Development and Evaluation of the Maintenance Office Duty Test: An Alternate Form of the Charge of Quarters Duty Test for Assessing Executive Function After Mild Traumatic Brain Injury to Inform Duty-Readiness After Concussion.

INTRODUCTION: After mild traumatic brain injury, service members may experience difficulty with executive functions, which could interfere with return to duty and life roles. Because performance-based multitasking assessments are sensitive to executive dysfunction, a team of military and civilian rehabilitation researchers developed the Charge of Quarters Duty Test (CQDT) to help inform duty readiness after concussion; it is a multitasking test based on a military task scenario that challenges executive functions, such as foresight and planning, set shifting, and prospective memory. Although previous study indicates that CQDT has reliability and known-groups validity, like other multitasking tests, it should not be readministered after rehabilitative care because of learning effects. The purpose of this study was to develop an alternate form of the CQDT and evaluate its equivalence to the CQDT. MATERIALS AND METHODS: A measurement development study was conducted in which subject matter experts on the study team used an iterative approach to create an alternate form. To evaluate equivalence, a repeated measures design was employed in which each participant performed one or both test versions twice and acted as their own control. RESULTS: The study team created the Maintenance Office Duty Test (MODT), the alternate form of the CQDT. A convenience sample of 40 adults performed both the MODT and CQDT approximately 2 weeks apart; 4 had a history of military service and 16 had a history of acquired brain injury. We compared mean scores and standard deviations of each test's 4 subscores using matched-pair t-tests and found that scores were not statistically different, suggesting that the 2 tests are equivalent. In addition, matched-pair t-tests were used to compare Time 1 and Time 2 subscores when (1) participants performed the 2 test versions (CQDT and MODT) and (2) participants performed the same test twice. None of the differences in Time 1 and Time 2 subscores were statistically significant when participants performed the 2 test versions. However, when participants performed the same test twice, three of the four Time 1 and Time 2 scores were significantly different, with Time 2 reflecting improved performance and possible learning effects (performance accuracy P = .013; total number of rule breaks P = .015; performance time P = .002). CONCLUSIONS: The MODT appears to be an equivalent form of the CQDT that mitigates learning effects that often accompany performance of multitasking assessments. Having developed and validated the equivalence of the CDQT's alternate form, military rehabilitation clinicians have an expanded set of clinical tools by which to identify possible executive dysfunction and evaluate service members' response to rehabilitative care via pre- and post-rehabilitation testing after mild traumatic brain injury.

Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer.

Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.

Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals?

PURPOSE: Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation. METHODS: Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals. RESULTS: The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers. CONCLUSION AND IMPLICATIONS: Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.

Grace Notes: feasibility of a manualized intervention to advance spiritual well-being for clients with acquired brain injury.

Spiritual well-being appears to contribute to mental health and adaptation in adults with acquired brain injury (ABI). ABI-related interventions, including those associated with spirituality, must be specifically designed with learning-related impairments in mind. We conducted a feasibility study of a manualized intervention to support spiritual well-being after ABI called Grace Notes. The goal is to provide clients with time tested, easily accessible spiritual practices that help them experience deeper feelings of being in relationship with their Higher Power as they understand it. Findings suggest that Grace Notes can be implemented by both its developer with the context of an interdisciplinary outpatient rehabilitation program and a rehabilitation clinician as a stand-alone group. People with ABI appear to be interested in a spiritually intervention that draws from a variety of spiritual practices and traditions. Further study related to the efficacy of spiritual well-being intervention after ABI is warranted.

Front Desk Duty Multitasking Test After Mild Stroke: Preliminary Reliability and Validity.

BACKGROUND.: Performance-based multitasking assessments may be more sensitive than cognitive screens to detect executive dysfunction after a mild stroke. PURPOSE.: This cross-sectional study examined inter-rater reliability and preliminary convergent and discriminant validity of the Front Desk Duty Test (FDDT). METHOD.: Adults with mild stroke (n = 35) and community controls (n = 33) were administered the FDDT and other measures of executive functions. FINDINGS.: Inter-rater reliability of the FDDT subscores were high (ICC 0.971-0.999). There were weak but statistically significant correlations between participants' scores on some of the executive function tests and some FDDT subscores. Participants with mild stroke and community controls had statistically significant different FDDT scores (performance accuracy p = .006; performance time, p = .033), with rank order FDDT score patterns across community controls, participants with mild stroke who passed the executive function screen, and participants with mild stroke who failed the executive function screen. IMPLICATIONS.: Preliminary validation results suggest that the FDDT warrants further study.

The feasibility of a purpose-renewal intervention after treatment for early stage breast cancer: A brief report.

This feasibility study evaluated the acceptability, implementability, and preliminary efficacy of a brief purpose renewal intervention (the Compass Course) using a one-group pretest-posttest design. Fifteen women who had completed treatment for early-stage breast cancer enrolled in the study. Twelve completed the eight-session group intervention that was designed to help participants identify daily priorities (actual and aspired) that most align with their personal strengths, values, and sources of meaning, that is, their inner compass. The intervention was found to be acceptable and implementable. Preliminary pre- and post-intervention outcomes suggested that participants experienced greater purpose in daily life at posttest but that they did not make demonstrable changes in their activities or roles. Results suggest that the Compass Course was feasible and further study related to purpose renewal for adults with early-stage cancer is warranted.

Physical Therapy-Based Exercise Protocol for Cancer Patients: Evaluating Outcomes for Cardiopulmonary Performance and Cancer-Related Fatigue.

BACKGROUND: Studies have shown that rehabilitation and fitness throughout cancer treatment interventions have been linked to improved outcomes for morbidity and mortality of cancer patients. This study serves to detail the efficacy of the Cancer Rehabilitation Physical Therapy Fitness and Debility (Ca PT) Program in cancer patients. OBJECTIVE: To describe the clinical population of cancer patients referred to the Ca PT Program and evaluate the efficacy of the program's therapy protocol in improving cardiopulmonary performance and cancer-related fatigue and pain. DESIGN: Retrospective study. SETTING: Outpatient clinics. PATIENTS: One hundred two adults who had been referred from a variety of referral sources and supervised individualized exercise programs. METHODS: Participation in the Ca PT Program. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was a change in baseline-to-discharge scores in the 6-Minute Walk Test (6MWT), a cardiopulmonary performance measure. The secondary measures were changes in baseline-to-discharge scores of cancer-related fatigue and general pain, measured by patient self-report using a visual analogue scale. RESULTS: 6MWT values were significantly higher at discharge (mean 523 yards) than at baseline (mean 436), (P < .001, r = 0.57). Ninety-two percent of cases showed improvement and 58% of cases had a change on the 6MWT that met threshold for minimal important difference. Quality of life factors, fatigue (P < .001) and pain (P < .001) also significantly improved. CONCLUSIONS: The results indicate the Ca PT Program yields significant improvement in cardiovascular fitness, fatigue, and pain in people with cancer history. Personalized physical therapy fitness programs for individuals recovering from cancer treatment should be a standard component of cancer intervention. LEVEL OF EVIDENCE: III.