Date Presented 03/23/24
This study's outcome will yield the first cognitive flexibility assessment in instrumental activities of daily living (IADL) contexts worldwide, offering crucial insights into investigating IADL context-based cognitive flexibility and the diverse interpretations of executive functions.
Primary Author and Speaker: Lin-Jye Huang
Contributing Authors: Hui-Fen Mao, Yi-Hong Yang, Chien-Te Wu
PURPOSE: This study developed an IADL-context-based cognitive flexibility assessment (ICFA) for individuals with schizophrenia, addressing the crucial yet under-emphasized need for cognitive flexibility in daily life.
BACKGROUND: Cognitive flexibility (CF) is a vital function for occupational competence and is typically impaired in individuals with schizophrenia. However, a proper CF assessment tool in real-life contexts is currently lacking. We hereby proposed ICFA to evaluate spontaneous and reactive flexibility in the contexts of potential challenges in IADLs.
DESIGN: We examined the expert validity of the ICFA through two rounds of reviews following the Delphi method, which was implemented to facilitate consensus among experts regarding the functional domains covered in ICFA development. The review board was formed with experts with at least ten years of experience in occupational therapy education or psychiatric practice.
METHOD: Using a 5-point Likert scale, experts evaluated the testing items for each question set, focusing on suitability, conceptual relevance, and feasibility. Scores of 4 or 5 signified expert agreement, with a Content Validity Index (CVI) threshold of ≥ 0.78. Each question set underwent a suitability vote for inclusion in ICFA.
RESULTS: Data from fourteen experts were used to refine the ICFA. After round 1 review, CVIs for relevance (0.79-1.00) and suitability (0.64-1.00) were obtained. Subsequently, we refined the remaining sets by excluding three question sets from the initial eight and enhancing the rest. In round 2, two categorical question sets were added, but only one was retained, leading to higher CVIs for relevance (0.93-1.00) and suitability (0.79-1.00). The final ICFA comprises six question sets, each addressing a distinct IADL context.
CONCLUSION: ICFA holds promise for evaluating CF in mental health practice. The tool may also inspire novel cognitive interventions targeting improving CF for people with mental disorders.
References
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Delahunty, A., Morice, R., & Frost, B. (1993). Specific cognitive flexibility rehabilitation in schizophrenia. Psychological Medicine, 23(1), 221-227.
Gibson, R. W., D’Amico, M., Jaffe, L., & Arbesman, M. (2011). Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: A systematic review. The American Journal of Occupational Therapy, 65(3), 247-256.
Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing & health, 30(4), 459-467.
