Objective: Translation and Cross-cultural adaptation of the Scale for Assessment and Rating Ataxia (SARA) in Greek ataxic pediatric population.

Background: Ataxia in the pediatric population has not been sufficiently studied in terms of both evaluation and intervention. The SARA has recently been validated for children over 8 years old however it is not available in Greek.

Method: The scale was adapted into Greek according to international guidelines by two bilingual translators. The adapted scale (SARA_GR) has so far been pilot tested and cross-validated in 13 children with ataxia (7 girls and 6 boys) of mean age 11±3 years (range 8 to 17 years old). In terms of reliability, the scale was undertaken over a period of 2 weeks (test-retest reliability) and the videotaped performance was rated by two pediatric physiotherapists (inter-rater reliability) twice in a period of 2-6 weeks (intra-rater reliability). Internal consistency was assessed by Cronbach’s a. To evaluate convergent validity, SARA_GR was correlated with the Brief Ataxia Rating Scale (BARS) and the Barthel Index (BI) while exploratory factor analysis (EFA) was also assessed for interpretation of SARA_GR’s index variability.

Results: Items 1, 2, 3, 5 and 6 of the pre-final SARA_GR were further clarified and terms like “finger chase” rephrased to semantically being meaningful in Greek language. SARA_GR yielded a very high test-retest for both raters (ICC of 0.999), inter-rater (ICC of 0.998) and intra-rater (ICC of 1.00) agreement. Internal consistency was excellent with Cronbach’s alpha of 0.966 and 0.960 for the 1^st and 2^nd rater, respectively. The very high correlation revealed between total scores of SARA_GR and BARS (r= 0.993, p < 0.001) and Bl (r=-0.920, p < 0.001) respectively satisfies the conver­gent validity. One factor, with eigenvalue of over 1 (7.06) was identified, explaining 88.25% of the variance.

Conclusion: Greek version of SARA is conceptual, semantic and content equivalent to the original scale. According to those preliminary results, its excellent reliability and very high convergent validity indicate its applicability in Greek paediatric ataxic population.

References: [1] Schmitz-Hübsch T et al (2006) Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology, 66(11):1717-20 https://doi:10.1212/01.wnl.0000219042.60538.92 [2] Hartley H et al (2019). Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review. Cerebellum 18: 951–968. https://doi.org/10.1007/s12311-019-01063-z [3] Brandsma R et al (2019). A clinical diagnostic algorithm for early onset cerebellar ataxia. Eur J Paediatr Neurol., 23(5):692-706. https://doi:10.1016/j.ejpn.2019.08.004 [4] Lawerman TF et al (2017). Age-related reference values for the pediatric Scale for Assessment and Rating of Ataxia: a multicentre study. Dev Med Child Neurol., 59(10):1077-1082. https://doi:10.1111/dmcn.13507 [5] Sousa VD, Rojjanasrirat W (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract., 17(2):268-74 https://doi:10.1111/j.1365-2753.2010.01434.x

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MDS Abstracts - https://www.mdsabstracts.org/abstract/reliability-and-validity-of-the-greek-translation-of-the-scale-for-assessment-and-rating-ataxia-in-ataxic-children/