Cross cultural adaptation and validation of Nepali Version of Activity Scale for Kids (ASK).

BACKGROUND: Activity Scale for Kids (ASK) is self reported, widely used tool to measure the physical disability in children aged 5-15 years. It has two versions; ASK-performance version and ASK-capability version, both with excellent psychometric properties in English and other translated languages. However, the tool is not available in Nepali. The aim of our study is to translate, culturally adapt and validate the tool in the context of the Nepali population. METHODS: A standard translation guideline was used to translate both the versions of ASK tool into the Nepali language. One hundred and two participants were assessed to establish the reliability and validity of the tool. Internal consistency and test retest reliability was established using cronbach's alpha and intra class correlation coefficient. Validity was established by three methods; ceiling and floor effects, group discriminations, and comparing the results of ASK with the Nepali version of KINDL. RESULTS: The mean age of the sample participants were 12.74 years (SD 2.2). The internal consistency and test retest reliability for both the Nepali versions of ASK was significant at 0.98 and 0.94 respectively. The tool had a negligible ceiling effect (< 5%) but a moderate floor effect (ASKp-Np 7.8% and ASKc-Np 8.8%). It was able to discriminate between the mobility aid required for moving inside and outside the home environment. Moderate correlation was observed between the both the Nepali versions of ASK and the total score of KINDL (r = 0.5). CONCLUSIONS: Nepali version of ASK is reliable and valid tool to measure physical disability in the Nepali pediatric population.

Leptomeningeal Disease as an Initial Presenting Manifestation in Breast Cancer.

Leptomeningeal disease (LMD) occurs in less than 5% of breast cancer patients. Rarely, patients present with LMD at diagnosis. We report a case of a 59-year-old female who presented with lower back pain, radicular neuropathy with lower extremity weakness, and was found to have diffuse LMD. Workup was initiated to evaluate the etiology of LMD and later involved iliac bone biopsy showed metastatic adenocarcinoma consistent with breast carcinoma. Patient received radiation therapy followed by abemaciclib with letrozole and responded well with the treatment.