ISS Commentary

The Indian Stroke Scale: Commentary by Dr Nilima Patel

In India, 60%-70% of stroke survivors suffer moderate to severe disability due to dependence in carrying out daily activities. Measuring post-stroke disability and stroke rehabilitation outcomes is essential to monitor and evaluate the effectiveness of stroke rehabilitation services targeted at reducing burden of stroke-related disability. However, one of the major challenges in measuring patient outcomes is lack of culturally appropriate patient reported outcome measure. This problem is typically addressed by translating an existing outcome measure originated from western cultural contexts into Indian languages. Those who attempted to use translated outcome measures within Indian context will agree with me that such measures are inadequate in representing what matters to patients with stroke in India.

The Indian Stroke Scale (ISS) was developed specifically to address the problems of limited content validity of the commonly used stroke functional outcome measures in Indian context. The ISS was rigorously developed and validated using gold-standard psychometric methods. The ISS was developed through a systematic process of literature reviews, content-expert review, qualitative research, pilot testing, and psychometric testing among more than 300 patients. I have had the opportunity to review entire work on development of Indian Stroke Scale as a PhD thesis reviewer. Certainly, one of the well-conceived and executed research work I have reviewed so far. I congratulate Dr Prakash for developing and validating this scale and making it freely available for use in three Indian languages. I encourage Indian clinicians, researchers and students working in the field of stroke rehabilitation to use the Indian Stroke Scale and contribute to its further development.