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ABSTRACT
Background: There is an increasing need of assessing functional communication in daily activities and the impact on the quality of life from the perspective of the major protagonists of life situations following aphasia. Several instruments are available for English. One of the most recent is the Communication Outcome after Stroke scale for patients (COAST) and caregivers (Carer COAST). These scales are comprised of two components, interactive communication skills and their impact on quality of life, assessed through 20 question items, from the point of view of patient and carer. In contrast, the number of tools available in Italian is very limited.
Aims: (i) To validate the COAST and Carer COAST scales for the Italian-speaking population; (ii) to explore the applicability of the COAST scales to a wider range of people with communication problems, not limited to moderate aphasia; (iii) to explore the agreement between patient’s and carer’s perspective on communication difficulties, and the effect of severity.
Methods & Procedures: The scales were translated into Italian and adapted for the sociocultural context, preserving the accessible presentation and response format. Thirty people with a history of aphasia (from mild to severe) and 28 caregivers provided usable data. The scales’ psychometric properties were measured, along with exploratory analyses on the agreement between patients and carers.
Outcomes & Results: The Italian versions of the COAST scales, i.e., COAST-IT and Carer COAST-IT, showed excellent internal consistency (α = 0.94 and 0.94–0.95, respectively), good test–retest reliability (ICC = 0.85 and 0.88, respectively), and indicative evidence of construct validity as judged by the correlations with measures derived from background and current Aachener Aphasia Test (AAT) scores (r ranging from 0.32 to 0.41 and from 0.47 to 0.70, respectively). The patient and caregiver scales were strongly correlated along the score range (r = 0.70–0.72) and agreement was not influenced by aphasia severity.
Conclusions: The COAST-IT and Carer COAST-IT scales are practical and reliable patient- and carer-centred measures of functional communication and its impact on the quality of life, applicable to people with communication problems of different severity. These scales fill an important gap of effectiveness indicators for speech–language assessment and therapy in Italy. More generally, the results strengthen the need of complementing traditional language assessment with functional outcome measures, and considering the perspective both of people with communication difficulties and their carers. This adaptation could pave the way for cross-national sharing of functional communication assessment instruments and comparative studies.
Acknowledgements
The authors wish to thank Audrey Bowen and Anne Hesketh for useful comments throughout the project. Thanks also go to Ludovica Serratrice for her contribution in the backward translation and to Donatella Resta for assistance in the adaptation of the scales.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes
1. With respect to the ASHA definition of functional communication as the ability to communicate effectively and independently, the COAST scale focuses explicitly on effectiveness. As for independency, the COAST, in the interests of keeping the items and scale as simple as possible, doesn’t introduce the idea of independence explicitly. However, it might be reflected in the difference between specific items (e.g., items 3 and 4, where people might succeed with a familiar and facilitative conversation partner but struggle with an unfamiliar person who is expecting them to communicate independently). Moreover, one could expect that an improvement that enabled the patient to communicate independently would be reflected in changes in scores. Within the COAST scale, these aspects would be something to be explored in discussion with people with aphasia and their communication partners.
2. In using the profile height as a general measure of aphasia severity, we followed previous literature (Ruiter, Kolk, Rietveld, Dijkstra, & Lotgering, Citation2011), although this index does not take into account the multimodal nature of aphasic disorders, as claimed by the authors of the AAT (Willmes et al., Citation1988).
3. Overall, at visit 1 about 1.1% of the items of all participants were not applicable. Specifically, items 8, 14, and 17 were not applicable in one occasion, and items 16 and 17 were not applicable in two occasions. At visit 2, about 1.6% of the items of all participants were not applicable. Specifically, items 1, 9, 11, 12, 14, 15, 17, and 18 were not applicable in one occasion.
Additional information
Funding
Notes on contributors
Valentina Bambini
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Giorgio Arcara
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Beatrice Aiachini
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Barbara Cattani
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Maria Leonilde Dichiarante
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Andrea Moro
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Stefano F. Cappa
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.
Caterina Pistarini
Ideation of the project: VB, GA. Translation and adaptation: VB, GA, AM. Supervision of clinical aspects: SC, CP, BA. Data collection: VB, BA. Patient’s enrolment and background data collection: BA, BC, MLD. Data analysis: GA, VB. Drafting of the manuscript: VB, GA. All authors provided feedback on the draft and approved the final version of the manuscript.