Profinteg: A Tool for Real-Life Assessment of Activities of Daily Living in Patients with Cognitive Impairment

Abstract

& (5) Fonds de la Recherche Scientifique FNRSAlthough there are many instruments for assessing activities of daily living (IADL) in brain injured patients, few instruments specifically target cognitive impairment and its impact on IADL. The present study presents the development of the Profinteg instrument, a tool for real-life assessment as well as rehabilitation of IADL in patients with cognitive impairment. This two-stage instrument covers over 90 activities. Psychometric properties of the different Profinteg measures were explored in twenty-five patients with mild to severe cognitive difficulties and twenty-five caregivers. The feasibility of the Profinteg rehabilitation procedure was explored in three patients. Excellent interrater reliability (r > 0.90, p < 0.01) was observed for all measures. Good sensitivity to changes in IADL disability over time was also observed (T = 2.37, p < 0.02). Significant improvement of IADL functioning was found after rehabilitation guided by Profinteg assessment. The Profinteg instrument detects with precision the difficulties patients encounter in their real-life setting via (1) assessment of a large number of activities and (2) detailed decomposition of activities into sub-activities. The Profinteg tool also provides promising results for guidance of IADL rehabilitation in the patient's real-life environment.

Efficacy of Cognitive Rehabilitation in Alzheimer Disease: A 1-Year Follow-Up Study

“…The Profinteg scale is a research scale that focuses specifically on impairment in IADLs (currently 98 IADLs; see Table 1) due to cognitive deficits, in order to efficiently guide an ecological cognitive rehabilitation of IADL and evaluate progress made on these activities. 31 We only used the caregiver's version of the scale. The caregiver had to identify and estimate the difficulties (see grid for evaluation in Figure 1) in each of 98 daily life activities (the total score corresponded to the severity of reported difficulties, with 0 point if no difficulties; 1 point for lack of activity initiation, omission of 1 or several steps, or wrong execution of one or several steps; 4 points corresponding to perseveration errors; and 5 points if the activity could not be carried out; points were summed over all the assessed activities and expressed in percentage of the maximal dependency score).…”

“…The first step was to identify difficulties in daily life activities that were important and relevant for the patient and the relatives using the PROFINTEG research tool. 31 This tool was used to determine the level of performance in daily life activities and to identify the presence of specific difficulties (see below). This tool also allowed evaluating the importance of the task for the patient and the corresponding objective and subjective caregiver’s burden if the task was not well achieved.…”

“…In a preliminary validation, it showed excellent interrater reliability and sensitivity to changes in IADL disability over time. 31…”

“…In a preliminary validation, it showed excellent interrater reliability and sensitivity to changes in IADL disability over time. 31 The second step was to select the activities for which adaptation was realistic and potentially rewarding. Several factors were decisive to make an appropriate choice: the preserved capacities of the patient and the possibility to use them to facilitate learning, the possibilities of the therapist (for example, rehabilitation of driving was excluded), and the risk associated with a given activity.…”

Modelado y Evaluación de Entornos Virtuales Interactivos para Rehabilitación Cognitiva en Daño Cerebral

“…Profinteg [Anselme:2013] es una herramienta que permite la evaluación del impacto de los déficits cognitivos sobre las actividades de vida diaria en los escenarios reales del propio paciente. Está orientada para que sea utilizada por terapeutas y por los propios cuidadores de los pacientes.…”