Cross-Cultural Adaptation and Validation of the Italian Version of the Observational Scale of Level of Arousal

Lucia Anna Martella, Luca Carmisciano, Chiara Giannotti, Alessio Signori, Roberto Pontremoli, Massimo Giusti, Elisa Gualco, Valentina Beccati, Alessandra Marengoni, Alessio Nencioni, Fiammetta Monacelli

Research output: Contribution to journalArticlepeer-review


Objectives: Along with deficit of attention, level of arousal is a primary criterion for the diagnosis of delirium. The Observational Scale of Level of Arousal (OSLA) is a quick, simple, and observational instrument used to evaluate the variation of arousal for rapid screening of delirium in clinical practice. The current study aims to perform a cross-cultural adaption of and to validate the Italian version of the OSLA scale to detect delirium in older aged, hospitalized patients. Design: Longitudinal study. Setting and Participants: In hospital and transitional care setting. Old age patients. Methods: A cross-cultural adaptation of the OSLA from English into Italian was conducted, including back-translation. The validation of the OSLA was assessed in 116 older patients (age >65 years) admitted to geriatric, internal medicine, and transitional care wards. The 4 “A”s Test serves as the gold standard for the measurement of delirium. Results: Incident delirium was assessed longitudinally at different time points during hospitalization. The Italian version of OSLA demonstrated adequate internal consistency, specificity, sensitivity, agreement, test-retest reliability, and sensitivity to change, indicating adequate its clinometric properties in the detection of delirium in a real world hospitalized cohort of older adults. Conclusions and Implications: The current study is among the few studies to assess arousal as a core feature of delirium by virtue of a longitudinal assessment of delirium, moving a step forward in the implementation of a brief and easy to use delirium-screening tool for the measurement of important clinical outcomes in a frail, old aged hospitalized population.

Original languageEnglish
JournalJournal of the American Medical Directors Association
Publication statusAccepted/In press - 2020


  • Delirium
  • level of consciousness
  • longitudinal assessment
  • older adults
  • OSLA validation.

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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