Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes
<p>Neuropsychological screening and assessment of cognitive changes following stroke requires the use of standardised and well validated tools to ensure the most accurate and evidence-based assessment of a patient’s abilities.The importance of cognitive assessment comes from the high relation...
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2024
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| _version_ | 1826313911307075584 |
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| author | Webb, SS |
| author2 | Demeyere, N |
| author_facet | Demeyere, N Webb, SS |
| author_sort | Webb, SS |
| collection | OXFORD |
| description | <p>Neuropsychological screening and assessment of cognitive changes following stroke requires the use of standardised and well validated tools to ensure the most accurate and evidence-based assessment of a patient’s abilities.The importance of cognitive assessment comes from the high relation between cognitive impairment and later recovery [1–3]. In my DPhil, I aimed to examine different cognitive screening tools and provide validity evidence for their use in assessing post-stroke cognitive impairment.</p>
<p>The first chapter examined the shift in modality of cognitive assessment during the COVID-19 pandemic in a completed web-based questionnaire of 114 allied health professionals (majority UK). This study was conducted at the height of the pandemic and provided time sensitive information about how the use of cognitive testing had changed. I found that the frequency of cognitive testing did not necessarily decrease, but that the modality changed to more remote and video based assessments. The rates of change were lower than other studies at the time, that primarily sampled neuropsychologists from the United States. Within the same chapter, I detailed a study, that provided some evidence for the valid use of a remote version of the Oxford Cognitive Screen (OCS). This study used 40 stroke survivors who had been administered the OCS both in person and remotely, in counterbalanced order. I found that there were minimal meaningful differences in performance across versions, and limited occurrences of a participant being considered impaired on one version and not on the other. This meant that, in light of the pandemic, I had provided some validity evidence for a tool usable via remote administration.</p>
<p>The second chapter provided some clinical validation evidence of a computer tablet-based extension of the OCS, named the OCS-Plus. OCS-plus is a recently standardized and normed domain-general cognitive screening tool. Prior to this DPhil, there was only psychometric validation in 320 healthy ageing adults and no evidence for use in stroke. Here I examined OCS-Plus data from 347 stroke survivors (n=181 <3 months post stroke & n=166 >=6 months post-stroke) and compared performance of a subset of them to a neuropsychological battery and/or the Montreal Cognitive Assessment (MoCA). I found that the OCS-Plus met convergent and divergent validation criteria compared to the neuropsychological battery, and detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS(98.50%). This project showed that the OCS-Plus is valid as a screening tool in stroke from subacute to chronic usage.</p>
<p>The third chapter detailed work regarding the Oxford Digital Multiple Errands Test (OxMET), which had previously been standardised and normed in 124 healthy controls and compared to 105 chronic (>6 months post-stroke) stroke survivors. In part one of chapter 3, I examined the OxMET in relation to the in-person Multiple Errands Test - Home version (MET-Home) in 98 participants, to determine evidence for convergence between the MET, as well as feasibility and acceptability for each MET. I recruited 48 stroke survivors and 50 healthy ageing adults to take part. I found that both METs met convergence criteria (r>=.30). I found the OxMET to be more feasible and acceptable by participants, but that there was an appropriate time and sample to use for each MET and thus both are satisfactory tools.</p>
<p>In part 2 of chapter 3, I examined the predictive validity of the OxMET taken subacutely with stroke survivors to clinically relevant future functional outcomes. The findings were clear that the OxMET was associated with both basic (n=117) and instrumental (n=66) activities of daily living, although more so with instrumental, over and above the contribution of other demographic and cognitive factors.</p>
<p>The aim of the work presented in this thesis was to provide clinicians with an evidence base to make judgement about which tools are best practice for use, and to highlight both strengths and weaknesses of each tool presented. None of the tests presented in this thesis are able to fully capture the full depth of human cognition nor the rich idiosyncrasies of real everyday behavior. Health care professionals should always follow latest guidance and be educated in best evidence-based screening use and trained in tools they administer.</p> |
| first_indexed | 2024-09-25T04:23:48Z |
| format | Thesis |
| id | oxford-uuid:99335eaa-1625-4c0d-8c0a-6ae6cbf05feb |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:23:48Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | oxford-uuid:99335eaa-1625-4c0d-8c0a-6ae6cbf05feb2024-08-20T08:00:57ZPost-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomesThesishttp://purl.org/coar/resource_type/c_db06uuid:99335eaa-1625-4c0d-8c0a-6ae6cbf05febCognitive psychologyPsychologyEnglishHyrax Deposit2024Webb, SSDemeyere, NPendlebury, S<p>Neuropsychological screening and assessment of cognitive changes following stroke requires the use of standardised and well validated tools to ensure the most accurate and evidence-based assessment of a patient’s abilities.The importance of cognitive assessment comes from the high relation between cognitive impairment and later recovery [1–3]. In my DPhil, I aimed to examine different cognitive screening tools and provide validity evidence for their use in assessing post-stroke cognitive impairment.</p> <p>The first chapter examined the shift in modality of cognitive assessment during the COVID-19 pandemic in a completed web-based questionnaire of 114 allied health professionals (majority UK). This study was conducted at the height of the pandemic and provided time sensitive information about how the use of cognitive testing had changed. I found that the frequency of cognitive testing did not necessarily decrease, but that the modality changed to more remote and video based assessments. The rates of change were lower than other studies at the time, that primarily sampled neuropsychologists from the United States. Within the same chapter, I detailed a study, that provided some evidence for the valid use of a remote version of the Oxford Cognitive Screen (OCS). This study used 40 stroke survivors who had been administered the OCS both in person and remotely, in counterbalanced order. I found that there were minimal meaningful differences in performance across versions, and limited occurrences of a participant being considered impaired on one version and not on the other. This meant that, in light of the pandemic, I had provided some validity evidence for a tool usable via remote administration.</p> <p>The second chapter provided some clinical validation evidence of a computer tablet-based extension of the OCS, named the OCS-Plus. OCS-plus is a recently standardized and normed domain-general cognitive screening tool. Prior to this DPhil, there was only psychometric validation in 320 healthy ageing adults and no evidence for use in stroke. Here I examined OCS-Plus data from 347 stroke survivors (n=181 <3 months post stroke & n=166 >=6 months post-stroke) and compared performance of a subset of them to a neuropsychological battery and/or the Montreal Cognitive Assessment (MoCA). I found that the OCS-Plus met convergent and divergent validation criteria compared to the neuropsychological battery, and detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS(98.50%). This project showed that the OCS-Plus is valid as a screening tool in stroke from subacute to chronic usage.</p> <p>The third chapter detailed work regarding the Oxford Digital Multiple Errands Test (OxMET), which had previously been standardised and normed in 124 healthy controls and compared to 105 chronic (>6 months post-stroke) stroke survivors. In part one of chapter 3, I examined the OxMET in relation to the in-person Multiple Errands Test - Home version (MET-Home) in 98 participants, to determine evidence for convergence between the MET, as well as feasibility and acceptability for each MET. I recruited 48 stroke survivors and 50 healthy ageing adults to take part. I found that both METs met convergence criteria (r>=.30). I found the OxMET to be more feasible and acceptable by participants, but that there was an appropriate time and sample to use for each MET and thus both are satisfactory tools.</p> <p>In part 2 of chapter 3, I examined the predictive validity of the OxMET taken subacutely with stroke survivors to clinically relevant future functional outcomes. The findings were clear that the OxMET was associated with both basic (n=117) and instrumental (n=66) activities of daily living, although more so with instrumental, over and above the contribution of other demographic and cognitive factors.</p> <p>The aim of the work presented in this thesis was to provide clinicians with an evidence base to make judgement about which tools are best practice for use, and to highlight both strengths and weaknesses of each tool presented. None of the tests presented in this thesis are able to fully capture the full depth of human cognition nor the rich idiosyncrasies of real everyday behavior. Health care professionals should always follow latest guidance and be educated in best evidence-based screening use and trained in tools they administer.</p> |
| spellingShingle | Cognitive psychology Psychology Webb, SS Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title | Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title_full | Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title_fullStr | Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title_full_unstemmed | Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title_short | Post-stroke neuropsychological screening and assessment: psychometrics, validation, and predictive value for functional outcomes |
| title_sort | post stroke neuropsychological screening and assessment psychometrics validation and predictive value for functional outcomes |
| topic | Cognitive psychology Psychology |
| work_keys_str_mv | AT webbss poststrokeneuropsychologicalscreeningandassessmentpsychometricsvalidationandpredictivevalueforfunctionaloutcomes |