Abstract
Introduction: Stroke contributes 87% of Disability-adjusted life years(DALYs) in low, middle-income countries. Patient-Reported Outcome Measures (PROMs) involve tools capturing patient perspectives on stroke's impact. The Barthel Index (BI), is widely used for predicting clinical outcomes, and non-standardized translations may cause disparities. A validated toolkit ensures clinical equivalence in translation. Methodology: A two-phase study translated and validated the BI in Hindi. Forward-backward translation and pre-testing involved a Hindi-speaking healthcare professional. Only confirmed stroke patients without concurrent spinal injury were included. Results: 127 patients from AIIMS Bhopal participated, averaging 55.26 years (σ=14.13), with 70.08% males and 29.92% females. Various stroke types were observed:1.57% had a hemorrhagic ischemic stroke, 10.24% had a hemorrhagic stroke, 86.61% had an ischemic stroke, and 1.57% had a thromboembolic stroke. Exploratory factor analysis unveiled a 3-factor model, reflecting mobility (Factor 1), self-care (Factor 2), and bowel/bladder control (Factor 3). Cronbach's alpha values indicated good internal consistency for Factor 1 (α = 0.889) and acceptable for Factor 2 (α = 0.774). Difficulty Index was highest for bathing, while the transfer was easier. All items were easily discriminated against. (Discrimination Index>0.28) Discussion: BI-H exhibited validity and reliability in stroke patients, aligning with cultural aspects. Stroke-specific recommendations include subscales excluding bowel/bladder functions and two additional subscales for Factors 1 and 2. Cultural differences impact task difficulty, especially 'bathing', and 'eating' while 'toileting' needs both linguistic and cultural readaptation. Limitations: Linguistic adaptation should be followed by cultural validation. BI-H's applicability is confined to stroke patients, and its factor model may not extend to other conditions.
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