To evaluate the intrarater and interrater reliability of the Thai version of the SARA (SARA-TH) for assessing ataxia in patients with acute ischemic stroke or transient ischemic attack (TIA).
This study included fifty patients from Naresuan University Hospital, Thailand, who had experienced a stroke or TIA and were diagnosed with ataxia, as confirmed by brain imaging (CT or MRI) and clinical signs, including gait, truncal, and limb ataxia. Participants were required to follow at least a two-stage verbal command. Ataxia was assessed using the SARA-TH by a PT from our research team. All assessments were recorded on video and subsequently reviewed by six healthcare professionals with varying levels of experience, including neurologists, PTs, and OTs. The raters were categorized based on their experience: three had over three years of practice (experienced), while three had less than three years (novice). Each rater independently evaluated the SARA scores from the videos on two separate occasions, two weeks apart. Interrater and intrarater reliability among both experienced and novice raters were assessed using weighted kappa.
The experienced neurologist, PT, and OT have 12, 12, and 13 years of experience, respectively, since obtaining their qualifications. In contrast, the novice neurologist has 2 months, the novice PT has 2 years, and the novice OT has 1 year of experience. Intraclass correlation coefficients for intrarater reliability of the eight SARA-TH items were as follows: experienced neurologist (0.820–0.974), PT (0.804–1.000), and OT (0.804–0.916). For novice professionals, the values were 0.765–0.948 (neurologist), 0.793–0.897 (PT), and 0.724–0.901 (OT). Interrater reliability between experienced and novice health professionals ranged from 0.475–0.747 for neurologists, 0.281–0.707 for PTs, and 0.309–0.662 for OTs. Additionally, interrater reliability among the different health professionals ranged from 0.511–0.816 (neurologist and PT), 0.593–0.927 (neurologist and OT), and 0.431–0.741 (PT and OT).
The SARA-TH shows robust intrarater reliability and satisfactory interrater reliability among neurologists, PTs, and OTs with different levels of experience.
The findings suggest that individual healthcare providers should consider using the SARA-TH to assess the severity of ataxia in patients following an acute ischemic stroke or TIA. Additionally, conducting SARA-TH assessments with a single rater in both clinical and research settings may enhance the reliability and consistency of the evaluations.
Stroke
Reliability
