Are clinician-administered ataxia scales truly culture-free? Rethinking contextual validity in diverse populations
- 1Department of Neurology, All India Institute of Medical Sciences
- 2Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS)
- 3Department of Neurology, St. John’s Medical College
Abstract
Hereditary cerebellar ataxias are genetically and phenotypically heterogeneous progressive neurodegenerative disorders characterized by substantial functional impairment. With the emergence of disease-modifying therapies and gene-targeted clinical trials, standardized and reliable clinical outcome measures are essential for assessing disease severity and progression. Among the available scales, two are widely used by clinicians to assess ataxia: The Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). Given considerable linguistic, educational and sociocultural heterogeneity across the globe, we opine that it may pose challenges to the uniform application and cross-cultural comparability of these instruments. Published translations and adaptations were also examined to determine whether cultural adaptation extended beyond linguistic translation. Among all the identified adaptations, reported processes predominantly comprised forward and backward translation, expert review and assessment of linguistic, conceptual or cultural equivalence. These findings suggest that linguistic translation alone may not be sufficient to ensure that clinician-rated ataxia scales retain equivalent meaning and measurement across diverse populations. We therefore introduce the concept of “contextual validity” emphasizing that language, educational heterogeneity, literacy, graphomotor familiarity, cultural practices and testing environments that may influence performance independently of cerebellar dysfunction. This perspective outlines considerations for developing contextually adapted and psychometrically validated Indian-language versions of SARA and ICARS to improve measurement accuracy and support equitable clinical assessment and participation in global clinical trials.
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BibTeX
@article{narzari2026clinicianadministered,
title = {{Are clinician-administered ataxia scales truly culture-free? Rethinking contextual validity in diverse populations}},
author = {Hina Narzari and Ravi Yadav and Achal Kumar Srivastava and Pramod Kumar Pal and Divyani Garg},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1991845},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1991845/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Are clinician-administered ataxia scales truly culture-free? Rethinking contextual validity in diverse populations
AU - Hina Narzari
AU - Ravi Yadav
AU - Achal Kumar Srivastava
AU - Pramod Kumar Pal
AU - Divyani Garg
PY - 2026
DA - 2026/10/23
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1991845
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1991845/full
AB - Hereditary cerebellar ataxias are genetically and phenotypically heterogeneous progressive neurodegenerative disorders characterized by substantial functional impairment. With the emergence of disease-modifying therapies and gene-targeted clinical trials, standardized and reliable clinical outcome measures are essential for assessing disease severity and progression. Among the available scales, two are widely used by clinicians to assess ataxia: The Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). Given considerable linguistic, educational and sociocultural heterogeneity across the globe, we opine that it may pose challenges to the uniform application and cross-cultural comparability of these instruments. Published translations and adaptations were also examined to determine whether cultural adaptation extended beyond linguistic translation. Among all the identified adaptations, reported processes predominantly comprised forward and backward translation, expert review and assessment of linguistic, conceptual or cultural equivalence. These findings suggest that linguistic translation alone may not be sufficient to ensure that clinician-rated ataxia scales retain equivalent meaning and measurement across diverse populations. We therefore introduce the concept of “contextual validity” emphasizing that language, educational heterogeneity, literacy, graphomotor familiarity, cultural practices and testing environments that may influence performance independently of cerebellar dysfunction. This perspective outlines considerations for developing contextually adapted and psychometrically validated Indian-language versions of SARA and ICARS to improve measurement accuracy and support equitable clinical assessment and participation in global clinical trials.
SN - 1664-2295
ER -