Reliability and validity of the Chinese behavioural inattention test-Hong Kong version (CBIT-HK) for patients with stroke and unilateral neglect

Objective: One of the explanations for the wide range in the reported incidence of unilateral neglect is probably the lack of agreement regarding evaluation methods. The aim of this study was to investigate the reliability and validity of the newly developed Chinese Behavioural Inattention Test - Hong Kong version (CBIT-HK) for research purposes, and for patients with stroke and unilateral neglect in Hong Kong. Methods: Fourteen consecutive subacute patients with stroke were selected to determine the external reliabilities and new cutoff scores, and 54 subacute right hemisphere patients were given evaluations including the CBIT-HK, a clock drawing test, and a functional assessment battery to find out the internal reliability and concurrent validity of the test battery. Results: The results indicated that the interrater, intrarater, and parallel-form reliability of the test were high [ICC (2,k) = 0.75 to 0.99]. The findings of low cutoffs and sensitivities for two language-related items in the Behavioural Subtest: "Article Reading" and "Address and Sentence Copying", suggested that these items should be used with caution. The significant relationship between the Conventional Subtest with the clock drawing test (r=0.34) and the functional assessment battery (r=0.47) suggested that the Conventional Subtest, especially the "Star Cancellation" item, rather than the Behavioural Subtest, could be used as a single screening test or item for neglect in the initial assessment of patients with stroke by occupational therapists in daily practice. Conclusion: The reliability and validity of the CBIT-HK were established. The results of this study should aid in making the CBIT-HK, designed to assess the unilateral neglect or visual inattention of patients with stroke and unilateral neglect, a tool for clinical application in occupational therapy as well as for future study in Hong Kong.