Cognitive Assessment in Occupational Therapy: A Qualitative Analysis

Abstract

Importance: Standardized evidence-based cognitive assessments, including functional cognitive assessments, are key to the identification of cognitive impairments and provision of occupational therapy services.

Objective: To explore the current practices related to cognitive assessments and barriers to their use in acute care and inpatient rehabilitation occupational therapy services.

Design: We used a cross-sectional, qualitative approach that included five focus groups conducted with occupational therapy practitioners and key informant interviews with occupational therapy supervisors (n = 5). Data were analyzed by two coders using an inductive content analysis approach.

Setting: Acute care and inpatient rehabilitation hospitals.

Participants: Occupational therapy practitioners (N = 31).

Results: Customary cognitive assessment included use of self- and proxy report measures, neurocognitive screening tools, and skilled observation. Use of standardized tests, including performance-based tests (PBTs), was limited. Barrier-related themes endorsed by most participants included organizational pressures, accessing and using evidence, conforming to the setting’s culture, characteristics of the built environment, and assessment complexity. An outlier group that relied heavily on performance-based functional cognitive tests was identified.

Conclusions and Relevance: Current occupational therapy practice primarily consists of informal, unstandardized methods of identifying cognitive impairments. Use of standardized assessment is infrequent. Personal and organizational barriers identified were consistent with those identified in the literature. Despite endorsing identified barriers that are perceived as constraining their use, an outlier group consistently used PBTs of functional cognition. This outlier group’s negotiation of barriers presents opportunities for how to target evidence-based implementation efforts.

Plain-Language Summary: This article describes occupational therapists’ current practices related to the use of cognitive tests. We asked therapists about factors that affect their use of different types of formal cognitive tests; specifically, we looked at the use of pencil-and-paper cognitive tests versus tests that use simulated real-world activities to assess function. Occupational therapists reported many barriers to using cognitive tests of either type, including a lack of time, difficulty accessing tests, and unfamiliar tests that are hard to learn. Most therapists predominantly use informal methods of assessing client’s cognition or pencil-and-paper screening methods. One group differed in that its members mostly used formal assessments of simulated real-world tasks to evaluate the ability to perform everyday life tasks.

This article describes occupational therapists’ current practices related to the use of cognitive tests.

In both acute and postacute care (PAC) settings cognitive impairments have been identified as risk factors for falls, increased length of stays, functional decline, and preventable 30-day hospital readmissions (Fogg et al., 2019; Muir et al., 2012; Zhu et al., 2017). Cognitive impairments occur at rates of 15%–35% in adults hospitalized for acute care and are a known sequela of many of the diagnoses treated in inpatient rehabilitation PAC settings (Joray et al., 2004). Despite the significant rate and associated risks of cognitive impairment, use of standardized cognitive screening and more comprehensive assessments in acute care and PAC settings is rare (Rouch et al., 2024), and when such assessments are administered they may be inadequate (Abzhandadze et al., 2021). Other than the Brief Interview for Mental Status, which has been found to be insensitive to mild cognitive deficits (Harmon & Gillen, 2023; Li et al., 2022), in PAC settings less than half of patients are documented to have been evaluated for cognitive impairment. Rouch et al. (2024) reported that less than 2% of patients in PAC settings had been evaluated with standardized assessments based in any discipline.

Occupational therapy practitioners in both acute care and PAC settings generally focus on activities of daily living (ADLs), which are fundamental to independent living skills (Bode et al., 2004; Latham et al., 2006; Smallfield & Karges, 2009). In this context, cognitive impairments severe enough to affect completion of instrumental ADLs, including medication management, attending medical appointments, and meal preparation, may be overlooked (Arieli et al., 2022). Proxy and patient reports may fail to identify newly occurring deficits in hospitalized patients (Marcotte et al., 2022). Observation of ADL performance may also be insufficient to detect milder but still-significant forms of cognitive deficit. Edwards et al. (2006) reported that 30%–40% of a sample of patients discharged from an acute care stroke unit had mild cognitive deficits that went unrecognized by clinicians prior to discharge. Furthermore, 50% of a sample of older adults who had elective surgery, and close to 84% of a sample of older adults admitted to an acute care unit with a cardiopulmonary diagnosis, showed evidence of executive dysfunction when tested prior to discharge (Buslovich & Kennedy, 2012).

Standardized measures available for use by occupational therapists fall into two categories. First are pencil-and-paper–based neurocognitive screening tests (e.g., the Montreal Cognitive Assessment [MoCA; Nasreddine et al., 2005], Short Blessed Test [Katzman et al., 1983]), which isolate and serially assess cognitive functions (e.g., attention, memory) and are the type most often used by occupational therapists (Burns & Neville, 2016; Manee et al., 2020). Neurocognitive screening tests are brief but are not intended to guide intervention and typically provide limited information about self-awareness and self-regulatory skills that are important for independent community living. Second are performance-based tests (PBTs) of functional cognition (e.g., the Executive Function Performance Test [Baum et al., 2008], Weekly Calendar Planning Activity [Toglia, 2015]), which measure cognition by observing how a test-taker performs a simulated real-world activity (American Occupational Therapy Association, 2019); as such, they are consistent with the philosophical foundations of occupational therapy. PBTs of functional cognition appear to add to the information derived from neurocognitive screening measures (Arieli et al., 2022; Goverover et al., 2020; Priestley & Manchester, 2020) and may allow for the assessment of self-awareness and self-regulatory skills. They also have been found to better predict real-world functioning. Such functional cognitive measures assess an individual’s capacity to perform real-world tasks given the totality of their abilities (including their use of strategies, habits and routines, and environmental resources; Wolf et al., 2019).

Qualitative studies have been used to establish the barriers to and facilitators of occupational therapy practices (Rouch et al., 2022, 2024; Ward et al., 2024). Little is known about the factors that influence the adoption of standardized measures of cognition or functional cognition in clinical practice. Several studies of the use of cognitive assessment in occupational therapy have been conducted; however, because of differing key variables across studies (geographic location, included clinical population, setting), further research is critical if a full understanding of the current practice of cognitive assessment in occupational therapy is to be achieved (Goodchild et al., 2021; Manee et al., 2020; Stigen et al., 2018). In the United States, Rouch et al. (2024) evaluated the general use of cognitive assessment in PAC through semistructured interviews with rehabilitation therapists. In addition, Burns and Neville (2016) used a survey to evaluate cognitive assessment use in home health care for populations with mild stroke. Health care policies and insurance vary greatly by country; thus, further evaluation of cognitive assessment in the United States is warranted. Given the importance of the use of screening tests for cognitive disorders in acute care and PAC settings, we wanted to achieve an in-depth understanding of the facilitators of and barriers to their use specifically in occupational therapy practice. To this end, we conducted a qualitative analysis of focus group feedback and data from key informant interviews to explore the current use of neurocognitive and functional cognitive measures and the facilitators of and barriers to their use in acute care and inpatient rehabilitation occupational therapy settings.

Method

Research Design

We conducted a cross-sectional, qualitative study to explore current practices and perceived barriers to the use of cognitive assessments in acute care hospitals and inpatient rehabilitation facilities. This work aligns with a pragmatic, interpretive descriptive conceptual framework using the lived experiences of participants to provide practical, discipline-specific results in a clinical setting (Thorne et al., 2004). We used a dual approach that consisted of focus groups conducted with occupational therapy practitioners and key informant interviews with rehabilitation supervisors to capture both clinician and management perspectives. We selected a qualitative approach to gather in-depth information that can inform future research questions and implementation efforts (Krueger & Casey, 2014; Rouch et al., 2022). We used focus groups with occupational therapy practitioners (ranging in size from four to six participants) and key informant interviews with supervisors to reflect the realities of team structure in everyday practice. The research focused on acute care and inpatient rehabilitation care phases because they occur first in the care continuum. Five focus groups and five key informant interviews were conducted across two midwestern states, in acute care and inpatient rehabilitation facility settings and at university-affiliated and non-university–affiliated sites.

We assessed our own positionality relative to the data (Merriam et al., 2001). The authorship team consists of occupational therapists (Anna E. Boone, Gordon M. Giles, Timothy S. Marks, Timothy J. Wolf) and a psychologist (Dorothy Farrar-Edwards). All of us possess expertise in functional cognition with a history of work related to PBT. Participants were informed of our position, and the purpose and funding of the research, at the outset of each focus group or interview.

Participants

Occupational therapy practitioners and supervisors were recruited through word of mouth and cold contact with area hospitals and inpatient rehabilitation facilities. Institutional review board approval was obtained, and all participants provided written informed consent. Focus group participants were occupational therapy practitioners and had been employed in an adult acute care or inpatient rehabilitation setting for ≥6 mo. Key informants met the same criteria but with the addition that they had been employed as an occupational therapist or rehabilitation supervisor for >1 yr.

Procedure

Audio data were recorded using secure Zoom video conferencing and auto-transcription. Data were collected in acute care settings (two focus groups, three key informant interviews), inpatient rehabilitation settings (two focus groups, one key informant interview), and one setting in which both acute and inpatient rehabilitative services were provided (one focus group, one key informant interview). Focus groups and interviews consisted of three phases: (1) welcome/introduction, during which the moderator introduced themselves and outlined the ground rules and study purpose; (2) a discussion guided by moderator questions and follow-up prompts; and (3) closing (Krueger & Casey, 2014). Questions were predetermined after a review of the existing literature and investigator brainstorming and refinement (Table A.1 in the Supplemental Material, available online with this article at https://research.aota.org/ajot). In an effort to ensure clinically actionable findings for future dissemination efforts, questions focused both on what was occurring and the factors influencing what was occurring (Thorne et al., 2004).

Data Analysis

We used NVivo (Version 14) data analysis software. Data were analyzed by two investigators (Boone and Marks) using an inductive content analysis approach (Elo & Kyngäs, 2008). Positioned within an interpretive design approach that focuses on lived experiences (Thorne et al., 2004), an inductive content analysis generates themes through analysis of patterns within the data (Elo & Kyngäs, 2008). The two investigators first completed a process of data immersion by thoroughly reading through all transcripts. Next, an initial coding frame was jointly developed. The coding frame was then revised iteratively through frequent debriefings between analysts and with content experts. To establish intercoder reliability, a transcript was randomly selected for dual coding. Intercoder reliability exceeded our a priori threshold of 80%; therefore, we proceeded to independently code the remaining transcripts. Twenty-five percent (n = 2) of the remaining transcripts were randomly selected for dual coding (O’Connor & Joffe, 2020). Final intercoder reliability for each of the dually coded transcripts exceeded 80%.

We followed the coding strategy outlined by Corbin and Strauss (2015). Codes were first established using open coding and a constant-comparison process (Corbin & Strauss, 2015; Sbaraini et al., 2011). After open coding, relationships between codes were analyzed using axial coding. Focus group and key informant interview data were analyzed together. During the coding process, consistent findings for cognitive assessment practices were found across all sites and between therapists and key informants. This was true except for one focus group and one key informant who differed from the others; that is, one acute care site differed from other sites in its extensive use of PBTs. Because of this divergence, we analyzed the qualitative data from the outlier group (the PBT group) separately from rest of the data (the customary care group) to allow for comparisons between perceived barriers.

Results

Focus group participants (n = 26) were predominantly master’s-level trained occupational therapy practitioners with a mean of approximately 7 yr of experience in occupational therapy overall and in their current setting. Key informants (n = 5) were occupational therapy practitioners with a mean of approximately 22 yr of experience in occupational therapy and 12 yr in their current setting (Table A.2 in the Supplementary Material). The PBT group was located at an acute care hospital affiliated with a university and did not notably differ from participants located at other sites included in this study.

Practices and Beliefs About Cognitive Assessment

Throughout this section, themes are identified, and representative quotes are provided. The quotes were selected to represent a general consensus during the focus group discussions and the key informant interviews. Themes are represented in graphic form in Figures 1 and 2. Shared themes by both the PBT group and the customary care group are presented first, followed by themes that were specific to either group.

Figure 1.

Practices and beliefs related to cognitive assessment.

Figure 2.

Perceived barriers to cognitive assessment.

Practices and Beliefs Shared by the Customary Care and PBT Groups

There were three themes shared by the customary care and the PBT groups with respect to practices and beliefs about cognitive assessment. Both groups reported multiple patient factors that influence decision making about cognitive assessments. Patient factors included diagnosis and medical stability, degree of cognitive impairment, anticipated discharge location, and level of support. Factors specific to individual patients, such as mobility, vision, hearing, and language abilities, also influenced the selection and timing of cognitive assessment. As an example, a therapist explained the impact of mobility: “The patient acuity level can limit their mobility, walking around and doing different things. We might be limited to the side of the bed, what you would do right there.”

In both groups, therapists consistently described use of nonstandardized functional cognitive assessments. This is illustrated by one participant, who stated, “[The assessment] is not standardized by any means. Basically, we just set up a whole bunch of hazards in the kitchen. [The patient has] to identify them and then correct them.” The third shared theme was methods of assessment; however, because of differences present in the subthemes, in the following sections we present the respective subthemes separately for the customary care and PBT groups.

Practices and Beliefs of the Customary Care Group Only

The customary care group articulated several methods of cognitive assessment, including frequent use of pencil-and-paper neurocognitive screening tools. The most frequently used screening tools were the MoCA, the Short Blessed Test, and the Saint Louis University Mental Status Exam (Tariq et al., 2006). A participant described their use of multiple pencil-and-paper neurocognitive screening tools as follows: “If … the Short Blessed Test isn’t capturing some of the deficits I’m noticing elsewhere and I kind of want to prove, then I’ll do the MoCA.” In addition, skilled observation of task performance was generally acknowledged as a common cognitive assessment method. A typical description of general skilled observation of cognitive abilities was provided: “Kind of [interacting] with people on my list and getting a general picture of how they’re interacting with you, following commands, following cues.” Finally, use of self- and proxy reports of cognitive abilities as compared with baseline was described as a common assessment method, with one participant explaining, “I use prior level of function [as a baseline]. [I ask] them about the prior level of function to evaluate their attention and memory and compare their answers to what their family might give if they’re in the room.”

Two themes emerged as influencing cognitive assessment: (1) new ideas come from newcomers and (2) protocol-driven assessment. Participants reported that one primary way they became aware of new cognitive assessments was through new employees or fieldwork students: “We have a lot of students who come through, so there is this regular information flow into the team.” Protocol-driven assessment also contributed to test selection, such as when a specific test is required when one is evaluating a patient for the presence of a particular diagnosis. A typical statement provided by a participant emphasized protocol-driven assessment for the population with stroke:

More of a[n assessment] protocol, because that is what the Short Blessed is for us. … It is our protocol for seeing a stroke patient. Probably very few people forget to do the Short Blessed with their stroke [patients], because that’s the first thing on our minds.

Practices and Beliefs of the PBT Group Only

The PBT group differed with respect to the methods of cognitive assessment that emerged as subthemes. Participants in this group outlined the use of a staged approach to cognitive evaluation that involved continuing skilled observation of task performance plus the potential use of multiple performance-based cognitive assessment and screening tools: “I rarely do a formalized assessment on my eval. I’ll quite often do an informal, like three-step task or something to get my own kind of read to then be able to gauge what assessment to bring later.” The results of these initial steps then informed selection of performance-based assessments. An example of the stepwise use of a performance-based testing was described as “Using the Medi-Cog just to kind of get an idea,” followed by a more comprehensive performance-based assessment: “We’re not supposed to use the MoCA anymore or any more of the written kind of things. I’ll usually use the Kettle Test, pillbox [test], or [the Executive Function Performance Test].”

Therapists acknowledged the frequent interruptions and distracting environments that are common in acute care and inpatient rehabilitation settings: “In our day-to-day [work], we have a lot of interruptions, like, we get a phone call, and it’ll distract us from something.” However, the group consensus also framed this as reflective of the cognitive demands of everyday life (i.e., the face validity of functional cognitive assessments). The PBT group also referenced the facility supports of a team structure, including a hierarchy of clinical positions that depend on expertise level, associated pay raises when one moves up an expertise level, and protected time for learning and implementing evidence-based procedures. As one participant stated, “I am supposed to get project time … being able to locate new, different tests, be able to find new things.” The occupational therapy supervisor strongly advocated for the use of standardized PBTs and discouraged the use of neurocognitive screening tools by the occupational therapy team.

Perceived Barriers to Cognitive Assessment

Perceived Barriers Shared by the Customary Care and PBT Groups

Both the customary care group and the PBT group identified several barriers to the use of cognitive assessments. These perceived barriers were identified both for non-performance–based and performance-based assessments. Assessment complexity was commonly reported as being a barrier to clinical implementation because of the increased cognitive burden it placed on therapists; specifically, additional training and more online awareness are required from the therapist when using PBTs that involve dynamic interaction (i.e., structured verbal cueing to guide performance). The impact of assessment complexity on clinical use was illustrated in the following statement: “We have so many patients to see. You don’t have the time or the cognitive load available to be able to think about ‘What did I see?’ [or] ‘What exactly does that mean?’” Participants described difficulty matching patient needs to the wide range of available PBTs. Similarly, electronic documentation support, such as keyboard shortcuts with template language, were needed to ease the burden of documenting PBTs.

Both groups also identified the built environment and assessment materials as barriers; specifically, the availability and organization of testing materials, infection control, and size and portability of materials were reported as challenges: “We only have one [test]. It’s a hot commodity. Sometimes you may go to use it, find it unclean, [and] clean it, and then doing it again takes a lot of extra time.” The social environment was also reported to influence occupational therapy practitioner behavior with pressure to conform to the practice culture. This was described as moving forward with the procedures that are customary if no reason to alter established behaviors present themselves. Of note is that therapists also discussed a discrepancy between what they had been taught in school and what they faced in everyday practice.

A theme emerged that related to the challenges of accessing and using evidence to inform cognitive assessment, including the need for a more thorough evidence base, increased availability of knowledge and materials in clinical practice, and support for clinical implementation. A participant described difficulties in access to evidence:

We don’t know what assessments are out there. We don’t know what to look for. It’s not like our supervisor says, “Here is this new cool cognitive assessment.” If we do not have access, we do not know about it, so we do not do anything about it.

Organizational pressures were identified as a barrier to use of evidence-based cognitive assessment. There was a strong pressure to focus on patients’ physical impairments and self-care. Similarly, the principal importance of physical capacity in determining whether further rehabilitation is needed or covered by insurance was underscored: “If [the patient’s requirement ranges from] contact guard assist to [minimal] assist, a lot of times inpatient or insurance will say no. So, cognition is not a factor, but we know it is a huge factor.” Similarly, participants expressed a mismatch between the limited time available for assessment and intervention and the extent of patients’ needs. Organizational pressures also included other aspects of time, such as length of stay and an overall lack of time for research and training. Finally, a disjointed continuum of care and an inability to follow up on cognitive assessment findings were identified as barriers.

Perceived Barriers of the Customary Care Group Only

A final theme of the unclear role of occupational therapy in cognitive assessment was identified by the customary care group. A lack of clarity on the role of occupational therapy in cognition was highlighted: “I’m still educating my own residents and physicians on what occupational therapy even is and its role in cognition. They call me [a physical therapist] and I am like, ‘I am an occupational therapist.’” Participants described their role in cognitive assessment as not being valued because it was duplicative of speech therapy services. The distinct role of occupational therapy was difficult to delineate and to explain to other health professionals. Buy-in of other occupational therapy team members and of patients was identified as critical for the successful uptake of performance-based cognitive assessments. The lack of clarity with respect to occupational therapy’s role, coupled with time pressures, led to the common practice of referring patients to speech therapy practitioners for cognitive evaluation. Participants also expressed a pressure to conform to the practice’s setting culture and continue with existing procedures for cognitive assessment even though they often differed from those learned during their educational experience. The pressure to continue with existing day-to-day practices of a setting were emphasized:

We are often run so ragged that I stick to what I know, and I stick to what I can do perfectly. If I’m carrying upwards of 15 to 20 patients, I’m literally going to go in and work to the lowest of my degree.

Perceived Barriers of the PBT Group Only

The PBT group expressed the importance of team familiarity with measures for ease of interpreting results: “A lot of our doctors like the number. … They like the score on those assessments. They know what the assessment is, so they know what the score means.” The participants described the need to advocate for a new, potentially unfamiliar cognitive assessment to other members of the rehabilitation team and the health care team.

Discussion

In this study, we explored current practice related to cognitive assessment in acute care and inpatient rehabilitation occupational therapy settings and identified perceived barriers to implementing evidence-based cognitive assessments. The existing evidence suggests that occupational therapists endorse the value of PBTs but do not routinely implement them (Abzhandadze et al., 2021; Burns & Neville, 2016; Goodchild et al., 2021; Pilegaard et al., 2014; Rouch et al., 2024). One large retrospective study found that 44% of patients admitted for acute stroke care were not screened for cognitive changes (Abzhandadze et al., 2021). The present study’s finding of an outlier group that used performance-based screening and diagnostic cognitive tools was surprising and offers a unique opportunity to describe facilitators of their use.

The majority of respondents who made up the customary care group, and the outlier PBT group, used skilled observation and facility-created nonstandardized tests, although the use of these informal assessment methods varied between groups. This finding is consistent with the work of Goodchild et al. (2021) and Burns and Neville (2016), who found informal assessment to be the most common method in acute care settings and home health occupational therapy, respectively. Consistent with prior literature, when standardized tests were used most participants (i.e., those in the customary care group) primarily used neurocognitive, pencil-and-paper screening tools. Mirroring prior qualitative literature (Ward et al., 2024), the majority of participants in both groups viewed cognitive assessment as a process that extends beyond a single cognitive test and requires ongoing skilled observation. However, the customary care and PBT groups differed with respect to how the steps of cognitive assessment are conceptualized. The customary care group typically reported outsourcing further cognitive concerns to speech therapy practitioners supplemented with ongoing skilled observation or repeated cognitive screening. In contrast, the PBT group reported the use of a functional cognitive screener to inform the next steps of formal functional cognitive assessment.

Respondents uniformly shared the perspective that functional cognition is a key domain for occupational therapy to address and central to the profession’s scope of practice. In the customary care group, the precise boundaries of the role of occupational therapy in cognition were blurred, as evidenced by the common practice of deferring to speech therapy practitioners. This lack of intraprofessional clarity may contribute to other health care team members’ uncertainty about the role of occupational therapy in cognition.

It is interesting that although PBT usage differed, similar barriers were identified across groups. Organizational pressures were reported as constraining occupational therapy practitioners’ interest in exploring the literature and implementing new assessment methods. For example, participants decried the impact of short stay lengths, multiple domains to address, and productivity demands that limited the time available to explore such topics. The effect of competing priorities in acute care settings is evidenced in the existing literature, which has shown, for example, that patients in acute stroke care who are unable to walk independently are less likely to undergo cognitive screening (Abzhandadze et al., 2021). Insufficient time was further identified as limiting therapists from using methods that are less familiar and more difficult to implement.

Some differences in perceived barriers emerged between the customary care and PBT groups. Although both groups acknowledged the unpredictability of the acute care and inpatient rehabilitation environments, the PBT group perceived the frequent interruptions as unfortunate but also reflective of everyday life. Similarly, both groups described the anxiety that cognitive evaluation can evoke in patients. The customary care group expressed concern that PBTs risk damaging therapeutic rapport; however, the PBT group perceived the high ecological validity of PBTs as actually mitigating these psychosocial concerns. With respect to different interpretations of barriers, the PBT group benefited from several advantages that may support their assessment practices. First, the rehabilitation supervisors served as team champions for initiating and maintaining use of PBTs. Second, the site structured therapy positions in tiers through which a therapist can be promoted on the basis of expertise and performance contributions. Finally, the management team discouraged the use of neurocognitive cognitive screening by occupational therapy practitioners.

The dependability of this study’s findings is enhanced by the recruitment of participants across multiple sites and different states, the use of multiple coders and double coding, and the triangulation of data through transcripts and multiple data sources. However, the clinical sites were all located in the midwestern United States and may not be representative of practices in other regions or practice settings.

Implications for Occupational Therapy Practice

This study has the following implications for occupational therapy practice:

Occupational therapy practitioners recognize the importance of functional cognition as it relates to occupational performance; however, standardized assessment of functional cognition is infrequent.

Clinical sites and management teams can use implementation strategies, such as financial and employment incentives, dedicated clinician administrative time, and active championing of functional cognition, to support the enhanced use of PBTs.

Conclusion

This study adds to our knowledge about the state of practice for cognitive assessment and factors that affect clinical decision making. The occupational therapy practitioners in this study embraced the importance of functional cognition as key to occupational performance, with informal assessment methods being the most common. They reported that pencil-and-paper neurocognitive screening tools are used more frequently than PBTs to assess functional cognition. An understanding of the perceived barriers to the use of PBTs will provide a starting point for implementing strategies to address practice gaps. Knowing how users of PBT have overcome barriers illustrates a way to catalyze the use of PBTs across the profession.

Supplemental Material

Supplemental Information

Supplementary material for Cognitive Assessment in Occupational Therapy: A Qualitative Analysis

Supplementary material, sj-pdf-1-aot-10.5014_ajot.2025.051112.pdf for Cognitive Assessment in Occupational Therapy: A Qualitative Analysis by Anna E. Boone, Timothy S. Marks, Timothy J. Wolf, Gordon M. Giles and Dorothy Farrar-Edwards in The American Journal of Occupational Therapy

Footnotes

Acknowledgments

This research has been supported in full with an AOTF Implementation Research Grant (AOTFIR22Boone) funded by the American Occupational Therapy Foundation.

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