Methodological Issues in Advancing the Status of Functional Cognitive Assessment.

Many individuals in acute hospital and post-acute care settings experience changes in their capacity to perform complex activities of daily living associated with deficits in functional cognition. Occupational therapists regularly assess and treat these occupational performance deficits. The construct of functional cognition offers oportunities for occupational therapists to define an approach to cognition that is both distinct from that of other disciplines and that supports evidence-based interventions. This article provides a rationale for performance-based assessment of functional cognition and an overview of the methodological issues associated with the development and implementation of reliable and valid screening and comprehensive asseements of functional.

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.

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.

Overview and inter-rater reliability of an incident-based rating scale for aggressive behaviour following traumatic brain injury: The Overt Aggression Scale-Modified for Neurorehabilitation-Extended (OAS-MNR-E).

PRIMARY OBJECTIVE: The presentation and evaluation of the Overt Aggression Scale-Modified for Neurorehabilitation-Extended (OAS-MNR-E). RESEARCH DESIGN: Inter-rater reliability study using data collection procedures mirroring clinical practice. METHODS AND PROCEDURES: Fifteen clinical staff representing five different disciplines received a 30-minute orientation to the study and a 30-minute overview of the OAS-MNR-E. There were 34 patients who engaged in a rateable behaviour and were observed by two raters. There were 199 observed aggressive behaviours during the 6-week study period. MAIN OUTCOMES AND RESULTS: All sub-scales of the OAS-MNR-E had high percentage agreement (>92%) and the kappa statistic was uniformly excellent (>0.77). Multiple ratings within a sub-scale resulted in lower reliabilities. Incidents with multiple interventions were of longer duration. Interventions were on average more intrusive when used in combination than when used singly. CONCLUSIONS: The OAS-MNR-E can be easily incorporated into facility routines and is reliable. The rating tool reported here can provide data that assists in programme design, evaluation and treatment planning.