Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

Focus Forward: Outcomes of a Brief Occupational Therapy Intervention for Cancer-Related Cognitive Dysfunction

Date Presented 3/30/2017

Results of this pilot and feasibility study indicate that women with breast cancer who received a brief occupational therapy intervention for cancer-related cognitive dysfunction experienced pre–post improvements in self-reported cognition and occupational functioning.

Primary Author and Speaker: Shayne Hopkins

Contributing Authors: Mary Vining Radomski, Marsha Finkelstein, Mattie Anheluk, Kristin Berling, Michele Darger, Kim Grabe, M. Tracy Morrison, Joette Zola, Nancy Hutchison

Performance-Based Testing in Mild Stroke: Identification of Unmet Opportunity for Occupational Therapy

Age at first stroke is decreasing, and most strokes are mild to moderate in severity. Executive function (EF) deficits are increasingly recognized in the stroke population, but occupational therapists have not altered their evaluation methods to fully accommodate changing patient needs. We present a hierarchical performance-based testing (PBT) pathway using data to illustrate how PBT could identify patients with mild stroke-related EF deficits in need of occupational therapy intervention. Data suggest that a substantial number of patients with EF deficits after mild stroke could benefit from occupational therapy services.

Multiple Errands Test-Revised (MET-R): a performance-based measure of executive function in people with mild cerebrovascular accident

OBJECTIVE. This article describes a performance-based measure of executive function, the Multiple Errands Test-Revised (MET-R), and examines its ability to discriminate between people with mild cerebrovascular accident (mCVA) and control participants. METHOD. We compared the MET-R scores and measures of CVA outcome of 25 participants 6 mo post-mCVA and 21 matched control participants. RESULTS. Participants with mCVA showed no to minimal impairment on measures of executive function at hospital discharge but reported difficulty with community integration at 6 mo. The MET-R discriminated between participants with and without mCVA (p ≤ .002). CONCLUSION. The MET-R is a valid and reliable measure of executive functions appropriate for the evaluation of clients with mild executive function deficits who need occupational therapy to fully participate in community living.

Somatosensation assessment using the NIH Toolbox

Touch sensation is one element of sensory function. As such, somatosensation is one of the sensory domains included in the NIH Toolbox, which is an assessment battery for measuring a range of human functions including emotional health, sensation, cognition, and motor function. We evaluated a variety of methods for inclusion in the NIH Toolbox main battery. In a convenience sample of 409 participants, we evaluated aspects of kinesthesia, pain, and tactile discrimination. We present results on these measures across the lifespan and discuss implications for future studies that use the NIH Toolbox and these measures.

Pain assessment using the NIH Toolbox

OBJECTIVE

Pain is an important component of health and function, and chronic pain can be a problem in its own right. The purpose of this report is to review the considerations surrounding pain measurement in the NIH Toolbox, as well as to describe the measurement tools that were adopted for inclusion in the NIH Toolbox assessment battery.

METHODS

Instruments to measure pain in the NIH Toolbox were selected on the basis of scholarly input from a diverse group of experts, as well as review of existing instruments, which include verbal rating scales, numerical rating scales, and graphical scales.

RESULTS

Brief self-report measures of pain intensity and pain interference were selected for inclusion in the core NIH Toolbox for use with adults. A 0 to 10 numerical rating scale was recommended for measuring pain intensity, and a 6-item Patient Reported Outcome Measurement Information System (PROMIS) short form for measuring pain interference. The 8-item PROMIS Pediatric Pain Interference measure was recommended as a supplemental measure. No specific measure was recommended for measuring pain intensity in children.

CONCLUSIONS

Core and supplemental measures were recommended for the NIH Toolbox. Additional measures were reviewed for investigators who seek tools for measuring pain intensity in pediatric samples.

Executive dysfunction and depressive symptoms associated with reduced participation of people with severe congestive heart failure

OBJECTIVE

We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF).

METHOD

People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation.

RESULTS

Possible depression (64%) and cognitive impairment (15%-59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%-46% of the variance in participation (ps < .01).

CONCLUSION

Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.