Cross-cultural adaptation and validation of the Italian Aachener Aphasie Bedside Test (I-AABT), a tool for Aphasia assessment in the acute phase

Background: Early recognition of post stroke aphasia is thought to be crucial to plan effective rehabilitation. The Aachener Aphasie Bedside Test (AABT) is a widely-used tool for aphasia assessment in acute phase. The AABT was translated into Italian (I-AABT) in 2011, but its psychometric properties had not yet been studied. Aims: The aims of the study were to assess the I-AABT 1) short-term test-retest and inter-rater reliability, 2) concurrent and construct validity, 3) responsiveness and 4) to develop preliminary Italian normative scores to stage aphasia severity. Methods & Procedures: Participants were recruited from three Italian hospitals and divided into four groups: 1) patients with acute aphasia (PwAA; n=116), 2) patients with post-acute aphasia (PwPA; n=54), 3) patients with right-hemisphere damage (PwRHD; n=48) and 4) patients without neurological disorders (PwND; n=30). The I-AABT was administered to all participants. The Aachner Aphasie Test (AAT) was administered to assess concurrent validity. Spearman’s correlations and Intraclass Correlation Coefficient (ICC) were used to calculate reliability. Concurrent and construct validity were assessed through Spearman’s correlations between I-AABT and AAT subscales and Mann-Whitney test, respectively. Wilcoxon signed test was used to assess responsiveness. Both normalized z and T scores were calculated to produce Italian normative scores. Finally, ROC curves were drawn to determine the diagnostic accuracy of the I-AABT Comprehension and Production subtests. Outcomes & Results. Test-retest and inter-rater ICCs were highly significant and strong (ICC >.837, ICC >.698, p<.001, respectively). Correlations between I-AABT and AAT Comprehension and Production subtests were significant and strong (rs>.611, p <.001). Mann-Whitney test confirmed statistically significant difference between PwAA, and both PwRHD and PwND for I-AABT Spontaneous Language, Comprehension and Production subtests. A significant improvement in the I-AABT items Semantic, Phonemic and Syntactic Spontaneous Language, Oral praxis, Object identification, Automatic Language and Naming (p <.05) was detected after intensive language therapy. Preliminary conversion tables were devised to classify comprehension and production impairment levels. I-AABT’s AUC-ROC values for Comprehension and Production parts were significant to detect patients with aphasia with a cut value of 139.5 (sensitivity = 72.9%, specificity = 79.5%9) and 94.5 (sensitivity = 75.2%, specificity = 74.4%.), respectively. Conclusions: The I-AABT proved to be a reliable, valid and responsive tool for the assessment of aphasia in acute stroke patients; its use is recommended in everyday clinical practice.