Date Presented 04/05/19
Primary Author and Speaker: Brittany Nguyen
Contributing Authors: Muhammad Al-Heizan, Hayley Engel, Courtney Smith, Erika Hoffman, Timothy Marks, Gordon Giles, Dorothy Farrar Edwards
PURPOSE: Performance-based tests (PBTs) of functional cognition allow occupational therapists (OTs) to observe and evaluate an individual’s functional performance of tasks based on complex, cognitively challenging real-world activities (Giles, Edwards, Morrison, Baum, & Wolf, 2017). Despite increased evidence supporting the effectiveness of PBTs in assessing functional cognition, research comparing outcome differences between PBT formats (i.e., structured versus unstructured PBTs) is limited (Morrison, Edwards, & Giles, 2015). Structured PBTs instruct participants to complete a set tasks following a step-by-step format, whereas unstructured PBTs instruct participants to complete a set tasks following an open-ended format. Each PBT format provides its own unique utility and benefits for assessing functional cognition; thus, the purpose of this study is to evaluate differences in performance between structured and unstructured PBTs among community-dwelling older adults.
DESIGN: A convenience sample of 200 healthy, community-dwelling older adults (ages 55 and older) were included in this cross-sectional design. Demographics of this population included an average age of 70.42 years (SD = 8.27) and average years of education of 15.09 (SD = 3.04). Additionally, participants were 76.1% female and 79.6% white.
METHOD: Participants completed four PBTs of functional cognition, which included two structured and two unstructured PBTs. We examined performance relationships between the following pairs of PBTs : (1) the structured, revised-Medication Transfer Screen (revised-MTS) and the unstructured Menu Task (MT), and (2) the structured Performance Assessment of Self-Care Skills (PASS) and the unstructured Weekly Calendar Planning Activity (WCPA).The first pair of measures (revised-MTS and MT) are used as screening tools and the second pair of measures (PASS and WCPA) are used as assessment tools. Scale-specific criterion cutoff scores were used to categorize participants into pass and fail groups for each of the four measures. Chi-square analyses were used to compare performance across the two groups of structured and unstructured tests.
RESULTS: In the comparison of the screening tools, 23% of participants failed the structured revised-MTS and 37% failed the unstructured MT. Among assessment tools, 49.5% of participants failed the structured PASS and 17.9% failed the unstructured WCPA. Chi-square tests for independence (with Yates Continuity Correction) demonstrated that the difference in percentages between structured and unstructured screening tools (revised-MTS and MT, respectively) was significant, (X
2
= 31.23, p < .001). Similarly, the difference in percentages between unstructured and structured assessment tools (PASS and WCPA, respectively) was also significant, (X
2
= 14.42, p < .001).
CONCLUSION: On the assessment tools, the results suggest that older adults were more likely to fail the structured than the unstructured PBT of functional cognition. However, on the screening tools, older adults were more likely to fail the unstructured than the structured PBT of functional cognition.
IMPACT STATEMENT: Further examination of preliminary results with a larger sample is underway to assess impact of item type on predictions of functional outcomes. It is important for OTs to examine demand characteristics of screening tools and diagnostic assessments as they select measures of functional cognition.
References
Edwards, D. F., Wolf, T. J., Al-Heizan, M. O., Marks, T., Maloney, S., Larkin, V., … Giles, G. M. (in press). Reliability and validity of a functional cognition screening tool to identify the need for occupational therapy. American Journal of Occupational Therapy.
Giles, G. M., Edwards, D. F., Morrison, M. T., Baum, C., & Wolf, T. J. (2017). Health policy perspectives--Screening for functional cognition in postacute care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. American Journal of Occupational Therapy, 71, 7105090010p1-7105090010p6. https://doi.org/10.5014/ajot.2017.715001
Morrison, M. T., Edwards, D. F., & Giles, G. M. (2015). The Issue Is—Performance-based testing in mild stroke: Identification of unmet opportunity for occupational therapy. American Journal of Occupational Therapy, 69, 6901360010p1-6901360010p5. http://dx.doi.org/10.5014/ajot.2015.011528
