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.