The role of executive functions and psychiatric symptom severity in the Allen Cognitive Levels

Psychometric Properties of Two Tasks in the Allen Cognitive Level Screen-Sixth Edition for Community-Dwelling People Living With Schizophrenia

IMPORTANCE

Empirical evidence is needed on the psychometric properties of the Allen Cognitive Level Screen-Sixth Edition (ACLS-6), an instrument that assesses cognitive functions and is commonly used for people living with schizophrenia.

OBJECTIVE

To examine the convergent validity, discriminative validity, and test-retest reliability of two tasks, stitching and copying, in the ACLS-6 for community-dwelling people living with schizophrenia.

DESIGN

Prospective observational study.

SETTING

Psychiatric center.

PARTICIPANTS

110 people living with schizophrenia.

OUTCOMES AND MEASURES

To examine convergent validity, we calculated correlations (Pearson's r) between the two tasks and between these two tasks and three cognitive measures. We checked for floor and ceiling effects and conducted independent t tests to evaluate discriminative validity. We calculated intraclass correlation coefficients (ICCs) to investigate test-retest reliability.

RESULTS

We found a strong correlation (r = .88) between the two tasks and moderate correlations (rs = .32-.52) between the two tasks and the three cognitive measures. No floor or ceiling effects were observed for the two tasks, and t tests showed significant differences between two participant groups with marginal and mild clinical symptoms (p < .001). The ICC values for the two tasks were .71-.74.

CONCLUSION AND RELEVANCE

The stitching and copying tasks of the ACLS-6 have good convergent validity, discriminative validity, and test-retest reliability for community-dwelling people living with schizophrenia. The copying task showed a strong correlation with the stitching task and a similar score range, so practitioners can consider using the copying task as a substitute for the stitching task. What This Article Adds: The stitching and copying tasks of the ACLS-6 have sound psychometric properties for measuring cognitive functions in community-dwelling people living with schizophrenia.

The relationship between Motivation for Occupation and Pattern of Occupation scores of the MOHOST and types of discharge placement from a mental health rehabilitation unit

Introduction

Model of Human and Occupational Screening Tool (MOHOST) is a scale used to assess occupational functioning in mental health inpatients which can inform suitable post-discharge placements. However, there is little research on the relationship between scores on Motivation for Occupation (MO) and Pattern of Occupation (PO) subscales of the MOHOST and types of discharge placement.

Method

The records of all patients discharged over a 2-year period from a male psychiatric rehabilitation unit were examined. All patients had undergone MOHOST assessments; however, these scores were not a factor in their discharge placement selection. Analyses were done on types of discharge placements (transfer to another psychiatric unit or community discharge) versus predischarge scores in MO and PO of MOHOST.

Results

N = 20 and average length of stay was 23 months. There was positive correlation between MO and PO scores and discharge placements (rs = 0.66, p = 0.002; rs = 0.67 and p = 0.001, respectively). Using ordinal logistic regression, for each unit increase of negative score in PO, there was 0.68 increase in the log odds of more restrictive discharge placements, p = 0.008.

Conclusion

The study suggests that MOHOST is a useful tool in determining suitable placements for patients being discharged or transferred from psychiatric rehabilitation units.

Functional Performance and the Allen Cognitive Level Screen for Adults With Mental Illness: A Scoping Review

IMPORTANCE

Research involving the use of the Allen Cognitive Level Screen (ACLS) in mental health practice has been available for more than 40 yr, yet there has been no comprehensive synthesis and review of this body of literature.

OBJECTIVE

To review, summarize, compare, and evaluate the existing literature regarding the relationship between the ACLS and the functional and adaptive functional performance of adults living with mental illness.

DATA SOURCES

Searches with no date limits were conducted in the CINAHL, MEDLINE, PsycINFO, ProQuest, and OTseeker databases. Study Selection and Data Collection: A five-stage scoping review methodology was used to examine peer-reviewed English-language literature reporting on the relationship between ACLS scores and functional and adaptive functional performance of adults with mental illness. Information from 15 studies was charted, collated, and numerically and thematically summarized.

FINDINGS

A positive relationship between ACLS scores and in-the-moment performance was consistently reported. The relationship of ACLS scores to community living performance was less consistent. Methods of assessing performance, complexity of tasks assessed, and timing of assessments affected relationships with cognition as measured by ACLS. Gaps in the literature were identified.

CONCLUSIONS AND RELEVANCE

Findings raise questions about how, why, and when occupational therapists use the ACLS. Increased examination is needed of what aspects of performance and functional cognition reliably determine people's ability to live successfully in the community. What This Article Adds: This article provides the first synthesis of the existing literature on the relationship between ACLS scores and functional and adaptive functional performance of people living with mental illness.