Translation and Validation of Rivermead Mobility Index in Urdu

Rivermead Mobility Index (RMI) is an internationally used tool to assess mobility for both research and clinical practice in stroke survivors. This tool had previously been translated into many languages. However, the Urdu version of RMI is not available yet.

The purpose of this study was to translate the RMI into Urdu (RMI-U) and to evaluate the validity and reliability of the translated version among Urdu-speaking stroke survivors in Pakistan. A standardized stepwise forward-backward translation procedure following international guidelines, was used to translate RMI into Urdu. The RMI-U pre-final version underwent thorough psychometric testing. Content validity was evaluated by measuring content validity indices (CVIs). The test-retest reliability of final version was then evaluated among 150 stroke survivors after a one-week interval. Furthermore, internal consistency was measured by Cronbach's alpha and construct validity by exploring factor analysis using the principle of component extraction and a Varimax rotation.

Stroke is the second most common cause of death and the third most common cause of disability in adults worldwide including in Asia. Stroke survivors experience varying degrees of sensory-motor impairments including lack of mobility, reduced functional activity, and poor coordination and balance either due to muscular weakness or spasticity. Mobility is adversely affected after stroke, as patients may face many problems in moving and getting around (walking, stair climbing, etc) .

In stroke rehabilitation, it is recommended to evaluate mobility deficits using standardized tools. RMI is a valid and reliable tool, used internationally for its appropriate psychometric properties. It is used in stroke patients as a marker of mobility, which assesses balance, mobility, transfer, and gait in stroke survivors. Originally it was developed in 1991 in English language. and translated into different languages for its feasibility and responsiveness such as German, Italian, Turkish, and Brazilian, Dutch, and Danish.

Stroke is a major public health concern in developing countries of South Asia including Pakistan. The estimated incidence rate of stroke in Pakistan is 250/100,000 annually. Currently, English RMI is used for the clinical evaluation of mobility in stroke patients. Whereas Urdu is the public language of Pakistani people and most of the patients suffering from stroke belong to rural areas of Pakistan, where the literacy rate is low, and a small proportion of the population can read and understand English. Due to the language barrier and moderate pace of education, it's difficult to them to understand English language. Therefore, its Urdu translation was needed. As per knowledge of the author no Urdu version of RMI is available yet. So, this study aimed to develop Urdu version RMI-U and to test the validity and reliability of the translated version in stroke patients. So that in future it can be easily implemented throughout the Pakistani healthcare system and its utility in public and private healthcare setup could increase.

Eligibility Criteria:
Inclusion Criteria:

* patients with chronic stroke; ischemic or hemorrhagic,
* Aged between 40 to 80 years who visited the respective rehabilitation center during the study time
* Those who could read and understand Urdu.

Exclusion Criteria