Measurement properties of performance-based instruments for assessing mental function during activity and participation in persons with stroke: A systematic review

BACKGROUND

Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice.

OBJECTIVES

To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke.

MATERIAL AND METHODS

We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach.

RESULTS

Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test.

CONCLUSIONS

Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose.

SIGNIFICANCE

Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018086744.

Executive Dysfunctions in Schizophrenia: A Critical Review of Traditional, Ecological, and Virtual Reality Assessments

In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools, and to describe the neurobiological and psychopathological correlates. The analysis revealed that ecological and VR tests have higher levels of verisimilitude and similar levels of veridicality compared to traditional tools. Both negative symptoms and disorganization correlate significantly with executive dysfunction as measured by traditional tools, but their relationships with measures based on ecological and VR methods are still unclear. Although there is much research on brain correlates of executive impairments in schizophrenia with traditional tools, it is uncertain if these results will be confirmed with the use of ecological and VR tools. In the diagnosis of executive dysfunction, it is important to use a variety of neuropsychological methods—especially those with confirmed ecological validity—to properly recognize the underlying characteristics of the observed deficits and to implement effective forms of therapy.

Reliability and Validity of the Spanish Version of the Executive Function Performance Test (EFPT) in Assessing People in Treatment for Substance Addiction

IMPORTANCE

Assessing people's executive function (EF) during addiction treatment makes it possible to design individualized occupational goals.

OBJECTIVE

To determine the reliability and validity of the Spanish version of the Executive Function Performance Test (EFPT) in the occupational assessment of people being treated for substance addiction.

DESIGN

Cross-sectional, observational study to determine the EFPT's internal consistency as well as its convergent and discriminant validity with complementary tests.

SETTING

A public, free addiction treatment center operated by Madrid Salud (Madrid City Council, Spain).

PARTICIPANTS

Fifty-two people referred to an occupational therapy department for evaluation and intervention. Inclusion was based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) criteria for substance abuse or dependence; the exclusion criterion consisted of any circumstances that made it difficult for a person to understand or perform the test.

OUTCOMES AND MEASURES

The EFPT, other occupational tests (Allen Cognitive Level Screen-5, Lowenstein Occupational Therapy Cognitive Assessment), and a battery of neuropsychological EF tests.

RESULTS

The EFPT had an unequivocal unifactorial structure and showed strong correlations between its components and adequate consistency with the scales and the complete test. As expected, the EFPT correlated with the neuropsychological tests with a considerable effect size (-.40 < r < -.60).

CONCLUSIONS AND RELEVANCE

The EFPT's psychometric properties are adequate to assess the EF of people being treated for substance addiction from an occupational perspective using real activities of daily living (ADLs).

WHAT THIS ARTICLE ADDS

The results show that the EFPT can be used to assess performance of ADLs without needing to use tests from disciplines other than occupational therapy. Further studies in different sociocultural settings are needed to generalize the results.

Executive functioning: a scoping review of the occupational therapy literature

BACKGROUND

Increasingly recognized as an important factor in the performance of complex, goal-directed tasks, executive functioning is understood in different ways across disciplines.

PURPOSE

The aim was to explore the ways in which executive functioning is conceptualized, discussed, described, and implied in the occupational therapy literature.

METHOD

A scoping review of the occupational therapy literature was conducted following Levac, Colquhoun, and O'Brien's (2010) recommended methodology.

RESULTS

Executive functioning is described both as a set of performance component skills or processes and as the executive occupational performance inherent in complex occupations. Executive functioning is implicit in occupational performance and engagement, and some health conditions seem to be commonly associated with impaired executive functioning. Assessing executive functioning requires dynamic occupation- and performance-based assessment. Interventions targeting executive functioning are grounded in metacognitive approaches.

CONCLUSION

Executive functioning is a complex construct that is conceptualized with considerable variance within the occupational therapy literature, creating barriers to effective service delivery.

Effectiveness of executive functions training within a virtual supermarket for adults with traumatic brain injury: a pilot study

Impairments of executive functions (EF) significantly affect the ability to lead an independent lifestyle. Virtual environments offer a way to rehabilitate EF due to their ecological validity. The purpose of this pilot study was to examine the effectiveness of a virtual reality (VR) supermarket (VMall) for treatment of EF in patients with Traumatic Brain Injury (TBI), compared to conventional occupational therapy (OT), in order to provide initial data regarding the effect sizes for calculation of sample size as well as to establish an intervention protocol for future Randomized Control Trials (RCTs). Twelve men and women, aged 19-55 years, who had TBI resulting in EF impairments participated in this study. Outcome measures were the Multiple Errands Test-Simplified Version (MET-SV) and the Executive Function Performance Test (EFPT). Cognitive treatment provided to both groups was based on the same principles; the participants in the experimental group received 10 45-min VR-based treatment sessions and the control group participants received 10 sessions of occupational therapy cognitive retraining without VR. Baseline performance prior to intervention showed no statistically significant differences between groups. Most participants improved their performance after therapy. Following a Bonferroni correction for multiple comparisons, no significant between or within group differences were found, Nevertheless, large effect sizes (0.51) for the percent (%) relative change of the MET-SV total score and EFPT total score after intervention were high in favor of the experimental group indicating a larger improvement in EF. Based on this pilot study, results show a trend towards an advantage to VR therapy compared to cognitive retraining OT without VR, as it leads to greater improvement in complex everyday activities.

The ecological and construct validity of a newly developed measure of executive function: the Virtual Library Task

Virtual reality (VR) assessment paradigms have the potential to address the limited ecological validity of pen and paper measures of executive function (EF) and the pragmatic and reliability issues associated with functional measures. To investigate the ecological validity and construct validity of a newly developed VR measure of EF, the Virtual Library Task (VLT); a real life analogous task--the Real Library Task (RLT); and five neuropsychological measures of EF were administered to 30 patients with traumatic brain injury (TBI) and 30 healthy Controls. Significant others for each participant also completed the Dysexecutive Questionnaire (DEX), which is a behavioral rating scale of everyday EF. Performances on the VLT and the RLT were significantly positively correlated indicating that VR performance is similar to real world performance. The TBI group performed significantly worse than the Control group on the VLT and the Modified Six Elements Test (MSET) but the other four neuropsychological measures of EF failed to differentiate the groups. Both the MSET and the VLT significantly predicted everyday EF suggesting that they are both ecologically valid tools for the assessment of EF. The VLT has the advantage over the MSET of providing objective measurement of individual components of EF.

Validation of the Executive Function Route-Finding Task (EFRT) in People with Mild Cognitive Impairment

Reliability and validity of the Executive Function Route-finding Task (EFRT) with people diagnosed as having mild cognitive impairment was examined. Twenty-three people with mild cognitive impairment with a mean age of 77.4 (± 7.5) years and 23 healthy controls with a mean age of 74.3 (± 4.9) years participated. The EFRT was administered along with other tests for executive functions: Executive Interview and two subtests from the Executive Functions Performance Test (EFPT). Findings showed high inter-rater reliability for the EFRT. In addition, the control group performed significantly better on all tests, thus confirming the construct validity of the EFRT. However, further examination into the clinical significance of these findings is needed. Concurrent validity was partially demonstrated by low to moderate significant correlation between the EFRT and one subtest from the EFPT. The results of this study support the reliability and validity of the EFRT among people with mild cognitive impairment.