Translation,Cross-cultural Adaptation And Validation Of The Poststroke Checklist

BackgroundStroke is a leading cause of death and disability worldwide.However,stroke survivors often have unmet needs in terms of follow-up care after discharge.Despite the existence of national stroke guidelines for regulating follow-up care after stroke,there still lacks standardized tools to guide medical staff in providing more consistent post-discharge follow-up care for stroke survivors.To address this issue,the Global Stroke Community Advisory Panel developed the Poststroke checklist(PSC)to help clinicians identify the follow-up needs of stroke survivors,thereafter,providing appropriate treatment and referrals.At present,although the PSC has been endorsed by the World Stroke Organization and many countries around the world,it has yet to be cross-culturally adapted and validated in China.Cognitive interviewing is a key research process when conducting cross-cultural adaptation for research tools.However,there is currently no standardized process for conducting cognitive interviews and researchers have been using a wide variety of analysis methods in their studies.Cognitive interviews have been criticized for being too subjective as the research processes related to the problems are inconsistent and cognitive interviews cannot quantify the problems within the questionnaire.Researchers have suggested that a combination of qualitative and quantitative methods in cognitive interviewing is desirable,but at present,there is no research to confirm the feasibility of this proposal.Objectives1.To translate the PSC into Mandarin and encourage its cross-cultural adaptation.2.To use the Mandarin version of the PSC(MPSC)as an example to verify the Questionnaire appraisal system(QAS-99)’s ability to combine qualitative and quantitative methods in cognitive interviewing and to link the research processes related to "problems".3.To explore the feasibility of MPSC in poststroke follow-up practices in telecare.Methods1.In accordance with the guidelines,the PSC was translated into Mandarin and subsequently reviewed by experts.Between November 2020 and February 2021,a purposive sampling method was used to recruit stroke survivors for cognitive interviews from one tertiary hospital,one secondary hospital,and one community in Guangzhou.In cognitive interviews,the QAS-99 was applied as a codebook to conduct quantitative content analysis to summarize categories and frequencies of problems identified in the MPSC and was also used for item appraisal,probe development,and result analysis.2.In November 2020,stroke survivors were consecutively recruited from a brain specialized hospital in Guangzhou on the discharge date.Follow-up telephone calls were made to these survivors from April to May 2021 using the MPSC.Medical staff were also recruited to act as follow-up clerks.Comments from both the medical staff and survivors on the MPSC were discussed in a focus group discussion and a debriefing meeting,subsequently leading to the revision of MPSC.Results1.A total of 27 stroke survivors participated in cognitive interviews.Each item of the M-PSC was modified at most five times and at least once.The content validity index for each item was 0.83-1.00,with a modified Kappa index of 0.81-1.00 and scalecontent validity indexes all greater than 0.90.The revised MPSC had 11 items,with the 11th item being questioned at the discretion of the medical staff.One item was added to the MPSC and QAS-99 respectively.2.A total of 113 stroke survivors completed follow-up at the sixth month after the stroke,and three were excluded due to missing data.76.4%of stroke survivors reported at least one need for follow-up.The median time to administer the MPSC was 6 minutes 48 seconds.Both patients’ and medical staff’s satisfaction were greater than 8.5/10.Conclusions1.The QAS-99 plays an active role in cognitive interviewing.2.The MPSC can be used as a tool in poststroke follow-up practices in telecare.