Chinese translation and validation of the Sport Concussion Assessment Tool 3 (SCAT3)

Objective The aim of this study was to translate, adapt and validate the Sport Concussion Assessment Tool 3rd edition (SCAT3), a test for assessing athletes for concussion, into the Chinese context. Methods Translation and adaptation were performed in several stages, which included forward translation by two independent teams, translation merging, backward translation, reviews by both native Cantonese-speaking and Mandarin-speaking multidisciplinary expert panels (n=49) for semantic and conceptual equivalence and reviews by pitch-side physiotherapists (n=18) as end-users of the SCAT3 and rugby players (n=11) for face validity. The Serial 3 s subtraction test was used as a substitute for the Months Backward Test (MBT) for measures of concentration in the Standardized Assessment of Concussion subscale. English-speaking and Chinese-speaking rugby players (n=52) were recruited to perform these tests to assess the level of difficulty, time for completion and accuracy. Inter-rater and test-retest reliability were assessed in 33 and 38 healthy young individuals, respectively. Results Despite the longer mean completion time (p<0.05) for the Serial 3 s test, no significant difference was found in the percentage accuracy between MBT and the Serial 3 s test. No significant difference was found in either the percentage accuracy or completion time between English-speaking and Cantonese-speaking rugby players. All subscales in the Chinese SCAT3 had excellent levels of inter-rater reliability for all items (ICC 2,1 range: 0.96-0.99) but a low to moderate test-retest reliability (ICC 3,2 range: 0.32-0.65). The mean completion time of the Chinese SCAT3 was 10.6 +/- 1.1 min. Conclusion Chinese SCAT3 is a valid instrument for pitch-side assessment of concussed Chinese-speaking athletes.