Assessing functional performance using computer-based simulations of everyday activities

Abstract

Current functional capacity (FC) measures for patients with schizophrenia typically involve informant assessments or are in paper and pencil format, requiring in-person administration by a skilled assessor. This approach presents logistic problems and limits the possibilities for remote assessment, an important issue for these patients. This study evaluated the feasibility of using a computer-based assessment battery, including simulations of everyday activities. The battery was compared to in-person standard assessments of cognition and FC with respect to baseline convergence and sensitivity to group differences. The battery, administered on a touch screen computer, included measures of critical everyday activities, including: ATM Banking/Financial Management, Prescriptions Refill via Telephone/Voice Menu System, and Forms Completion (simulating a clinic and patient history form). The sample included 77 older adult patients with schizophrenia and 24 older adult healthy controls that were administered the battery at two time points. The results indicated that the battery was sensitive to group differences in FC. Performance on the battery was also moderately correlated with standard measures of cognitive abilities and showed convergence with standard measures of FC, while demonstrating good test-retest reliability. Our results show that it is feasible to use technology-based assessment protocols with older adults and patients with schizophrenia. The battery overcomes logistic constraints associated with current FC assessment protocols as the battery is computer-based, can be delivered remotely and does not require a healthcare professional for administration.

A Novel Method for Direct Assessment of Everyday Competence Among Older Adults

“…These results and previous studies of older adults with chronic mental health conditions (see Czaja et al [26]) indicate that performance-based computer simulations of real-world tasks may be important tools with respect to assessing functional performance. This is especially true in cases where there is not a reliable informant who has an opportunity to observe functional performance or may have biased estimates of performance or the older adult is unable to access a clinical setting.…”

“…This expands upon the work of Czaja et al [26] that indicates that the UMCFAB has good to moderate test-retest reliabilities and good concurrent validity among cognitively normal older adults and older adults with persistent mental illness such as schizophrenia.…”

“…In addition to the excellent discriminative ability shown in the current aMCI and cognitively normal older adult samples, recent research has also demonstrated that the UMCFAB is highly sensitive to deficits in older adults with severe mental illness such as schizophrenia [26]. Of note, our findings that 40% of older adults with aMCI had difficulties with commonly encountered tasks such as an ATM machine and over a quarter of individuals had difficulties comprehend instructions on the Doctor’s Task indicate that subtle performance-based cognitive deficits can be detected utilizing technology-based direct functional assessment.…”

“…The UMCFAB has previously shown good-moderate test-test reliabilities, concurrent and discriminative abilities among older adults with persistent mental illness and cognitively normal elders [26]. In the current study, we examined: criterion validity by comparing performance on this battery relative to in-person standardized assessments of cognition and sensitivity to group differences between individuals with aMCI and non-cognitively impaired older adults.…”

“…We also report test-retest reliability for sample of aMCI patients. Test-retest reliabilities for non-impaired older adults are reported elsewhere (see Czaja et al [26]).…”