Translation and Validation of the Korean Version Revised Nottingham Sensory Assessment

Abstract

The aim of this study was to translate and validate the revised Nottingham Sensory Assessment(rNSA) in Republic of Korea. A cross-sectional study was conducted to translate the rNSA into Korean using a modified forward/backward translation procedure. Inter-rater and intra-rater reliability, internal consistency, and concurrent validity were investigated to validate the Korean version rNSA. The Korean version rNSA showed excellent inter-rater reliability (r=0.92-1.00) and intra-rater reliability (r=0.93-1.00). Significant correlations were found between sensory assessment results of the Korean version of the rNSA and the Korean Fugl Meyer Assessment Sensory subscales (r=0.96). The Cronbach ɑ value of internal consistency of Korean version rNSA was ranged from 0.73 to 0.90, the value of K-FMA-S was ranged from 0.70 to 0.88. In these results, psychometric properties of the Korean version of the rNSA achieved the standard level and can be feasible in clinical practice to assess sensory function following stroke in Republic of Korea. ■ keyword :∣Rehabilitation∣Sensory Assessment∣Translation∣Validation∣Stroke∣ 접수일자 : 2020년 06월 16일 수정일자 : 2020년 07월 13일 심사완료일 : 2020년 07월 14일 교신저자 : 이상헌, e-mail : sangheon@sch.ac.kr 한국콘텐츠학회논문지 '20 Vol. 20 No. 9 512 from detecting dangerous levels of heat to knowing where one’s body is in space[1]. Somatosensory deficits are a common symptom after stroke occurring in about 50–80% of stroke survivors[2]. These sensory deficits can dramatically impact a person’s ability to function and live safely and independently[3]. Studies suggest that sensory impairment is related to motor impairment after stroke[4]. In addition, Lima et al. found that somatosensory impairments induced by stroke affected activities of daily living[5]. Many stroke survivors experience somatosensory deficits in the Republic of Korea and there is currently no “gold standard” reliable standardized assessment commonly used by clinicians. Clinicians working with stroke survivors report that they use sensory assessments on a regular basis and find them important for clinical practice[6]. Information gained from sensory assessments is important for the entire therapeutic process: diagnosis, prognosis, client and caregiver education, and intervention planning[7]. Sensory impairment can occur in both left and right hemispheric patients due to stroke[8]. It follows that being able to determine the extent and severity of sensory deficits in stroke survivors allows for more informed treatment and may potentially lead to better client outcomes. The American Occupational Therapy Association (AOTA) strongly recommends that occupational therapists use appropriate, evidence-based measures during the evaluation and intervention processes as much as possible in order to guide effective clinical decision-making. However, there are a limited number of standardized sensory measures available, and most possess low clinical utility and have not been found to be reliable or valid[9]. Standardized assessment tools for testing somatosensory function in stroke patients include the Rivermead Assessment of Somatosensory Performance, the Hand Active Sensation Test, Fugl Meyer Assessment Sensory subscales (FMA-S) and the revised Nottingham Sensory Assessment (rNSA)[10]. The Rivermead Assessment of Somatosensory Performance has good inter-rater and intra-rater reliability in hemiplegia patients; however, its main disadvantage is the need for expensive commercial equipment. The Hand Active Sensation Test, a measure of haptic performance of hand, evaluates the sense of weight and texture of objects in hemiplegia patients and has strong test-retest reliability, but it does not evaluate sense of temperature or stereognosis of the hand[8][11]. The FMA-S have high inter-rater reliability and internal consistency in proprioception, and light touch of the upper and lower extremities. Also, The validity and responsiveness of the FMA-S have been established at different post-stroke stages of recovery. but reliability of light touch items are minimal to moderate[12]. The NSA is an established standardized multimodal assessment used with patients post-stroke in other countries[13]. The NSA was first developed in the U.K. In 1991 as a comprehensive sensory evaluation tool, and includes the following test items: Light Touch, Temperature, Pinprick, Pressure, Tactile Localization, Bilateral Simultaneous Touch, Stereognosis, Proprioception, and Two-Point Discrimination. Unfortunately, using Cohen’s kappa (K) coefficients, the assessment was found to have a wide range of inter-rater reliability (K = .01 to K = .89)[5]. After 1998, test 한국판 수정된 노팅엄 감각평가의 신뢰도 타당도 연구 513 items were revised and the scale was shortened by reducing testing of the unaffected limb to light touch, temperature, and kinesthetic sensation only[6]. A hierarchy of items was identified so that testing could be terminated if no impairments were detected in the distal portion of the limb. One of significant advantages of rNSA over other sensory assessment tools is that only inexpensive equipments are required and the assessment includes both the upper and lower extremities. The rNSA has not been used in the Republic of Korea. One possible reason for the nonuse of the rNSA in the Republic of Korea could be that there are unique differences in language and culture between U.K. and the Republic of Korea. These facts are significant enough to potentially cause Korean occupational therapists and patients to misunderstand some of the test items, which may reduce the reliability and validity of the rNSA when used in the Republic of Korea. The purpose of the current study was to translate the rNSA into Korean with cultural adaptation and to validate its reliability and validity in hemiparetic patients after stroke. II. Materials and Methods