Validity of the Internet-Based Bill-Paying Task for Assessing Executive Functions (EF) in Adults With Traumatic Brain Injury (TBI)

Abstract

Date Presented 04/04/19

Executive function (EF) deficits following traumatic brain injury (TBI) negatively affect independence in daily living. The use of performance-based assessments are recommended. This cross-sectional study compared the performance of the Internet-based bill-paying task in adults with TBI to healthy adults and correlated this task to WebNeuro computerized assessment and independence in daily living. The bill-paying task has construct and initial criterion validity to assess EF deficits after TBI.

Primary Author and Speaker: Yael Nadler Tzadok

Additional Authors and Speakers: Rotem Eliav

Contributing Authors: Sigal Portnoy, Debbie Rand

PURPOSE: Executive function (EF) deficits are the main consequences of Traumatic brain injury (TBI) (Centers for Disease Control and Prevention, 2015) and can contribute to poor community, social and occupational integration (Faul, Xu, Wald, & Coronado, 2010; Lezak, 2004). Traditionally, neuropsychological assessments have been considered the gold standard to assess EF deficits (Hahn et al., 2014). However, these assessments have been criticized as having limited ecological validity, i.e. limited ability to generalize to real-world functioning (Burgess et al., 2006). Therefore, it is important for practitioners to use performance-based assessments relevant to performance in the real world (Connor & Maeir, 2011; Hahn et al., 2014).

The Executive Function Performance Test (EFPT) is a well-known performance-based assessment that assesses EF deficits (Baum et al., 2008). The bill payment task from the EFPT was modified for internet use and can be freely downloaded: https://www.tau.ac.il/∼portnoys/Internet-based_Bill_Paying_Task.html. This task provides quantitative performance data in addition to the traditional scoring of the assessment. Alternative-form reliability, construct and criterion validity for the Internet-based Bill-Paying task were verified in different populations (Rand, Ben-Chaim, Malka & Portnoy, 2018).

The aims of this study were to establish construct validity & criterion validity of Internet-based Bill-Paying task for adults with TBI.

DESIGN AND METHOD: A cross-sectional study including two groups of participants.

Participants with TBI (n=42) were recruited from a rehabilitation center, using convenience sampling. Inclusion criteria were age >18 years, basic computer skills and preserved basic cognitive abilities. Healthy, independent participants (n=47) with 12 years of education and previous use of computers were recruited by advertisements. Exclusion criteria for all participants were epilepsy, psychiatric or neurologic conditions.

The Internet-based Bill-Paying task-was administered to all participants. Scoring of each EF components is based on the level of cueing, ranging from 0 (no cue) to 5 (do for the participant) higher scores indicate more EF deficits (Baum et al., 2008). In addition, time on each web page (secs), number of mouse clicks, and mouse travel distance were registered. Adults with TBI were also administered the Webneuro computerized assessment battery (Brain Resource Ltd., 2010) to assess EF deficits. Their independence in basic activities of daily living was assessed using the Functional Independence Measure (FIM: Keith, Granger, Hamilton, & Sherwin, 1987).

Mann-Whitney U test was conducted to assess differences between groups. Spearman correlations were used to assess associations between the Internet-based task to the WebNeuro subtests and the FIM for the participants with TBI. The statistical level was set at p< .05.

RESULTS: All participants were able to complete the Internet-based Bill-Paying task. significant differences were found between groups; participants with TBI were significantly slower (t=-4.8, p<.01) and scored higher scores, indicating EF deficits (t=-5.6, p<.01). In the TBI group, significant correlations were found between Internet-based Bill-Paying task and the Stroop and Maze subtests (r=0.33, r=0.51, p<.01, respectively) of the WebNeuro and with the FIM scores (r=-0.41, p<.01).

CONCLUSION: The internet-based Bill-Paying task is a feasible and challenging task to detect EF deficits in adults with TBI. The use of this ecological valid task may contribute to a better understanding of the cognitive profile and daily functioning of adults recovering from a TBI. Therefore, the use of this task is recommended. Further research is needed.

References

Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards D. F. (2008). Reliability, validity, and clinical utility of the executive function performance test: A measure of executive function in a sample of people with stroke. The American Journal of Occupational Therapy, 62(4), 446-455.

Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., & Morse, P. A. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives of physical medicine and rehabilitation, 81(12), 1596-1615.

Rand, D., Ben-Chaim, K., Malka, R., & Portnoy, S. (2018). Development of Internet-based Tasks for the Executive Function Performance Test. The American Journal of Occupational Therapy. 72, 1–8. https://doi.org/10.5014/ajot.2018.023598