Reliability and validity of the Nepali wolf motor function test following cross-cultural adaptation

Background The Wolf motor function test is a standardized, reliable and valid performance-based measure, which evaluates upper-extremity function. Neither there is any evidence of neurological measure in Nepali nor has this tool been cross-culturally adapted to date. Objective To cross-culturally translate and evaluate reliability and validity of Nepali Wolf motor function test. Method Two forward-translators translated the original version into Nepali. After synthesizing, two back- translators translated it into English. The expert committee consolidated and derived a final Nepali version. Two assessors pretested on three participants to confirm that the original concept of the tool is preserved. The agreement and correlation between back-translators were evaluated. The inter- and intra-rater reliability and agreement of two physiotherapists on eight participants were demonstrated through intra-class-correlation- coefficient and weighted-kappa for time and functional ability respectively. Criterion validity was explored against Fugl-Meyer assessment scale. Result A cross-culturally adapted Nepali Wolf motor function test was pretested and ensured that the Nepali version was still retaining its equivalence (rho: 0.74 to 1.0 for time, 0.82 to 1.0 for functional ability). Good-to- excellent inter- and intra-rater reliability {intra-class-correlation-coefficient(2,1) and (3,1): 0.80 to 1.0 and 0.81 to 1.0 respectively} were demonstrated. Excellent agreement (kappa 0.90, p<0.00) and good correlation (rho 0.57 to 1.0) between back-translators were found. An adequate criterion validity (rho -0.95 for time, 0.91 for functional ability) against Fugl-Meyer assessment scale has been demonstrated. Conclusion A cross-culturally adapted Nepali Wolf motor function test, preserving its original concept, was developed, and the reliability and validity of the tool on individuals with stroke has been demonstrated.