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 psycho- metric 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 adminis- tered to all participants. The Aachner Aphasie Test (AAT) was adminis- tered 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 responsive- ness. 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, respec- tively). 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 compre- hension 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.