Comparing the Oxford Digital Multiple Errands Test (OxMET) to a real-life version: Convergence, feasibility, and acceptability.

We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p < .006). MET-Home accuracy was related to age (B = -.04, p = .03), sex (B = -.98, p = .03), disability (B = -0.63, p = .04), and MoCA (B = .26, p < .001), whereas OxMET accuracy was predicted by MoCA score (B = .40, p < .001). Feedback indicated that the OxMET was easy and fun and more acceptable than the MET-Home. The MET-Home was more stressful and interesting. The MET tasks demonstrated good convergent validity, with the OxMET digital administration providing a more feasible, inclusive, and acceptable assessment, especially to people with mobility restrictions and more severe stroke.

The cultural and linguistic adaptation of the Oxford Cognitive Screen to Tamil.

OBJECTIVE: The Oxford Cognitive Screen (OCS) is a screening tool to assess stroke patients for deficits in attention, executive functions, language, praxis, numeric cognition, and memory. In this study, the OCS was culturally and linguistically adapted to Tamil, for use in India (OCS TA), considering the differences between formal and spoken versions of Tamil and consideration of its phonetic complexity. METHOD: We adopted two-parallel form versions of the OCS and generated normative data for them. We recruited 181 healthy controls (Mean = 39.27 years, SD 16.52) (141 completed version A, 40 completed version B, 33 completed version A and B) and compared the data with the original UK normative sample. In addition, 28 native Tamil-speaking patients who had a stroke in the past three years (Mean = 62.76 years, SD 9.14) were assessed. Convergent validity was assessed with subtasks from Addenbrooke's Cognitive Examination III (ACE-III). RESULTS: We found significant differences between the UK normative group and the OCS TA normative group in age and education. Tamil-specific norms were used to adapt the cutoffs for the memory, gesture imitation, and executive function tasks. When domain-specific scores on the ACE-III were compared, OCS TA exhibited strong convergent validity. CONCLUSIONS: The OCS TA has shown the potential to be a useful screening tool for stroke survivors among Tamil speakers with the two-parallel forms demonstrating good equivalence. Further empirical evidence from larger studies is required to establish their psychometric performance and clinical validity.

Predictive validity of the Oxford digital multiple errands test (OxMET) for functional outcomes after stroke.

The Oxford Digital Multiple Errands Test (OxMET) is a brief computer-tablet based cognitive screen, intended as an ecologically valid assessment of executive dysfunction. We examined aspects of predictive validity in relation to functional outcomes. Participants (≤ 2 months post-stroke) were recruited from an English-speaking stroke rehabilitation in-patient setting. Participants completed OxMET. The Barthel Index, Therapy Outcome Measure (TOMS), and modified Rankin Scale (mRS) were collected from medical notes. Participants were followed up after 6-months and completed the Nottingham Extended Activities of Daily Living (NEADL) scale. 117 participants were recruited (M = 26.18 days post-stroke (SD = 25.16), mean 74.44yrs (SD = 12.88), median NIHSS 8.32 (IQR = 5-11)). Sixty-six completed a follow-up (M = 73.94yrs (SD = 12.68), median NIHSS 8 (IQR = 4-11)). Significant associations were found between TOMS and mRS. At 6-month follow up, we found a moderate predictive relationship between the OxMET accuracy and NEADL (R2 = .29, p < .001), and we did not find this prediction with MoCA taken at 6-months. The subacute OxMET associated with measures of functionality and disability in a rehabilitation context, and in activities of daily living. The OxMET is an assessment of executive function with good predictive validity on clinically relevant functional outcome measures that may be more predictive than other cognitive tests.

The Oxford Cognitive Screen for use with Australian people after stroke (OCS-AU): The adaptation process and determining cut scores for cognitive impairment using a cross-sectional normative study.

INTRODUCTION: Two parallel versions (A and B) of the Oxford Cognitive Screen (OCS) were developed in the United Kingdom (UK) as a stroke-specific screen of five key cognitive domains commonly affected post-stroke. We aimed to develop the Australian versions A and B (OCS-AU), including Australian cut-scores indicative of impairment. We hypothesised there to be no difference in performance between the UK and Australian normative data cohorts. METHODS: Our multidisciplinary expert panel used the UK pre-defined process to develop the OCS-AU versions A and B. We then conducted a cross-sectional normative study. We purposively recruited community-dwelling, Australian-born, and educated adults; with no known cognitive impairment; representative of age, sex, education level, and living location; at seven sites (four metropolitan, three regional) across four Australian states. Participants completed one or both OCS-AU versions in a randomised order. Australian cohorts were compared with the corresponding UK cohorts for demographics using Pearson's chi-squared test for sex and education, and Welch two-sample t test for age. For the cut-scores indicating cognitive impairment, the fifth (95th) percentiles and group mean performance score for each scored item were compared using Welch two-sample t tests. The pre-defined criteria for retaining OCS cut-scores had no statistically significant difference in either percentile or group mean scores for each scored item. RESULTS: Participants (n = 83) were recruited: fifty-eight completed version A [age (years) mean = 61,SD = 15; 62% female], 60 completed version B [age (years) mean = 62,SD = 13, 53% female], and 35 completed both [age (years) mean = 64,SD = 11, 54% female]. Education was different between the cohorts for version B (12 years, p = 0.002). Cut-scores for all 16 scored items for the OCS-AU version B and 15/16 for version A met our pre-defined criteria for retaining the OCS cut scores. CONCLUSIONS: The OCS-AU provides clinicians with an Australian-specific, first-line cognitive screening tool for people after stroke. Early screening can guide treatment and management.

Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation.

Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.

The Oxford digital multiple errands test (OxMET): Validation of a simplified computer tablet based multiple errands test.

Impairments in executive functioning are common following Acquired Brain Injury, though there are few screening tools which present a time efficient and ecologically valid approach to assessing the consequences of executive impairments. We present the Oxford Digital Multiple Errands Test (OxMET), a novel and simplified computer-tablet version of a Multiple Errands Test. We recruited 124 neurologically healthy controls and 105 stroke survivors to complete the OxMET task. Normative data and internal consistency were established from the healthy control data. Convergent and divergent validation was assessed in a mixed subset of 158 participants who completed the OxMET and OCS-Plus. Test-retest reliability was examined across a mixed subset of 39 participants. Finally, we investigated the known-group discriminability of the OxMET. The OxMET demonstrated very high internal consistency, and stable group level test-retest performance as well as good convergent and divergent validity. The OxMET demonstrated high sensitivity and good specificity in overall differentiation of stroke survivors from controls. The Oxford Digital Multiple Errands Test is a brief, easy to administer tool, designed to quickly screen for potential consequences of executive impairments in a virtual environment shopping task on a computer tablet. Initial normative data and validation within a chronic stroke cohort is presented.

Validating the OCS-Plus against a clinical standard: A brief report.

This research aimed to determine the sensitivity and clinical validity of the OCS-Plus, a stroke-specific tablet-based cognitive screening tool, in comparison with the MoCA, a routinely used screening tool, after stroke. Eighty-six patients were recruited from Oxfordshire stroke wards over a 22-month period and completed both screens. Overall, we found that the OCS-Plus has good convergent validity and excellent sensitivity when compared with the MoCA. The OCS-Plus is therefore of potential benefit to those seeking a sensitive screening tool.

Using Multiverse Analysis to Highlight Differences in Convergent Correlation Outcomes Due to Data Analytical and Study Design Choices.

In neuropsychological research, there are a near limitless number of different approaches researchers can choose when designing studies. Here we showcase the multiverse/specification curve technique to establish the robustness of analytical pathways choices within classic psychometric test validation in an example test of executive function. We examined the impact of choices regarding sample groups, sample sizes, test metrics, and covariate inclusions on convergent validation correlations between tests of executive function. Data were available for 87 neurologically healthy adults and 117 stroke survivors, and a total of 2,220 different analyses were run in a multiverse analysis. We found that the type of sample group, sample size, and test metric used for analyses affected validation outcomes. Covariate inclusion choices did not affect the observed coefficients in our analyses. The present analysis demonstrates the importance of carefully justifying every aspect of a psychometric test validation study a priori with theoretical and statistical factors in mind. It is essential to thoroughly consider the purpose and use of a new tool when designing validation studies.

The COVID-19 pandemic altered the modality, but not the frequency, of formal cognitive assessment.

PURPOSE: We investigated the impacts of the COVID-19 pandemic on the modality of formal cognitive assessments (in-person versus remote assessments). MATERIALS AND METHODS: We created a web-based survey with 34 items and collected data from 114 respondents from a range of health care professions and settings. We established the proportion of cognitive assessments which were face-to-face or via video or telephone conferencing, both pre- and post-March 2020. Further, we asked respondents about the assessment tools used and perceived barriers, challenges, and facilitators for the remote assessment of cognition. In addition, we asked questions specifically about the use of the Oxford Cognitive Screen. RESULTS: We found that the frequency of assessing cognition was stable compared to pre-pandemic levels. Use of telephone and video conferencing cognitive assessments increased by 10% and 18% respectively. Remote assessment increased accessibility to participants and safety but made observing the subtleties of behaviour during test administration difficult. The respondents called for an increase in the availability of standardised, validated, and normed assessments. CONCLUSIONS: We conclude that the pandemic has not been detrimental to the frequency of cognitive assessments. In addition, a shift in clinical practice to include remote cognitive assessments is clear and wider availability of validated and standardised remote assessments is necessary.IMPLICATIONS FOR REHABILITATIONWe caution the wider use and interpretation of remote formal cognitive assessments due to lack of validated, standardised, and normed assessments in a remote format.Clinicians should seek out the latest validation and normative data papers to ensure they are using the most up to date tests and respective cut offs.Support is needed for individuals who lack knowledge/have anxiety over the use of technology in formal cognitive assessments.

Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors.

Introduction: Stroke survivors are routinely screened for cognitive impairment with tools that often fail to detect subtle impairments. The Oxford Cognitive Screen-Plus (OCS-Plus) is a brief tablet-based screen designed to detect subtle post-stroke cognitive impairments. We examined its psychometric properties in two UK English-speaking stroke cohorts (subacute: <3 months post-stroke, chronic: >6 months post-stroke) cross-sectionally. Patients and methods: This study included 347 stroke survivors (mean age = 73 years; mean education = 13 years; 43.06% female; 74.42% ischaemic stroke). The OCS-Plus was completed by 181 sub-acute stroke survivors and 166 chronic stroke survivors. All participants also completed the Oxford Cognitive Screen (OCS) and a subset completed the Montreal Cognitive Assessment (MoCA) and further neuropsychological tests. Results: First, convergent construct validity of OCS-Plus tasks to task-matched standardized neuropsychological tests was confirmed (r > 0.30). Second, we evaluated divergent construct validity of all OCS-Plus subtasks (r < 0.19). Third, we report the sensitivity and specificity of each OCS-Plus subtask compared to neuropsychological test performance. Fourth, we found that OCS-Plus detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS (98.50%). Discussion and conclusion: The OCS-Plus provides a valid screening tool for sensitive detection of subtle cognitive impairment in stroke patients. Indeed, the OCS-Plus detected subtle cognitive impairment at a similar level to validated neuropsychological assessments and exceeded detection of cognitive impairment compared to standard clinical screening tools.

Introducing the tablet-based Oxford Cognitive Screen-Plus (OCS-Plus) as an assessment tool for subtle cognitive impairments.

Here, we present the Oxford Cognitive Screen-Plus, a computerised tablet-based screen designed to briefly assess domain-general cognition and provide more fine-grained measures of memory and executive function. The OCS-Plus was designed to sensitively screen for cognitive impairments and provide a differentiation between memory and executive deficits. The OCS-Plus contains 10 subtasks and requires on average 24 min to complete. In this study, 320 neurologically healthy ageing participants (age M = 62.66, SD = 13.75) from three sites completed the OCS-Plus. The convergent validity of this assessment was established in comparison to the ACE-R, CERAD and Rey-Osterrieth. Divergent validity was established through comparison with the BDI and tests measuring divergent cognitive domains. Internal consistency of each subtask was evaluated, and test-retest reliability was determined. We established the normative impairment cut-offs for each of the subtasks. Predicted convergent and divergent validity was found, high internal consistency for most measures was also found with the exception of restricted range tasks, as well as strong test-retest reliability, which provided evidence of test stability. Further research demonstrating the use and validity of the OCS-Plus in various clinical populations is required. The OCS-Plus is presented as a standardised cognitive assessment tool, normed and validated in a sample of neurologically healthy participants. The OCS-Plus will be available as an Android App and provides an automated report of domain-general cognitive impairments in executive attention and memory.

Validation of an automated scoring program for a digital complex figure copy task within healthy aging and stroke.

OBJECTIVE: Complex Figure Copy Tasks are one of the most commonly employed neuropsychological tests. However, manual scoring of this test is time-consuming, requires training, and can then still be inconsistent between different examiners. We aimed to develop and evaluate a novel, automated method for scoring a tablet-based Figure Copy Task. METHOD: A cohort of 261 healthy adults and 203 stroke survivors completed the digital Oxford Cognitive Screen-Plus (OCS-Plus) Figure Copy Task. Responses were independently scored by two trained human raters and by a novel automated scoring program. RESULTS: Overall, the Automated Scoring Program was able to reliably extract and identify the separate figure elements (average sensitivity and specificity of 92.10% and 90.20%, respectively) and assigned total scores which agreed well with manual scores (intraclass correlation coefficient [ICC] = .83). Receiver Operating Curve analysis demonstrated that, compared to overall impairment categorizations based on manual scores, the Automated Scoring Program had an overall sensitivity and specificity of 80% and 93.40%, respectively (Area Under the Curve; AUC = 86.70%). Automated total scores also reliably distinguished between different clinical impairment groups with subacute stroke survivors scoring significantly worse than longer-term survivors, which in turn scored worse than neurologically healthy adults. CONCLUSIONS: These results demonstrate that the novel Automated Scoring Program was able to reliably extract and accurately score Figure Copy Task data, even in cases where drawings were highly distorted due to comorbid fine-motor deficits. This represents a significant advancement as this novel technology can be employed to produce immediate, unbiased, and reproducible scores for Figure Copy Task responses in clinical and research environments. Key Points-Question: We aimed to develop and evaluate a novel, automated method for scoring a tablet-based Figure Copy Task. FINDINGS: The novel Automated Scoring Program was able to reliably extract and accurately score Figure Copy Task data, even in cases where drawings were highly distorted due to comorbid fine-motor deficits. IMPORTANCE: This represents a significant advancement as this novel technology can be employed to produce immediate, unbiased, and reproducible scores for Figure Copy Task responses in clinical and research environments. Next Steps: Trialing the Automated Scoring Program in clinical environments. (PsycInfo Database Record (c) 2021 APA, all rights reserved).