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Occupational Therapy Graduate Student Evidenced-Based Research Reviews Occupational Therapy

6-22-2015

Effectiveness of Executive Function Performance Test (EFPT) in Effectiveness of Executive Function Performance Test (EFPT) in

Stroke Population Stroke Population

Faryal Shaheen Western Michigan University, faryal.shaheen@wmich.edu

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WMU ScholarWorks Citation WMU ScholarWorks Citation Shaheen, Faryal, "Effectiveness of Executive Function Performance Test (EFPT) in Stroke Population" (2015). Occupational Therapy Graduate Student Evidenced-Based Research Reviews. 1. https://scholarworks.wmich.edu/ot_posters/1

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Effec%veness  of  Execu%ve  Func%on  Performance  Test  (EFPT)  in  Stroke  Popula%on    Faryal  Shaheen,  BS,  OTS  

College  of  Health  &  Human  Services  Western  Michigan  University,  Kalamazoo  MI,  49008  

Introduction

Methods What is EFPT?

Reliability & Consistency

Conclusion

Figure  1.  During  the  CPP  test,  animals  that  had  received  cocaine  (10  or  20  mg/kg)  during  drug  condi?oning  trials  spent  more  ?me  in  the  cocaine-­‐paired  side.  These  effects  were  enhanced  in  the  Cocaine  20/MDMA  3.0  treatment  group,  and  reduced  in  the  Cocaine  10/MDMA  3.0  and  Cocaine  20/MDMA  1.5  treatment  groups.    

Stroke is the leading cause of long term disability in the U.S, causing 15,000 deaths each year (Hall et al, 2015). It has been estimated that 71% of clients are discharged with minimal to no services from acute/subacute after stroke because of deficits that go undetected (2015). One of the most common deficits in stroke is loss in executive functioning (EF). Occupational therapists (OTs) have typically used a combination of tools to measure EF and most of these assessments did not involve observations in the everyday environment (Morrison et al, 2015). A new measure, known as the Executive Function Performance Test (EFPT) was developed to fill that gap.

Limitations: Limited literature is available for this tool since it was recently established in early 2000. Findings: This review led to the inclusion of 17 studies from 2005-2015. Out of these 17 articles, 5 studies used cross sectional study design, 4 were prospective longitudinal cohort design studies, 4 were pre-post studies and the other 4 were descriptive analyses of EFPT. Databases: PubMed, MEDLINE, CINAHL plus, ProQuest, Pubfacts, OTseeker, Scopus, Pedro, PsycINFO, ClinicalKey, Google scholar, EMBASE, RehabMeasures, and Cochrane library. Exclusion Criteria: Studies that measured EF in conditions other than stroke were excluded. Inclusion Criteria: Studies comparing EFPT with other assessment tools for EF were included. Keywords: Stroke, EFPT, Executive function, Executive dysfunction, CVA, acute stroke, & IADL.

Results

!

*All!tests!are!significant!at!p<0.05!!!

Tests Correlation Source DKEFS (Delis Kaplan

Executive function system)

EFPT total score: Sorting: r= -0.511, p=0.030 Verbal fluency: r=-0.474,p=0.035 Color-word interference: r=-0.566,p=0.011 EFPT- Bill pay: Sorting: r=-0.504, p=0.003 Color word interference: r=0.595, p=0.007 Trailmaking: r=-0.484, p=0.031 EFPT-cooking: Sorting: r=-0.498, p=0.025 Verbal fluency: r=0.527, p=0.017 EFPT-telephone use: Color word interference: r=-0.499, p=0.030

Wolf et al, 2009. Wolf et al, 2011

Short Blessed Test (SB) EFPT total score: Short blessed: r=0.548, p=0.012 EFPT-cooking: Short blessed: r=0.710, p=0.000

Wolf et al, 2009. Wolf et al, 2011.

AMPS (Assessment of Motor and Process Skills)

rho=0.65, p=0.002 Cederfeldt et al, 2011

FIM (Functional Independence Measure)

r=-0,40, p=0.001 Baum et al, 2008.

FAM (Functional Assessment Measure)

r=-0.68, p=0.0001 Baum et al, 2008.

MET-R (Multiple Errands Test Revised)

r=-0.55, p=0.034 Morrison et al, 2013.

Story Recall (Wechsler memory Scale):

r=-0.59, p=0.0001 Baum et al, 2008.

Digits backward: r=-0.49, p=0.001

Baum et al, 2008.

Trail B: r=0.39, p=0.001 Baum et al, 2008.

EFPT has been shown to be superior to other assessment in gauging independence. People, who were identified as independent on functional independence measure (FIM), 46% of them were reported as impaired on EFPT (Morrison et al, 2015) When mean scores of IADL groups that used EFPT were compared to the control group, results indicated significant differences in mean scores at 2 weeks and 3 months period of time post stroke. Results were reported as t(39)= -3.4, p=0.002 (Babulal et al, 2015). EFPT is also useful in demonstrating change in important IADL tasks. For example, EFPT showed significant gain in UE functions post stroke while preforming 4 tasks: cooking; p=0.02, telephone use; p=0.001, medication management; p=0.01. Bill payment was not found significant (Simmons et al, 2014).

Ini?a?on:  r=0.91  Organiza?on:  r=0.93  Sequencing:  r=0.88  Safety  and  judgment:  r=0.78  Comple?on  of  all  tasks:  r=0.89    

Cooking: α=0.86  Paying bill: α=0.78  Med. management: α=0.88 Telephone use: α=  0.77  

!! Task!

(Cooking)!Independent!0!

Verbal!guidance!1!

Gestural!guidance!2!

Verbal!instruction!3!

Physical!assistance!!4!

Do!for!patient!!5!

Score!

Initiation! ! ! ! ! ! ! !Organization! ! ! ! ! ! ! !Sequencing! ! ! ! ! ! ! !Judgment!&!Safety!

! ! ! ! ! ! !

Completion!of!all!tasks!

! ! ! ! ! ! !

Table 4: EFPT compared with other assessment tools

Table 2: Correlation b/w test domains

Table 3: Internal consistency for Sub tests

Overall, the EFPT has been shown to be a reliable tool to measure executive deficits post-stroke that other tools are not able to detect EFPT measures EF in the environment and with tasks that are closer to real life scenarios. It is an additional benefit of this tool. Occupational therapists should consider adding the EFPT to their assessment repertoire as an important tool with stroke populations.

WESTERN MICHIGAN UNIVERSITY

EFPT has indicated high internal consistency (ICC) with α=0.94 (Poulin et al, 2012). i: Cooking & Medication management= Excellent ICC ii: Telephone use & Bill payment= Moderate ICC

EFPT is an assessment tool that evaluates EF in real environment. It has 4 subtests: cooking, bill payment, telephone use, and medication management. EFPT evaluates the client’s ability to initiate, organize, sequence, judge safety, and complete all tasks. Benefits: It has been rated to show following benefits: 1: Uses top-down approach rather than bottom-up. 2: Focuses on what client can do. 3: Assesses the required level of assistance. Scoring: It is completed by summing the score for 4 subtests (0-5 score for each task and total 20 pts.) and then summing four scores for each task (0-25 for each task and 100 total pts.) Table 1 shows the template used for each task. Table 1: Scoring template used for 4 tasks

Objective: This review was conducted to analyze the effectiveness of EFPT in stroke population, as compared to other tools.

Results indicated moderate to high correlation between EFPT and other tools. Adequate to excellent correlation has been found with DKEFS and SB test. Excellent correlation is shown with FAM while adequate with digits backward, trail B, story recall, and animal fluency. The highest significance was found between FAM and EFPT (see table 4).

Correlation between test domains were significantly higher. Table 2 & 3 show ICC for EFPT test domains and subtests.