Assessing the Impact of Real-Life Cognitive Functioning in the Home: Development and Psychometric Study of the Multiple Errands Test–Home

PURPOSE: Occupational therapists are afforded the opportunity to assess the impact of disability in naturalistic environments. Hartman-Maeir, Katz, and Baum (2009) stressed the importance of assessing the home environment for adults with suspected cognitive impairments because the environment can optimize or hinder performance. Executive function impairments related to mild stroke are often difficult to identify with paper-and-pencil assessments and activity of daily living (ADL) evaluations (Morrison, Edwards, & Giles, 2015). The purpose of this presentation is to describe the development and preliminary psychometric properties of an assessment used to categorize and quantify the impact of executive dysfunction for adults with mild and moderate stroke in the home environment.

DESIGN: This study examined the validity and reliability of the Multiple Errands Test (MET)–Home. Adults with mild and moderate stroke (n = 23) and healthy control participants matched for gender, age, and education (n = 12) were assessed within their home. Purposive and snowball sampling was used to identify participants in three metropolitan areas. Adults with stroke were included if they had no history of other neurological impairments, < moderate depression on the Beck Depression Inventory (BDI–II), no dementia with the Short Blessed Test (SBT), chronicity >3 mo, living at home >30 days, and independent with ADLs prior to stroke. Healthy control participants were included if they had no history of neurological impairments, < moderate depression on the BDI–II, no presence of dementia with the SBT, living at home >30 days, and independent with ADLs.

METHOD: The MET–Home was developed on previous versions of the MET (Shallice & Burgess, 1991) and was modified to fit the home through a comprehensive literature review and interviews with adults with mild and moderate stroke (n = 10). The tool went through an expert panel review and was piloted by five home health occupational therapists across the United States. Revisions were made to the tool prior to the psychometric study.

Adults with stroke and healthy control participants participated in a 3-hr in-home testing visit with the following assessments: MET–Home, Executive Function Performance Test (EFPT), Reintegration to Normal Living Index, Delis–Kaplan Executive Function System (D–KEFS) Tower Test, D–KEFS Card Sorting, Symbol Digit Modalities Test (SDMT), Behavioural Assessment of the Dysexecutive Syndrome Dysexecutive Questionnaire, and Montreal Cognitive Assessment (MoCA). To assess reliability, two raters independently watched video-recorded performance of the MET–Home and scored performance. (Validity study is still in progress.)

RESULTS: Face and content validity were established through the expert panel and interviews with adults with mild and moderate stroke. Interrater reliability was evaluated on four subscores of the MET–Home: tasks accurately completed, frequency of rule breaks, frequency of passes, and frequency of inefficiencies. Intraclass correlation coefficients (ICCs) were high (ICCs = .88–.94) with 95% confidence intervals, indicating excellent interrater reliability. Preliminary analysis suggests strong correlations at the .01 level between MET–Home Accuracy and EFPT total score and between MET–Home Accuracy and SDMT score. Preliminary findings also suggest a moderate correlation at the .05 level between the MET–Home Omitted and MoCA Delayed Recall subcomponent.

CONCLUSION: The preliminary findings suggest the MET–Home is a psychometrically sound tool that can categorize and quantify the impact of executive dysfunction in the home environment while enabling the evaluator to examine the relationship between context and performance. This tool can be used in the home environment as a means of assessing performance that extends beyond routinized tasks in the familiar environment.

References

Hartman-Maeir, A., Katz, N., & Baum, C. M. (2009). Cognitive Functional Evaluation (CFE) process for individuals with suspected cognitive disabilities. Occupational Therapy in Health Care, 23, 1–23. https://doi.org/10.1080/07380570802455516

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. https://doi.org/10.5014/ajot.2015.011528

Shallice, T., & Burgess, P. W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114(Part 2), 727–741. https://doi.org/10.1093/brain/114.2.727