CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MALEKA STROKE COMMUNITY RE-INTEGRATION MEASURE AMONG YORUBA SPEAKING STROKE SURVIVORS A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PHYSIOTHERAPY, FACULTY OF CLINICAL SCIENCES, COLLEGE OF MEDICINE, UNIVERSITY OF IBADAN IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MPHIL DEGREE IN NEUROLOGICAL PHYSIOTHERAPY

Abstract

One of the major goals of stroke rehabilitation is adequate community re-integration of the stroke survivors. Although some instruments have been developed to measure community re-integration in post-stroke individuals, the Maleka Stroke Community Re-Integration Measure (MSCRIM) which was developed in South Africa closely captures cultural and belief concept among Nigerians. The MSCRIM had been previously adapted into Igbo culture and environment but not Yoruba culture. Despite the fact that South Africa culture is similar to that of Nigeria culture in some areas, there are specific cultural variability. Hence, the need to adapt the MSCRIM into Nigeria Culture. Therefore, the aim of this study was to adapt the scale into another one of the major indigenous Nigerian Language which is Yoruba and to validate it among Yoruba-speaking stroke survivors. The study followed the guidelines of American Association of Orthopaedic Surgeons (AAOS) of self-report scale for this adaptation. Seventeen out of the 40 items of English MSCRIM that were not familiar to Yoruba culture were modified by the expert committee in order to adapt it to Yoruba culture. The Yoruba culture adapted MSCRIM was then translated into Yoruba language by two forward translators who eventually produced consensus translations. The consensus’s translations was back-translated into English by two back-translators and was reviewed again by the expert committee to produce pre-final Yoruba version. The pre-final Yoruba MSCRIM was pre-tested on 30 Yoruba stroke survivors (as recommended by AAOS guidelines) who were also interviewed for cognitive debriefing. The expert committee reviewed these feedbacks and modified another 22 unfamiliar items. An extra option of ‘‘not available’’ was added to the response scale in domain 2 and 5 to produce final Yoruba MSCRIM. The reason for the addition of extra option of ‘‘not available’’ to these domains was to differentiate the items among the stroke survivors who have the ability to perform those activities on the items from those who do not have the facilities for the activities on the items. For the validation process, the adapted English and the final Yoruba were administered to 60 (30 males) stroke survivors on the same day. Final Yoruba MSCRIM was re-administered again to the stroke survivors after one-week of the first administration. The mean age was 59.98±10.32 years. The participants’ total scores of the adapted English did not significantly different from the finalYoruba MSCRIM (z=-0.00 at p=1.00). For concurrent validity, there was no significant difference in participants’ domain scores between the adapted English and final Yoruba MSCRIM (z=-0.14 to -1.42, at p=0.00). There was significant correlation in participants’ total scores between final Yoruba MSCRIM on two occasions (r=0.89, at p=0.00) provides evidence of test re-test reliability. For internal consistency, there was significant correlation between participants’ total scores and domain scores on final Yoruba MSCRIM (Cronbach’s Alpha correlation coefficient ranged from α=0.36 to 0.96, at p=0.00). The Yoruba MSCRIM scale is a valid, reliable, internally consistent and suitable to measure community re-integration among stroke survivors who are Yoruba-speakers. It is therefore recommended for evaluating community re-integration among Yoruba-speaking stroke survivors.