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). Conclusion: The NIHSS, BI and mRS show good validity when translated and culturally adapted. Using a structured interview for the mRS improves interobserver concordance rates.

Keywords:
Stroke, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index, Stroke trials, Brazil
1.
Mansur AP, de Souza MFM, Favarato D, Avakian SD, Machado CLA, Aldrigui JM, Franchini RJA: Stroke and ischemic heart disease mortality trends in Brazil from 1979 to 1996. Neuroepidemiology 2003;22:179–183.
2.
Cabral NL, Moro C, Silva GR, Scola RH, Werneck LC: Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil. Arq Neuropsiquiatr 2003;61:188–193.
3.
Sociedade Brasileira de Doencas Cerebrovasculares (SBDCV): Brazilian consensus for thrombolysis in acute ischemic stroke. Arq Neuropsiquiatr 2002;60:675–680.
4.
de Caneda MA, Fernandes JG, de Almeida AG, Mugnol FE: Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral. Arq Neuropsiquiatr 2006;64:690–697.
5.
Brott T, Adams HP Jr, Olinger CP, et al: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870.
6.
Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989;42:703–709.
7.
Wilson JT, Hareendran A, Hendry A, Potter J, Bone I, Muir KW: Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke 2005;36:777–781.
8.
Quinn TJ, Lees KR, Hardemark HG, Dawson J, Walters MR: Initial experience of a digital training resource for modified Rankin scale assessment in clinical trials. Stroke 2007;38:2257–2261.
9.
Josephson SA, Hills NK, Johnston SC: NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis 2006;22:389–395.
10.
Lyden PD, Lu M, Levine SR, Brott TG, Broderick J, NINDS rtPA Stroke Study Group: A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminary reliability and validity. Stroke 2001;32:1310–1317.
© 2008 S. Karger AG, Basel
2008
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