Assessing auditory comprehension in the context of severe physical disability: the PACST

Existing tests of auditory comprehension are frequently unsuitable for patients with physically disabling conditions as tests require skills such as physical manipulation of materials. A suitable test is required to assess the reliability and validity of responses in patients who can only indicate 'yes' and 'no'. This has implications for enabling patients to participate, for example, in decision making over their care. In the construction of the Putney Auditory Comprehension Screening Test (PACST) 200 normal participants were tested with 258 yes/no questions. From their results a test consisting of 60 unambiguous questions, varying in difficulty, type, syntactic complexity and length were selected. A clinical trial was completed with 112 patients from the Royal Hospital for Neuro-disability. The 60 item test was found to be reliable and valid. Results were also compared with independent ratings by ward managers and speech and language therapists. Effects of demographic variables were as expected. A 60 question test was developed which was shown by the clinical trial to be a useful tool. Questions vary in difficulty, but not enough to establish a difficulty gradient. On the basis of performance on the test, patients can be allocated to three groups: normal, impaired, and chance performance.