Assessing reliability and validity of the Chinese version of the stroke scale: Scale development

Background: The National Institutes of Health Stroke Scale (NIHSS) is a systematic, 15-point evaluation tool, designed to assess neurological deficit in acute stroke patients and written in English. It is used to support important medical and nursing decisions. Objectives: To translate the NIHSS into Chinese and establish its psychometric properties using Chinese evaluators. Design: Methodological research design. Setting: One medical centre. Participants: Using convenience sampling, 48 subjects admitted with acute ischemic stroke were selected. Methods: In this study, six clinicians from the Department of Neurology (3 nurses, 3 doctors) assessed the 48 patients using the C-NIHSS, the Glasgow Coma Scale and the Barthel index. Results: The C-NIHSS content validity index reached 1.00, and the Cronbach's α coefficient for internal consistency was 0.92. Of the 15 scale items, two (facial palsy and limb ataxia) had low inter-rater values (k values below 0.39). Kappa (κ) values were substantial (over 0.60) for all other items. The C-NIHSS has a significantly negative correlation with both Glasgow Coma Scale (r=-0.824, p<0.01), and Barthel index (r=-0.683, p<0.01) scores. Conclusions: The C-NIHSS is a reliable and valid scale for the clinical assessment of neurological deficit in acute stroke patients.