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Improving prediction of rehabilitation outcomes by establishing ecological validity for neuropsychological assessment instruments

Abstract:
1. Executive Function Evaluation in Persons with Traumatic Brain Injury:
Ecological Validity of Five Neuropsychological Tests

Primary Objective: To evaluate the ecological validity of five neuropsychological tests of executive function. Research Design: Comparison of neuropsychological tests and year one post-injury outcome measures. Methods and Procedures: 51 Traumatic Brain Injury (TBI) Model System participants were administered the Controlled Word Association Test (COWAT), Ruff Figural Fluency Test (RFFT), Wisconsin Card Sorting Test (WCST), Delis-Kaplan Executive Functioning System (DKEFS) Sorting Test (DKEFS: ST), and DKEFS Twenty Questions Test (DKEFS: TQ) at one year post-injury follow-up. Outcome measures including the Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Craig Handicap Assessment and Reporting Technique – Short Form (CHART-SF) were also collected at one year post-injury follow-up. Multivariate stepwise linear regressions were used to examine the relationships between outcome measures and neuropsychological tests. Main Outcomes and Results: Tests of executive function accounted for 37.5% of the variance in DRS scores with significant contributions from the WCST, RFFT, and DKEFS: ST (Confirmed Correct Sorts). The FIM model accounted for 35.6% of the variance with significant contributions from the WCST, RFFT, and DKEFS: ST (Description Score). The CHART-SF model accounted for 35.3% of the variance with significant contributions from the WCST, and DKEFS: TQ (Weighted Achievement Score). Conclusions: Each of the WCST, RFFT, DKEFS: ST, and DKEFS: TQ tests contributed unique variance within the three outcome measures providing support for their ecological validity and complimentary use in the evaluation of executive functions after TBI.

2. Speed of Processing Deficits Associated with Traumatic Brain Injury

Primary Objective: To evaluate the predictive and the concurrent ecological validity of
Neuropsychological speed of processing tests. Research Design: Comparison of neuropsychological tests and year one post-injury outcome measures. Methods and Procedures: 50 Traumatic Brain Injury (TBI) Model System participants were administered the California Computerized Assessment Package (CalCAP), Symbol Digit Modalities Test and the Trail Making Test Part A and Part B during acute rehabilitation, and then again at one year post-injury follow-up. Outcome measures including the Disability Rating Scale (DRS), Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), and Craig Handicap Assessment and Reporting Technique – Short Form (CHART-SF) were also collected at one year post-injury follow-up. Multivariate stepwise linear regressions were used to examine the relationships between neuropsychological tests and outcome measures. Main Outcomes and Results: Acute rehabilitation speed of processing tests were predictive of all four outcome measures. Symbol Digit Modalities Test scores accounted for 15% of the variance in the DRS; CalCAP scores accounted for 21% of the variance in the FIM; CalCAP and Symbol Digit Modalities Test scores together accounted for 20% of the variance in the GOS; and CalCAP and Trail Making Test scores together accounted for 21% of the variance in the CHART-SF. Year one post-injury speed of processing tests were also predictive of all four outcome measures. CalCAP and Trail Making Test scores together account for 21% of the variance in the DRS; CalCAP, Symbol Digit Modalities Test and Trail Making Test scores together accounted for 51% of the variance in the FIM; CalCAP and Trail Making Test scores together accounted for 31% of the variance in the GOS; and CalCAP scores accounted for 10% of the variance in the CHART-SF. Conclusions: Findings from this study support the predictive and concurrent ecological validity of the CalCAP, Symbol Digit Modalities Test, and Trail Making Test, and further demonstrate the critical consequence of speed of processing in regards to long-term outcome after TBI.

Registry Project Number: 225
Lead Investigator: Schraa, J
Lead Center for Project: Craig Hospital
Collaborating Investigators: Gerber, D, Cusick, C
Keywords: neuropsychology, rehabilitation, outcome, executive functioning, prediction
Date of Completion: 09/30/2002
Type: Local
Status of Project: Latest Information Shown

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