Date Presented 04/07/19
We conducted a validation study on a performance-based assessment of EF called Front Desk Duty in mild stroke patients. Preliminary findings suggest that FDD can be scored reliably and distinguishes between groups of healthy adults and those with mild stroke who fail an EF screen. This study expands the repertoire of available multitasking assessments, which will contribute to better identification of people with mild stroke who could benefit from OT intervention.
Primary Author and Speaker: Ginger Carroll
Additional Authors and Speakers: Romina Takimoto
Contributing Authors: Mary Radomski, Jerry Halsten, Shayne Hopkins, Kristen Johnson, Kristina Kath, Rob Kreiger, Amy Meyers, Stacey Rabusch
PURPOSE: We conducted a validation study on a performance-based assessment of executive functions (EF) called Front Desk Duty (FDD) for use with mild stroke (MS) patients. People who experience a MS are at-risk for having problems that go undetected. Most people discharged directly home from the hospital after MS are able to independently walk and swallow but an estimated 60% experience impaired EF that interferes with resumption of valued activities (Wolf et al., 2011). Performance-based measures that incorporate multitasking appear to be sensitive to detecting deficient EF after MS (Wolf et al., 2015). However, there are relatively few validated tests involving multitasking that meet requirements for clinical feasibility (Morrison et al., 2015).
DESIGN: This is a cross-sectional, case-control study in which we recruited healthy individuals (ages 35 – 80) and patients in the same age range who were hospitalized for a first-time MS (NIHSS score of 5 or less) prior to their discharge home.
METHOD: Data were collected at one session in two parts. For Part 1 the Behavioral Rating Inventory of Executive Function-Adult Version, the Quick Executive Interview, and the Trailmaking Test: Trails A and B were administered. The latter two tests were used as screens for executive dysfunction. Part 2 included the Wide Range Achievement Test Reading Test, the Tower of Hanoi, and the FDD, a performance-based multitasking test that challenges EF. The FDD is a civilian version of the Charge of Quarters Duty Test, which was developed to inform duty readiness after military concussion (Radomski et al., 2018). The FDD involves performing tasks associated with a simulated shift at a hotel. Performance metrics included completion time, performance accuracy, and number of trips between work areas. Two raters scored the first 7 participants’ FDD performance. Krippendorff’s alpha was used to examine inter-rater reliability. Stroke effect on outcomes of interest were evaluated using non-parametric methods. One test compared medians and two were based on comparing rank order. The sample was split into three distinct groups: those with no stroke; those with stroke, passing the EF screen; those with stroke, failing the EF screen.
RESULTS: A total of 86 participants completed the study protocol (47 with MS and 39 healthy controls). 19 (40%) of the participants with stroke failed the EF screen; 4 (1%) of the healthy controls did so. Paired-rater FDD score comparisons suggested strong interrater reliability (Krippendorff’s alpha 0.984 – 0.999). There were statistically significant differences in median scores for FDD completion time (p=0.012) and number of visits (p=0.049) for healthy controls and those with stroke who failed the EF screen. There were significant differences in performance accuracy between the aforementioned groups (p=0.019) as well as between those with MS who passed and failed the EF screen (p=0.030). The Jonckheere-Terpstra test revealed a rank-ordered pattern of the data across metrics and group.
CONCLUSION: The FDD demonstrated strong interrater reliability and preliminary validity by distinguishing between healthy controls and people with MS, both with and without deficient EF. Rank order data analyses suggest that even participants with MS who passed the EF screen may have performance decrements relative to healthy controls. While further study is needed, this suggests that the FDD may be better able to identify deficient EF after MS than EF screens.
IMPACT: This study expands the repertoire of multitasking assessments available to clinicians and researchers. Clinical use of reliable and valid multitasking assessments will assure that people with MS and EF disorders are identified and referred to OT for cognitive intervention.
References
Morrison, M.T., Edwards, D.F., & Giles, G.M. (2015). Performance-based testing in mild stroke: Identification of unmet opportunity for occupational therapy. American Journal of Occupational Therapy, 69, 6901360010. doi:10.5014/ajot.2015.011528.
Radomski MV, Davidson LF, Smith L, Finkelstein M, Cecchini A, Heaton KJ, McCulloch K, Scherer M, Weightman M M (2018). Towards return to duty decision-making after military mild traumatic brain injury: Preliminary validation of the Charge of Quarters Duty Test. Military Medicine. doi:10.1093/milmed/usx045.
Wolf, T.J., Barbee, A.R., & White, D. (2011). Executive dysfunction immediately after mild stroke. OTJR: Occupation, Participation, and Health, 31(1), S23 – S29. doi: 10.3928/15394492-20101108-05.
Wolf, T.J., Dahl, A., Auen, C., Doherty, M. (2015). The reliability and validity of the Complex Task Performance Assessment: A performance-based assessment of executive function. Neuropsychological Rehabilitation, 27(5), 707-721. doi: 10.1080/09602011.2015.1037771.
