Translation, cultural adaptation, and validation of the Concussion Recognition Tool 6 (CRT6™), Sport Concussion Assessment Tool 6 (SCAT6®) and Sport Concussion Office Assessment Tool 6 (SCOAT6™): the Italian process

Background: To ensure wide implementation of the Concussion in Sport Group (CISG) recommendations beyond English-speaking countries, the availability of recommended concussion assessment tools in other languages is a key step, especially in countries where few sport-related concussion guidelines exist. We describe the process and adaptations followed in the Italian translation of the latest CISG concussion assessment tools: the Concussion Recognition Tool 6 (CRT6™), the Sport Concussion Assessment Tool 6 (SCAT6®) and the Sport Concussion Office Assessment Tool 6 (SCOAT6™). Methods: Based on CISG procedures, we engaged in an 8-step process which sequentially included verbatim translation in Italian, reconciliation of translation and cultural adaptation, back-translation (from Italian into English), appraisal of the back-translation, validation of the refined Italian version, review and adjustment by an expert committee, pilot testing in 12 amateur athletes and document finalization. Results: The immediate memory test required replacement with Rey Words to be meaningful in Italian, as per the advice of the working group neuropsychologists. The remaining tests did not need any substantial changes except for translation and cultural adaptation. The refinement process continued until the Italian CRT6 ™, SCAT6® and SCOAT6 ™ were rated as ‘extremely clear/coherent/grammatically correct’ (score 7 on a 7-point Likert scale). The average time needed to carry out assessments using the final Italian version of CRT6 ™, SCAT6® and SCOAT6 ™, was 3.2 min (SD 0.69), 21.12 min (SD 3.16) and 24.50 min (SD 3.18), respectively. These were found to have acceptable clarity, understandability, grammatical correctness, and coherence. Conclusion: The Italian CRT6 ™, SCAT6® and SCOAT6 ™ are the first concussion assessment tools available in the Italian language for both healthcare providers and athletes and enable improvement of concussion management based on the CISG recommendations.