Date Presented 03/27/20
This study examined the association between total time to complete the WCPA and the number of cognitive strategies used and total errors on the test. Results suggest that more time taken on the WCPA may increase the number of cognitive strategies used, but it may not necessarily result in improved overall test performance. These findings support the importance of understanding factors that contribute to successful performance and interpretation of WCPA scores.
Primary Author and Speaker: Timothy Marks
Contributing Authors: Vanessa Everson, Meaghan Leighton, Shelby Manor, Lionel Palomar, Guadalupe Rivas, Muhammad Al-Heizan, Dorothy Farrar Edwards
PURPOSE: Occupational therapists often use performance-based assessments to identify functional cognitive deficits that may impact an individual’s ability to independently complete basic and instrumental activities of daily living (Giles, Edwards, Morrison, Baum, & Wolf, 2017). In order to manage cognitively challenging tasks, many individuals employ strategies to increase the probability of successful occupational performance (Toglia, Rodger, & Polatajko, 2012). The purpose of this study was to explore the effect of time on total strategy use and total errors made when completing a test of functional cognition.
DESIGN: This study used a cross-sectional design to assess a convenience sample of 197 healthy, community-dwelling older adults. Inclusion criteria were: age 55 years or older, living independently in the community, and able to read and communicate in English. Convenience sampling was used to recruit participants via study flyers posted throughout the community in addition to in-person recruitment at community events, senior centers, and word-of-mouth referrals from study participants.
METHOD: Participants were administered the Weekly Calendar Planning Activity (WCPA), a performance-based measure of functional cognition. Published percentile scores were used to establish three groups based on total time to complete the WCPA: participants who completed the assessment in 11 minutes or less (70th percentile and above), between 11 minutes and 20 minutes (between 30th percentile and 70th percentile), and 20 minutes or more (30th percentile and below). Analysis of covariance (ANCOVA) was conducted to determine whether the groups differed in terms of mean number of strategies used and mean number of errors made on the assessment.
RESULTS: The participant sample was predominantly female (76.1%) and white (80.7%), with a mean age of 70.36 (SD = 8.24). There was a significant difference in mean number of strategies used, F(2, 191) = 12.96, p < .001, between groups controlling for age, education, and WCPA accuracy. Post-hoc pairwise comparisons indicated a significant increase in total strategy use between participants who took more than 20 minutes to complete the WCPA and those who took between 11 and 20 minutes (p < .001), and between participants who took more than 20 minutes and those who took less than less than 10 minutes (p < .001). However, there was no significant difference in total errors made, F(2,192) = .96, p = .39, between time groups, after adjusting for age and education.
CONCLUSION: We found that individuals who took more time to complete the WCPA used more cognitive strategies. Conversely, increased time and increased strategy use did not result in better WCPA performance as measured by the total number of errors made on the assessment.
IMPACT STATEMENT: While the amount of time spent completing a performance-based functional cognitive assessment may not be indicative of test performance, clinicians can gain valuable insight regarding strategy use by observing how an individual uses their time while completing the test.
References
Giles, G. M., Edwards, D. F., Morrison, M. T., Baum, C., & Wolf, T. J. (2017). 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(5), 7105090010p1. doi:10.5014/ajot.2017.715001
Toglia, J. P., Rodger, S. A., & Polatajko, H. J. (2012). Anatomy of cognitive strategies: A therapist’s primer for enabling occupational performance. Canadian Journal of Occupational Therapy, 79(4), 225-236. doi:10.2182/cjot.2012.79.4.4
