Predictive validity of the Neurobehavioural Cognitive Status Examination (NCSE) in a post-acute rehabilitation setting

Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review

Background: Performance-based measures that focus primarily on the ability to engage in ADL are routinely used by occupational therapists to assess a client's cognitive abilities.Objective: To perform a systematic review to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in individuals with traumatic brain injury.Material and methods: Pubmed, EMBASE, CINAHL, PsycINFO and OTseeker were searched. The Consensus-based Standards for the selection of health measurement instruments checklist was used to evaluate methodological quality of each included study. The quality criteria adapted by Terwee were applied to extract the results of each measurement property followed by a best evidence synthesis.Results: Twenty-eight articles, including 40 ratings of measurement properties, were included. The combination of the Functional Independence Measure and the Functional Assessment Measure showed moderate evidence of good internal consistency (Cronbach's alpha 0.99), but conflicting evidence of reliability (ICC 0.83) and poor evidence of construct validity. All other instruments showed limited or unknown evidence.Conclusions: This review provides an overview of measurement properties of performance-based instruments and contributes to such methodological considerations before choosing an instrument. Though, the results reveal a lack of high-quality evidence for any of the measurement properties, it is recommended to use tools with the highest possible evidence for positive ratings.Significance: This review contributes with psychometric evidence on instruments to use in occupational therapy practice and research.

Differentiating cognitive functions of poststroke patients with specific brain lesions: A preliminary study on the clinical utility of Cognistat-P

The Cognistat is widely used to measure the cognitive profile of neurological patients. This study aimed to further obtain evidence on the construct and discriminative validity of the Putonghua version of the Cognistat (Cognistat-P) on poststroke patients with specific brain lesions. Cognistat-P was administered to poststroke patients (n = 98), as well as healthy elderly (n = 40) and adult (n = 34) participants as the control groups. Poststroke patients were further categorized into 4 lesion groups using standard brain slice templates. Exploratory factory analysis reflected a 2-factor structure for the Cognistat-P that resembles that for the original English version. The Construction, Similarities, and Judgment subtests were found to differentiate patients with frontal or parietal lesions from those with subcortical lesions (p < .01, R(2) = .48). The Construction subtest, tapping the "fluid" ability, was the most useful for differentiating patients with parietal lesions from those with subcortical lesions. The Similarities subtest together with the Construction subtest was the most useful for differentiating patients with frontal lesions from those with subcortical lesions. This study established the validity of the Cognistat-P for differentiating poststroke patients with specific brain lesions. Future studies should replicate the results on a larger sample size and test the clinical significance of the Cognistat-P profiles.

Factors discriminating employment status following in-patient evaluation among persons with schizophrenia

BACKGROUND

Employment is a key element in recovery from schizophrenia. Yet 60%-80% of people with schizophrenia are not involved in work occupations. Factors influencing employment were explored mostly in community settings, while the recovery process begins already during hospitalization.

OBJECTIVE

The aim of the study was to investigate parameters that can distinguish during hospitalization between people with schizophrenia who will work in competitive employment, in sheltered employment or will not work after discharge.

METHODS

The research followed 104 participants from acute hospitalization to the community, six months after discharge, to obtain employment related data. The participants' cognitive abilities, schizophrenia symptoms, and functional capacity were evaluated during hospitalization. In addition, demography and illness related factors were collected.

RESULTS

The results indicate that persons with different employment statuses varied in several parameters during hospitalization. However, the most effective discriminant model includes negative symptoms, functional capacity measure and the number of hospitalizations.

CONCLUSIONS

The study suggests that people with different employment statuses have unique characteristics already during hospitalization. In the future, appropriate rehabilitation programs may be suggested to each group based on these characteristics to promote employment among people with schizophrenia and contribute to recovery.

From hospital admission to independent living: is prediction possible?

An integral component of recovery from mental illness is being able to engage in everyday activities. This ability is often restricted among people with schizophrenia. Although functional deficits are addressed during hospitalization, the ability to predict daily functioning based on information gathered during hospitalization has not been well established. This study examines whether measurements completed during hospitalization can be useful for predicting independent living within the community. Inpatients with schizophrenia (N=104) were enrolled in the study and assessed for cognitive functioning, functional capacity and symptoms. They were approached again 6 months after discharge to evaluate their functioning with respect to everyday life Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Functional capacity during hospitalization predicted 26.8% of ADL functioning and 38.8% of IADL functioning. ADL was best predicted by the severity of negative symptoms, cognitive functioning, and the number of hospitalizations (51.2%), while IADL was best predicted by functional capacity, cognition, and number of hospitalizations (60.1%). This study provides evidence that evaluations during hospitalization can be effective, and demonstrates the advantage of a holistic approach in predicting daily functioning. When a holistic approach is not practical, a functional capacity measurement may serve as an effective predictor.

Virtual reality (VR)-based community living skills training for people with acquired brain injury: A pilot study

PRIMARY OBJECTIVE

The purpose of the present study was to test the usability and effectiveness of a newly-developed virtual reality (VR)-based community living skills training program for people with acquired brain injury (ABI).

METHOD

A small-sample, pre- and post-quasi experimental design was adopted to initially study the efficacy of the VR-based training program. Its usability was also investigated through interviewing subjects. Outcomes were documented in terms of subjects' skills acquisition, self-efficacy in applying the learnt skills and the transfer ratio of the learnt skills to the real environment. Global cognitive ability and the functional independence level were also assessed.

RESULTS

Four subjects with ABI (one traumatic brain injury and three stroke subjects) were successfully recruited and received 10 sessions of VR-based community living skills training. All four subjects showed improvement in skills acquisition and memory performance, while three out of four also showed improvement in self-efficacy and demonstrated transfer of skills to the real environment. Usability was initially supported.

CONCLUSIONS

Preliminary results suggested positive changes in ABI subjects. The proposed virtual reality (VR) community living skills training software will be further investigated in a randomized controlled trial.

Prediction of functional rehabilitation outcomes in clients with stroke

OBJECTIVES

To evaluate the validity of the Neurobehavioral Cognitive Status Examination (NCSE or Cognistat) and to determine its effects in order to estimate the functional outcomes of survivors with stroke.

METHODS

The present study first studied the factor structure NCSE in 148 Chinese survivors with stroke (aged 45-91 years). They were admitted to hospital consecutively and recruited prospectively. The relationship of NCSE with Functional Independence Measures (FIM), a set of measures commonly adopted as an indicator of the outcome of rehabilitation, was studied.

RESULTS

One hundred and forty-eight patients with stroke (49.3% male, 50.7% female), with a mean age of 70.38 and an average number of years of education of 3.50 years joined the study. A two-factor NCSE structure was obtained, namely verbal-spatial and integrated cognition, accounting for 62.77% of the variance. A significant relationship between NCSE factors and the functional status of clients with stroke on admission and upon discharge, as well as age, years of education and length of hospital stay were indicated.

CONCLUSIONS

This study supports a systematic relationship between cognitive factors and functional outcome in Chinese patients with stroke. Similarities and differences in the NCSE factor structure between the population with stroke and general neurological populations were discussed and the utility of NCSE in stroke rehabilitation, such as its predictive validity in functional independence is suggested.

The measurement and magnitude of awareness difficulties after traumatic brain injury: a longitudinal study

Previous research suggests that reduced self-awareness is common following traumatic brain injury (TBI). However, few studies have examined the magnitude of this problem in a sample representative of hospitalized individuals. In this longitudinal study, individuals with complicated mild to severe TBIs and their significant others (SO) were evaluated at 1 and 12 months postinjury on the Sickness Impact Profile. Awareness was measured by comparing the level of injury-related problems reported by a person with TBI and their SO. Overall, individuals with TBI did not report fewer difficulties than their SO. In contrast, they frequently reported more injury-related difficulties than their SO. As there is no commonly or universally accepted definition for differential awareness, the magnitude of underreporting and over-reporting problems is presented using four different cutoff scores. A minimum discrepancy is proposed for defining awareness difficulties that is based on the standard error of measurement of the test-retest difference of the measure. Reduced self-awareness was inconsistent across both time and functional domains. These results suggest that reduced self-awareness is not the norm at 1 or 12 months postinjury and highlight the need for a more standardized approach to the measurement and classification of self-awareness.

Cognitive functions among Hong Kong Chinese people with schizophrenia

Persons with schizophrenia show deficits in a variety of cognitive domains including executive function, attention, memory and language. Similar interest in studying the impact of cognitive deficits on the everyday functioning of people with schizophrenia has been documented. This study examined the cognitive functioning among Hong Kong Chinese schizophrenic patients compared with other patient groups, and its relationship with functional outcome, especially in the social aspect. Results indicated that schizophrenic patients presented with mild cognitive problems compared with neurosurgical and demented patients. Initial support was found in relating cognitive functions, as measured by Neurobehavioral Cognitive Status Examination, with functional outcome as measured by Functional Independence Measures. The implication for community rehabilitation is also discussed.