Date Presented 04/03/2025
The study provides psychometric data to support the clinical use of the IADL-Context-Based Cognitive Flexibility Assessment (ICFA), the first cognitive flexibility assessment based in the context of instrumental activities of daily living (IADLs). The ICFA can be used as a useful reference to design suitable cognitive flexibility interventions for individuals with mental disorders.
Primary Author and Speaker: Lin-Jye Huang
Contributing Authors: Hui-Fen Mao, Yi-Hong Yang, Shu-Chun Lee, Yi-Ching Wu, Chien-Te Wu
PURPOSE: We previously developed ICFA, with a high content validity, to evaluate clients’ spontaneous and reactive cognitive flexibility (CF) in mental health OT. Here, we aim to further examine the psychometric properties of the ICFA in individuals with schizophrenia.
DESIGN: A cross-sectional study of 112 adult participants (mean age 43.8 y/o; 66 females) with a diagnosis of schizophrenia or schizoaffective disorder.
METHOD: Each participant completed ICFA (5 question modules with 2 Parts in each module), Alternatives Use Task (AUT), Cognitive Flexibility Inventory (CFI), Wisconsin Card Sorting Test (WCST), and Activities of Daily Living Rating Scale III (ADLRS III), and were assessed with PANSS, MoCA, and ACLS. Eighty-seven participants were retested with the ICFA after an interval of at least two weeks. The psychometric properties of ICFA were evaluated with internal consistency, test-retest reliability, and criterion validity.
RESULTS: ICFA Part I and Part II scores showed good internal consistencies (Cronbach’s α = 0.833 and 0.899) and adequate test-retest reliabilities (r = 0.73 and 0.82, p < 0.01). ICFA also showed good criterion validities: a high correlation between ICFA part I and AUT (r = 0.70, p <0.01), a moderate negative correlation between ICFA part II and perseverative errors in WCST (r = −0.47, p <0.01), and alternative scores of CFI (r = −0.45, p <0.01). Both Part I and II of ICFA positively correlated with ADLRS III (r = 0.55 and 0.59, p <0.01), MoCA (r = 0.59 and 0.70, p <0.01), and ACLS (r = 0.28 and 0.45, p <0.01), but negatively correlated with negative symptoms in PANSS (r =−0.55 p <0.01).
CONCLUSION: Current data suggests that ICFA is a valid and reliable instrument for evaluating CF in mental health practice.
IMPACT STATEMENT: CF is critical for adaptive behaviors in daily living and an important indicator for clients’ long-term outcomes. ICFA provides a useful clinical reference to design suitable CF interventions in individuals with mental disorders.
References
Huang, L. J., Mao, H. F., Yang, Y. H., & Wu, C. T. (2024, March). Development and validation of the IADL-context-based cognitive flexibility assessment (ICFA) for individuals with schizophrenia with Delphi method. Poster session presented at the American Occupational Therapy Association’s Annual Congress and Expo, Orlando, FL, USA. https://doi.org/10.5014/ajot.2024.78S2-PO40
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