Date Presented 4/21/2018
The Functional Cognitive Assessment is a standardized cognitive performance assessment that is criterion referenced and administered during everyday tasks. This study established the content-oriented validity evidence of the Functional Cognitive Assessment.
Primary Author and Speaker: Alyssa Ford
Additional Authors and Speakers: Beth Ann Walker, Candace Beitman
BACKGROUND AND PURPOSE: Users of the cognitive disabilities model incorporate a battery of assessments to assess the cognitive abilities of clients. Nonstandardized skilled observation is a method of observing functional abilities during everyday activities (McCraith et al., 2011). For users of the cognitive disabilities model, no protocols are currently in place to standardize clinician cues or observations during skilled observation of clients who have Alzheimer’s disease or related dementias. The Functional Cognitive Assessment is a standardized cognitive performance assessment that is criterion referenced and administered during the completion of specific areas of occupation (Ebell et al., 2016). The Functional Cognitive Assessment was specifically designed for clients who have Alzheimer’s disease or related dementias (ADRD). Psychometric testing is needed to establish content validity and utility of this tool. The purpose of this study was to determine the content validity of the Functional Cognitive Assessment.
RESULTS: This study used a cross-sectional design with a web-based survey to obtain feedback about the representativeness and clarity of items during the evaluation phase of the Functional Cognitive Assessment. Ten subject matter experts anonymously responded to a survey comparing the test items to the construct of functional cognition; these experts had at least an associate’s degree and either had published papers or presented at a state, regional, or national meeting on the topic of implementing the cognitive disabilities model with clients who have ADRD or had experience in psychometric testing. Experience in psychometric testing was an inclusion criterion in the hope that participants would be able to provide additional information regarding test construction. Rehabilitation professionals who did not meet the above criteria were considered for inclusion as a lay expert if they had ≥5 yr of work experience using the cognitive disabilities model with older adults who have ADRD.
RESULTS: The data were analyzed to determine an item-level content validity index, scale content validity index, item factor validity index, scale factor validity index, and interrater agreement. Item-level content validity indices ranged from .70 to .90 for representativeness. The scale content validity index was .80. Factor validity indices ranged from .90 to 1.00 for each subtask. The overall factor validity index was .98. Interrater agreement ranged from .66 to .90 for each subtask, indicating good to excellent agreement.
CONCLUSION: Results of this study indicate that the Functional Cognitive Assessment demonstrates evidence of content validity. The Functional Cognitive Assessment could eventually be used to aid physicians in identifying the core clinical criteria associated with the diagnosis of dementia or Alzheimer’s disease dementia (McKhann et al., 2011). Occupational therapy practitioners who use the Functional Cognitive Assessment with clients who have ADRD can share recommendations with caregivers about the client’s best ability to function and make safety recommendations. Practitioners can share information with caregivers about the specific verbal, visual, and tactile cues that are useful to maximize the client’s performance, thereby decreasing the risk of excess disability and reducing the risk of hospital readmissions.
References
Ebell, C., Ford, A. A., & Warchol, K. (2016). Standardized administration and scoring manual for the Functional Cognitive Assessment. Milwaukee, WI: Crisis Prevention Institute.
McCraith, D. B., Austin, S. L., & Earhart, C. A. (2011). The cognitive disabilities model in 2011. In N. Katz (Ed.), Cognition, occupation, and participation across the life span: Neuroscience, neurorehabilitation, and models of intervention in occupational therapy (3rd ed., pp. 383–406). Bethesda, MD: AOTA Press.
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., . . . Phelos, C. H. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Journal of the Alzheimer’s Association, 7, 263–269. https://doi.org/10.1016/j.jalz.2011.03.005
