A Qualitative Study of the Instrumental Activities of Daily Living for Mild Cognitive Impairment and Caregivers

Inter-Rater Reliability of the Pizzi Health and Wellness Assessment (PHWA)

The objective of this study is to determine the inter-rater reliability of the Pizzi Health and Wellness Assessment (PHWA) by comparing the consistency in scores between clients and their caregivers in the following areas of participation: social, physical, family, occupational, mental/emotional, and spiritual. A retrospective inter-rater correlational design was used to analyze the agreement of scores from a convenience sample consisting of two groups: clients with disabilities (n = 19) and their healthy caregivers (n = 19). Inter-rater reliability was calculated using correlations for the PHWA as a whole, and for the current level of participation and wishing to improve participation subsections. Inter-rater reliability as calculated by an Intraclass Correlation Coefficient, and either the Pearson or Spearman rho correlation and found to be reliable between clients and caregivers (rICC = .636, p < .001; rho = .642, p < .001). More specifically, current level of participation demonstrated acceptable reliability (rICC = .513, p < .001; r = .521, p < .001) as did wishing to improve participation (rICC = .689, p < .001; r = .725, p < .001). This supports the PHWA as a clinically relevant health and wellness occupational therapy assessment.

High-Ecological Cognitive Intervention to Improve Cognitive Skills and Cognitive-Functional Performance for Older Adults With Mild Cognitive Impairment

IMPORTANCE

Evidence of the effectiveness of cognitive activity and preparatory tasks in improving the cognitive skills and functional performance of people with cognitive decline is limited.

OBJECTIVE

To examine the efficacy of a high-ecological cognitive intervention.

DESIGN

Quasi-experimental, pretest-posttest design with nonequivalent control.

SETTING

Community.

PARTICIPANTS

Older adults with mild cognitive impairment from two senior centers.

INTERVENTION

Twelve 90-min weekly group sessions of a high-ecological cognitive intervention using simulated everyday cognitive tasks (experimental group) and of nutrition education (active control group). Outcomes and Measures: Cognitive skills were measured with the Color Trails Test (CTT), the Contextual Memory Test (CMT; Immediate Recall [CMT-Im] and Delayed Recall [CMT-De] tasks), and the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span subtest (Digits Forward and Digits Backward). Cognitive-functional performance was measured with the Rivermead Behavioural Memory Test-Third Edition (RBMT-3; Immediate Recall [RBMT-3-Im] and Delayed Recall [RBMT-3-De] tasks) and the Cognitive Failures Questionnaire (CFQ).

RESULTS

Thirty-seven participants (M age = 70.84 yr; 70.3% women) met the inclusion criteria for analysis (20 participants in the intervention group, 17 participants in the control group). Multivariate linear regression showed that the intervention group improved significantly more than the control group on the CTT, CMT-Im, and RBMT-3-Im but not on the CMT-De, RBMT-3-De, and CFQ.

CONCLUSIONS AND RELEVANCE

Twelve 90-min weekly group sessions of a high-ecological cognitive intervention improved attention, executive function, immediate memory, and objective cognitive-functional performance with immediate-memory task demands. What This Article Adds: Carefully designed and structured simulated everyday cognitive tasks can be used as a cognitive training agent to improve both cognitive skills and objective cognitive-functional performance. The effectiveness of group-based cognitive interventions depends on the skills of occupational therapy practitioners in activity analysis and grading.