Validation of the Italian version of the American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults (I-ASHA-FACS)

Abstract

Background: Impairment of communicative-linguistic and cognitive functions is common after stroke and traumatic brain injury (TBI). While assessment of language function is usually performed in clinical practice, standardised assessment of pragmatic, functional, and communicative competences is less common, even though suggested by many recent national and international guidelines. The “American Speech-Language and Hearing Association—Functional Assessment of Communication Skills for adults” (ASHA-FACS) is a measure of communication disability that investigates functional communication. It has been translated and adapted into Italian in 2001, but psychometric properties of Italian version of ASHA-FACS (I-ASHA-FACS) have not yet been investigated.

Aims: To investigate psychometric properties of the I-ASHA-FACS scale and provide normative data.

Methods & Procedures: Participants included 100 healthy adult persons without neurological disorders nor communicative-cognitive deficits and 80 post-acute outpatients with aphasia following stroke (n = 60) or TBI (n = 20). Mini Mental State Examination (MMSE) was used to exclude control participants with cognitive decline (MMSE > 24). I-ASHA-FACS was completed for all participants. All patients were also assessed with Functional Independent Measure (FIM) and either Aachener Aphasie Test (AAT) for persons with aphasia due to stroke or Levels of Cognitive Functions scale (LCF) for TBI persons. I-ASHA-FACS internal consistency, inter- and intra-rater reliability and construct validity were calculated; normative data were also calculated for healthy controls stratified by age and education. Cronbach’s alpha was used for internal consistency analysis. Spearman’s test was used to correlate I-ASHA-FACS and FIM, AAT, and LCF scores.

Outcomes & Results: I-ASHA-FACS showed good internal consistency (α > .84) and strong intra- and inter-rater reliability (r > .97 and >.89). All healthy persons showed very high level of functional communication abilities in all domains of communication independence (higher than 6, on a 7-point scale) and all qualitative dimensions scores (higher than 4, on a 5-point scale). Correlations between I-ASHA-FACS scores and FIM were strong in aphasic persons, particularly in problem solving (r > .71) and comprehension (r > .73) subscales. Correlations between I-ASHA-FACS and AAT were generally from moderate to strong (r values ranging from r = .31 to r = .81), and particularly strong in spontaneous speech subtest (r > .70). Correlations between I-ASHA-FACS and LCF did not reach statistical significance.

Conclusions: I-ASHA-FACS shows good internal consistency, strong intra- and inter-rater reliability and satisfactory validity. The application of I-ASHA-FACS to the Italian population of patients with communicative deficits due to aphasia or TBI is recommended.

Keywords:

• functional communication
• aphasia
• traumatic brain injury
• ASHA-FACS