, 137 patients were recruited (mean age ± standard deviation 62 ± 12 years; 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 3 months mRS score (Spearman correlation −0.46 and 0.58 respectively; P < 0.001 for both).
We developed and validated a culturally adapted Arabic version of the NIHSS. Further validation in other Arab countries is recommended.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the Neurological Sciences
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Measurements of acute cerebral infarction: a clinical examination scale.Stroke. 1989; 20: 864-870
- A critical appraisal of stroke evaluation and rating scales.Stroke. 1991; 22: 1345-1352
- Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.N. Engl. J. Med. 1995; 333: 1581-1587
- Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group.Stroke. 1994; 25: 2220-2226
- Recommendations for the establishment of primary stroke centers. Brain Attack Coalition.JAMA. 2000; 283: 3102-3109
- Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality.Stroke. 2011; 42: 2403-2409
- Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 870-947
- Production and validation of Putonghua– and Cantonese–Chinese language National Institutes of Health Stroke Scale training and certification videos.Int. J. Stroke. 2010; 5: 74-79
- 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.Cerebrovasc. Dis. 2009; 27: 119-122
- Spanish cross-cultural adaptation and validation of the National Institutes of Health Stroke Scale.Mayo Clin. Proc. 2006; 81: 476-480
- Establishment of the Thai version of National Institute of Health Stroke Scale (NIHSS) and a validation study.J. Med. Assoc. Thai. 2010; 93: S171-S178
- Validity and reliability of a Korean version of the National Institutes of Health Stroke Scale.J. Clin. Neurol. 2012; 8: 177-183
- Development of the Italian version of the National Institutes of Health Stroke Scale: It-NIHSS.Stroke. 2009; 40: 2557-2559
- Validation of the Hindi version of National Institute of Health Stroke Scale.Neurol. India. 2012; 60: 40-44
- 2015 (http://www.ethnologue.com/statistics/size. Accessed November 2014 [online]) 17th.
- The neurology map of the Arab world.J. Neurol. Sci. 2009; 285: 10-12
- Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment.J. Clin. Epidemiol. 1998; 51: 913-923
- Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment.J. Clin. Epidemiol. 1998; 51: 953-959
- Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.J. Neurol. Neurosurg. Psychiatry. 2005; 76: 1528-1533
- Can DWI-ASPECTS substitute for lesion volume in acute stroke?.Stroke. 2013; 44: 3565-3567
- Recovery of motor function after stroke.Stroke. 1988; 19: 1497-1500
- Comparison of telephone and face-to-face assessment of the modified Rankin Scale.Cerebrovasc. Dis. 2010; 29: 137-139
- NIHSS training and certification using a new digital video disk is reliable.Stroke. 2005; 36: 2446-2449
- The modified National Institutes of Health Stroke Scale: its time has come.Int. J. Stroke. 2009; 4: 267-273
Published online: July 15, 2015
Accepted: July 10, 2015
Received in revised form: June 20, 2015
Received: March 5, 2015
☆Funding source: None.
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.