Translation and Validation of Abnormal Involuntary Movement Scale (AIMS) into Sinhala

Abstract

INTRODUCTION AND OBJECTIVES: Tardive dyskinesia (TD) is a pattern of abnormal involuntary movements among patients on long-term antipsychotics. As there is no medication universally effective, prevention of TD is important. Non-medical clinicians are now involved in the follow-up of patients on antipsychotics in Sri Lanka; therefore, translation and validation of a screening tool in Sinhala, that can be administered by different mental health professionals, was deemed pertinent. Aim of the study was to translate and validate the Abnormal Involuntary Movement Scale (AIMS) into Sinhala. METHODS: Translation followed standard guidelines. The finalized Sinhala version was administered independently by five raters (two registrars in psychiatry, a medical officer, a community psychiatry nurse (CPN) and a psychiatry social worker) on patients on antipsychotics for a minimum of one year. The gold standard diagnosis of TD was the Diagnostic and Statistical Manual (DSM)-5 criteria conducted by a consultant psychiatrist. Sensitivity, specificity, and Cohen’s kappa values were calculated. RESULTS: Out of 137 patients, 53.3% were male. Mean age was 49 and average duration of antipsychotic treatment was 14 years. The percentage of patients diagnosed with TD using AIMS and DSM-5 were 33% and 34% respectively. Sensitivity and specificity of AIMS to detect TD were 67% and 83.4% respectively. The degree of agreement between AIMS and DSM-5 indicated moderate criterion validity (kappa= 0.5). For different raters, the kappa statistic ranged from 0.41 (CPN) to 0.63 (registrar), signifying modest reliability between raters. CONCLUSION: This provides preliminary evidence for validity and reliability of AIMS in detecting TD, when administered by a range of mental health professionals. Given the clinical experience required and the subjectivity involved in diagnosing TD, the foregoing modest statistical indicators seem reasonable.