Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The Menu Task Assessment is a brief, reliable, and valid functional cognitive assessment designed for use by OTs in both the acute- and the postacute-care environment. This poster describes the feasibility of its use in an inpatient heart failure population, as well as the prevalence of cognitive dysfunction and association between Menu Task Assessment score and discharge disposition.
Primary Author and Speaker: Malachy James Clancy
Additional Authors and Speakers: Megan Drollinger
PURPOSE: Prevalance of cognitive dysfunction in the heart failure patient population is estimated at 25–75% (Dodson, et al., 2013). While pen and paper assessments exist to assess cognitive impairment in the heart failure population, these assessments do not incorporate performance based components that are more representative of real world activities. The Menu Task Assessment (MTA) is a brief, reliable, and valid functional cognitive assessment designed for use by Occupational Therapists in both the acute and post-acute care environment (Edwards, et al., 2019). The primary purpose of our preliminary study was to assess the feasibility of the MTA in an inpatient heart failure population. Our secondary aim was to understand the difference between the score of the MTA and discharge disposition.
METHODS: After IRB approval, we utilized a prospective cohort design via convenience sampling to recruit patients for participation. Subjects were recruited from an 800 bed, urban, academic medical center during their initial occupational therapy evaluation if they had a primary diagnosis of heart failure during their hospitalization, were independent in ADL's prior to admission, over 18 years of age, and could read and write in English.
METHOD: During subsequent follow-up treatment sessions, subjects were administered the Montreal Cognitive Assessment (MoCA) and then the MTA in their hospital room. All Occupational Therapists involved in the study have completed training for the MoCA. We utilized descriptive statistics to explore characteristics of subjects and Mann Whitney U Test to assess the relationship between MTA scores on discharge disposition.
RESULTS: A total of 15 patients (8 females), ranging in ages from 39–79 (mean: 62.4±SD) completed both the MoCA and MTA. The majority of patients (n = 10, 66.7%) completed high school. Most subjects presented with New York Heart Association (NYHA) Class III (n = 8), with a mean Left Ventricular Ejection Fraction (LVEF) of 32% (SD: 18.6). The MoCA took on average 8 minutes and 34 seconds (SD: 2:03) to complete and the MTA took on average 5 minutes (SD: 1.45 minutes) to complete. Thirteen (86.6%) subjects scored below normal on the MoCA, compared to only 10 (66.7%) subjects scoring impaired on the MTA. A Mann-Whitney U Test revealed no significant difference in the MTA score of those discharging home (n = 13) and to a skilled nursing facility (n = 2), U = 18, z = .88, p = .476, r = .23.
CONCLUSION: While a small sample, the results demonstrate a high prevalence of cognitive dysfunction in this cohort of inpatients diagnosed with heart failure. The MTA was a highly feasible functional cognitive assessment that on average took approximately 5 minutes to administer. However, we found no statistical association between the score on the MTA and discharge disposition.
IMPACT STATEMENT: The implementation of functional cognitive assessments is of extreme importance for Occupational Therapists. The MTA is a highly feasible outcome measure that will improve the ability of Occupational Therapists to assess a patients cognitive functioning and provide targeted skilled rehabilitation services for that individual's unique deficits.
References
Dodson, J. A. Truong, T. N., Towle, V. R., Kerins, G., & Chaudhry, S. I. (2013). Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes. American Journal of Medicine, 126, 120–126. https://doi.org/10.1016/j.amjmed.2012.05.029.
Edwards, D. F., Wolf, T. J., Marks, T., Alter, S., Larkin, V., Padesky, B. L., et al. (2019). Reliability and validity of a functional cognition screening tool to identify the need for Occupational Therapy. American Journal of Occupational Therapy, 73(2), 7302205050. https://doi.org/10.5014/ajot.2019.028753.
