School of Medicine and Health Sciences Poster Presentations
Document Type
Poster
Status
Graduate Student - Doctoral
Abstract Category
Rehabilitation and Recovery
Keywords
measurement, stroke, cognition, rasch analysis
DOI
10.13140/RG.2.2.34375.55202
Publication Date
Spring 2019
Abstract
The purpose of this work is to create a cognitive measure detecting change in cognitive deficits for post-acute stroke patients. Many individuals with stroke experience cognitive impairment contributing to ongoing disability. Identifying change in cognitive skills in response to treatment is important for demonstrating the value of rehabilitation services. Yet, the ability of federally mandated post-acute assessments to detect change has not been described. A total of 147 stroke patients in post-acute care receiving rehabilitation services were assessed using 26 cognition items from the federally mandated assessments. Rasch analysis, using the partial credit model, was conducted to evaluate the construct validity of these items. The standardized effect size (ES), response mean (SRM), and minimal detectable change (MDC) were calculated using MedCalc. Six items created a logical hierarchy for the cognition construct. Two items--long-term and short-term memory—represented the easiest and hardest items, respectively. The remaining items are problem-solving, memory, decision-making, and cognitive function. Evidence of good construct validity: Eigenvalue=2.13, unexplained variance in first contrast=7.5%, and person separation reliability of 0.87, person strata=3.8. Evidence of person-item alignment: adequate person fit, moderate ceiling effect, and person mean=1.53. Evidence of responsiveness: improvers (n=74) large ES 0.72, large SRM 1.19, 10% of patients made a change beyond the MDC. The six identified cognitive items from the federally mandated post-acute care assessment tools represents a continuum of cognitive performance areas, from foundational arousal skill through higher level problem-solving. Advancing meaningful, precise cognitive assessment will help identify effective occupation-based cognitive skill training strategies for stroke survivors.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Open Access
1
Developing a Cognition Scale Using Items from Three Federally Mandated Assessments in Post-Acute Care
The purpose of this work is to create a cognitive measure detecting change in cognitive deficits for post-acute stroke patients. Many individuals with stroke experience cognitive impairment contributing to ongoing disability. Identifying change in cognitive skills in response to treatment is important for demonstrating the value of rehabilitation services. Yet, the ability of federally mandated post-acute assessments to detect change has not been described. A total of 147 stroke patients in post-acute care receiving rehabilitation services were assessed using 26 cognition items from the federally mandated assessments. Rasch analysis, using the partial credit model, was conducted to evaluate the construct validity of these items. The standardized effect size (ES), response mean (SRM), and minimal detectable change (MDC) were calculated using MedCalc. Six items created a logical hierarchy for the cognition construct. Two items--long-term and short-term memory—represented the easiest and hardest items, respectively. The remaining items are problem-solving, memory, decision-making, and cognitive function. Evidence of good construct validity: Eigenvalue=2.13, unexplained variance in first contrast=7.5%, and person separation reliability of 0.87, person strata=3.8. Evidence of person-item alignment: adequate person fit, moderate ceiling effect, and person mean=1.53. Evidence of responsiveness: improvers (n=74) large ES 0.72, large SRM 1.19, 10% of patients made a change beyond the MDC. The six identified cognitive items from the federally mandated post-acute care assessment tools represents a continuum of cognitive performance areas, from foundational arousal skill through higher level problem-solving. Advancing meaningful, precise cognitive assessment will help identify effective occupation-based cognitive skill training strategies for stroke survivors.