Behavioral Inattention Test (BIT)

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Behavioral Inattention Test (BIT) in individuals with stroke. We identified 5 studies.

Floor/Ceiling Effects

No studies have reported floor/ceiling effects of the BIT in clients with stroke.

Reliability

Internal Consistency:
No studies have reported the internal consistency of the BIT in clients with stroke.

Test-retest:
Wilson, Cockburn, and Halligan (1987) examined the test-retest reliability of the BIT in 28 clients with stroke and 14 healthy individuals. Participants were re-assessed within 1 week. The test-retest reliability for the BIT, as calculated using Pearson Correlation Coefficient, was excellent (r = 0.83).

Halligan, Cockburn, and Wilsom (1991) estimated the test-retest reliability of the BIT conventional subtest (BITC) and the BIT behavioral subtest (BITB) in 10 clients with stroke. Participants were re-assessed within 15 days. The test-retest reliability was excellent for both BITC and BITB (r = 0.89; r = 0.97, respectively).

Intra-rater:
No studies have reported the intra-rater reliability of the BIT in clients with stroke.

Inter-rater:
Wilson et al. (1987) assessed the inter-rater reliability of the BIT in 7 clients with stroke. Two raters assessed participants simultaneously. 100% agreement level was found between raters.

Halligan et al. (1991) verified the inter-rater reliability of the BIT conventional subtest (BITC) and the BIT behavioral subtest (BITB) in 13 clients with stroke. Two independent raters scored participants separately but simultaneously. Correlation between raters mean scores, as calculated using Pearson Correlation Coefficient, was excellent (r = 0.99) for both BITC and BITB.

Validity

Content:
Wilson et al. (1987) obtained information about client’s everyday difficulties in order to construct a brief battery of tests that included real world’ experiences of patients recovering from stroke. Information was retrieved from published cases, behavioral observation of patients with neglect, as well as from discussions with occupational therapists, physiotherapists, clinical psychologists, and neurologists, all of whom had worked with patients with visual neglect. The final selection of items was determined based on results of a pilot study.

Criterion:
Concurrent: 
The concurrent validity of the BIT has not been examined in clients with stroke.

Predictive:
Jehkonen, Ahonen, Dastidar, Koivisto, Laippala, Vilkki et al. (2000) examined in 50 clients with stroke to determine if visual neglect measured 10 days post stroke was predictive of poor functional outcomes at 3, 6 and 12 months post stroke. Visual neglect was measured with the BIT and functional outcomes with the Frenchay Activities Index (FAI) (Holbrook & Skilbeck, 1983). Linear regression analysis indicated that the BIT is an excellent predictor of poor functional outcomes, accounting for 73%, 64% and 61% of the total variance of the FAI at 3, 6 and 12 months respectively.

Halligan et al. (1991) analyzed the percentage of people that were correctly classified as having visual neglect using the BITC and the BITB. This study included 80 clients with stroke. Results were as follows:

  • BITC
  Right brain damaged clients (n = 26) Left brain damaged clients (n = 54)
  Sensitivity Specificity Sensitivity Specificity
Line crossing 65% 76% 75% 96%
Letter cancelation 77% 82% 100% 95%
Star cancelation 100% 64% 100% 77%
Figure copying 96% 97% 100% 91%
Line bisection 65% 76% 75% 96%
Representational drawing 42% 64% 0% 85%
  • BITB
  Right brain damaged clients (n = 26) Left brain damaged clients (n = 54)
  Sensitivity Specificity Sensitivity Specificity
Picture scanning 65% 76% 25% 88%
Telephone dialing 57% 72% 25% 88%
Menu reading 65% 76% 75% 96%
Article reading 38% 64% 50% 92%
Telling time 69% 78% 100% 100%
Coin sorting 100% 100% 100% 95%
Address and sentence copying 65% 76% 50% 92%
Map navigation 46% 67% 100% 95%
Card sorting 54% 70% 25% 88%

Construct:
Convergent/Divergent:
Halligan et al. (1991) examined the convergent validity of the BIT by comparing it to the Occupational Therapist Checklist and the Rivermead Activities of Daily Living Assessment (Whiting & Lincoln, 1980) in 80 clients with stroke. Excellent correlations were found between the BIT and the Occupational Therapist Checklist (r = -0.65); adequate correlations between the BIT and the Rivermead Activities of Daily Living Assessment (r = 0.55).

Hartman-Maier and Katz (1995) verified the convergent validity of the BIT Behavioral subtest by comparing it to a checklist of activities of daily living (ADL). Correlations, as calculated using Pearson Coefficient Correlation, were excellent (r = 0.77).

Cassidy, Bruce, Lewis, and Gray (1999) evaluated the convergent validity of the BIT by comparing it to the Barthel Index (Mahoney & Barthel, 1965) in 44 clients with stroke. Correlations between both measures were excellent (r = 0.64).

Known Groups:
Halligan et al. (1991) studied 80 clients with stroke to determine if the BITC subtest was able to distinguish between persons with visual neglect from those healthy ones. Individuals with visual neglect performed significantly worse on the BITC as compared to healthy ones (p<0.001; calculated using Kruskal-Wallis test). Therefore, the BITC is capable of discriminating between known groups.

Responsiveness

No studies have reported the responsiveness of the BIT in clients with stroke.

References
  • Albert, M. L. (1973). A simple test of visual neglect. Neurology, 23, 658-664.
  • Beschin, N., Robertson, I. H. (1997). Personal versus extrapersonal neglect: a group study of their dissociation using a reliable clinical test. Cortex. 33, 379-384.
  • Brunila, T., Jalas, M., Lindell, J.A., Tenovuo, O., Hamalainen, H. The two part picture in detection of visuospatial neglect. Clin Neuropsychol 2003;17:45-53.
  • Cassidy, T.P., Bruce, D.W., Lewis, S., & Gray, S.G. (1999). The association of visual field deficits and visuospatial neglect in acute right hemisphere stroke patients. Age Ageing, 28, 257-260
  • Diller, L., Ben-Yishay, Y., Gerstman, L. J., Goodin, R., Gordon, W., Weinberg, J. (1974). Studies in scanning behavior in hemiplegia. Rehabilitation Monograph No. 50, Studies in cognition and rehabilitation in hemiplegia. New York: New York University Medical Center, Institute of Rehabilitation Medicine.
  • Goodenough, F. L. (1926). The measurement of intelligence by drawing. New York: World Books.
  • Halligan, P., Cockburn, J., Wilson, B. (1991). The Behavioural Assessment of Visual Neglect. Neuropsychological Rehabilitation 1, 5-32.
  • Hartman-Maeir, A., Katz, N. (1995). Validity of the Behavioral Inattention Test: relationship with functional tasks. Am J Occup Therapy, 49, 507-516.
  • Holbrook, M., Skilbeck, C. E. (1983). An activities index for use with stroke patients. Age and Ageing, 12(2), 166-170.
  • Jehkonen, M., Ahonen, J.P., Dastidar, P., et al. (2000). Visual neglect as a predictor of functional outcome one year after stroke. Acta Neurol Scand, 101, 195-201.
  • Mahoney, F. I., Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-5.
  • Menon, A., Korner-Bitensky, N. (2004). Evaluating unilateral spatial neglect post stroke: working your way through the maze of assessment choices. Top Stroke Rehabil 11, 41-66.
  • Zoccolotti, P., Antonucci, G., Judica, A. (1992). Psychometric characteristics of two semi-structured scales for the functional evaluation of hemi-inattention in extrapersonal and personal space. Neuropsychological Rehabilitation, 2, 179-191.
  • Whiting, S. & Lincoln, N. (1980). An A.D.L. assessment for stroke patients. British Journal of Occupational Therapy, 43, 44-46.
  • Wilson, B., Cockburn, J., Halligan, P. (1987) Development of a behavioral test of visuospatial neglect. Arch Phys Med Rehabil 68, 98-102.