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Advanced Neurology Cognitive assessment using performance-based tests

review found a large variation in the pragmatic aspects of some occupational therapists to choose brief screening
the assessments, such as time required for administration tests. For example, assessment using a microwave or an
and physical environments required such as kitchens or electric cook plate may be clinically indicated but is not
bathrooms. For qualified health professionals, the choice of always safe or possible in an acute ward. This may lead
assessments should not be based solely on practical issues occupational therapists to use shorter screening tests
of individual assessments, nor the usual practices in the that are performance-based. The risk of using a shorter
organization, but on the best available research evidence. test is that occupational therapists may fail to detect mild
However, a systematic review of the measurement properties impairments of cognition, which may impact subsequent
of PBTs for patients who had TBI could not recommend support or rehabilitation access. An alternative option may
specific assessments based on psychometric data and be to develop shorter versions of existing comprehensive
recommended further consideration of feasibility factors assessments to suit time constraints in an acute care setting.
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affecting assessment use. This scoping review attempted This review has several limitations. Assessments
to summarize factors relevant to acute care occupational designed for use with populations other than patients who
therapists when comparing assessments of cognitive function have had a TBI were excluded, and relevant assessments
with patients following TBI. PBTs that are quick to administer, may have been missed. The search strategy was targeted
such as the menu task, actual reality test, and weekly calendar to include articles with patients with TBI, and as such,
planning activity, have good potential for use in acute care, as assessments designed for use with stroke or acquired brain
they use a degree of novel problem-solving, are inexpensive, injury populations may have been missed. This review
can be used at the bedside, and present alternatives to focused on a defined range of clinical applicability criteria
traditional kitchen-based assessments. This review was available in the assessment articles, which is a limitation.
limited to assessments that met inclusion and exclusion It is acknowledged that an assessment’s applicability to
criteria as defined for this study. Additional assessments may patients encompasses other criteria not reported in the
exist that are used by acute care occupational therapists but data, and these were beyond the scope of this review,
were excluded from this review due to their apparent limited such as respondent burden, format compatibility, and
application for use on an acute care ward (e.g., assessments assessment popularity. 13,15 Assessments were excluded if
requiring access to community shops). they required geographical access to home or community
It is important to test patients with items relevant to shops; however, assessments were not excluded based on
their context and occupational history to ensure patient time taken to administer, and, arguably, an assessment that
motivation and valid outcomes. Assessments have the requires an hour or more is not practical in acute care. The
methodological quality of assessments was not included
potential for gender and cultural bias based on their content. in this review, as this was the subject of earlier systematic
An individual’s performance may be unduly affected by reviews. 7,13,14 In their systematic review, Kristensen et al.
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their work history or educational background. Where an highlighted that there are limited studies of psychometric
assessment requires a prescribed task to be administered, properties for PBTs of cognitive function, which restricts
maintaining the relevance of task items becomes an issue. the ability to make recommendations about which
Checkbooks are present in three included assessments; assessments to use. Attempts were made to comment on
while they remain a common financial practice in America the quality of reporting and methodology of the included
and Canada, many patients in Australia do not use checks. articles referencing 18 assessments. To supplement the
The NAT was modified to suit the Korean population, with findings of the scoping review, the QuADS appraisal
the modified version substituting assessment tasks such tool was used; however, its effectiveness is dependent
as “wrapping a present” with “folding laundry.” Although on published methodology data. Virtual reality (VR)-
assessments may be modified to suit the cultural norms based assessments were excluded and are an area for
of the country where they will be used, this process can separate review and further research, especially regarding
be time-consuming and limit future comparisons with the comparison to real-world environment observations
original tests’ psychometrics. and examination of the ecological validity of VR. This
Comprehensive assessments, such as the PRPP, review has highlighted the need for a wider exploration
AMPS, and performance of self-care skills, undoubtedly of assessments developed for other populations and their
provide client-centered, occupation-based evaluations potential suitability for patients following TBI.
of an individual’s cognition. However, the time required
to complete and score comprehensive assessments 6. Conclusion
may prohibit their use on an acute ward, despite valid Providing evidence to estimate a patient’s cognitive
information gained. Time pressures in acute care will lead functioning in real-world environments following discharge

Volume 4 Issue 1 (2025) 66 doi: 10.36922/an.4508