Development and Validation of the Occupational Therapy Engagement Scale for Patients with Stroke.

BACKGROUND/AIM: Almost all interventions in occupational therapy require the active engagement of the patients. However, no scale has been specifically designed for assessing engagement in occupational therapy. The purposes of this study were to develop the occupational therapy engagement scale (OTES) and to examine its unidimensionality, reliability, and predictive validity. METHODS: The OTES was developed through the review of similar scales, eight experts' opinions, cognitive interviews, and pilot testing. The unidimensionality was verified with Rasch model fitting and principal component analysis. The Rasch reliability was also estimated. Pearson's correlation coefficient (r) was used to validate the predictive validity by examining the association between the Rasch scores of the OTES and patients' performance of activities of daily living (ADL). RESULTS: A total of 253 patients with stroke were rated by 22 therapists using the OTES. The mean age of the patients was 62.3 ± 13.2 years old, and 65.2% of the patients were male. The infit and outfit MNSQ of the 12 items of the OTES ranged from 0.62 to 1.34. The unexplained variance of the first dimension of the principal component analysis was 4.0%. The mean person reliability of the OTES was 0.88. Pearson's r between the OTES and patients' ADL performance was 0.37. CONCLUSIONS: The results of Rasch analysis supported that the items of the OTES were unidimensional. The OTES had sufficient person reliability and predictive validity in patients with stoke.

Minimal Detectable Change on the Lawton Instrumental Activities of Daily Living Scale in Community-Dwelling Patients With Schizophrenia.

The main purpose of this study was to estimate the minimal detectable change (MDC) on the Lawton Instrumental Activities of Daily Living (LIADL) scale in community-dwelling patients with schizophrenia. Fifty-seven patients completed the LIADL assessment twice, about 14 days apart. Two scoring methods (dichotomous and polytomous) were used to record the patients' performance on the LIADL scale. The MDCs of the LIADL scale were 1.5 (dichotomous) and 4.4 (polytomous) points. The MDC percentages were 22.0% (dichotomous) and 22.5% (polytomous), both of which are within acceptable measurement errors. The test-retest reliabilities of the LIADL scale were both acceptable with two different scoring methods (dichotomous = .75; polytomous = .76). Users can choose the scoring method according to their individual needs.

Interrater and Intrarater Reliability of the Balance Computerized Adaptive Test in Patients With Stroke.

OBJECTIVE: To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions. DESIGN: Repeated assessments design (1wk apart). SETTING: Seven teaching hospitals. PARTICIPANTS: A pooled sample (N=102) including 2 independent groups of outpatients (n=50 for the interrater reliability study; n=52 for the intrarater reliability study) with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance CAT. RESULTS: For the interrater reliability study, the values of intraclass correlation coefficient, minimal detectable change (MDC), and percentage of MDC (MDC%) for the Balance CAT were .84, 1.90, and 31.0%, respectively. For the intrarater reliability study, the values of intraclass correlation coefficient, MDC, and MDC% ranged from .89 to .91, from 1.14 to 1.26, and from 17.1% to 18.6%, respectively. CONCLUSIONS: The Balance CAT showed sufficient intrarater reliability in patients with chronic stroke having balance functions ranging from sitting with support to independent walking. Although the Balance CAT may have good interrater reliability, we found substantial random measurement error between different raters. Accordingly, if the Balance CAT is used as an outcome measure in clinical or research settings, same raters are suggested over different time points to ensure reliable assessments.

Validation of the European Health Literacy Survey Questionnaire in Women With Breast Cancer.

BACKGROUND: Health literacy enables effective communication, participation, and cooperation with clinicians of patients with breast cancer in healthcare processes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) comprehensively assesses multiple conceptual domains of health literacy in a diverse range of health contexts. However, the HLS-EU-Q has not been validated in women with breast cancer. OBJECTIVES: We examined the psychometric properties, particularly the factorial validity, of the HLS-EU-Q in women with breast cancer. METHODS: We performed a first-order confirmatory factor analysis (CFA) to verify the 12-subdomain model of the 47-item HLS-EU-Q. A second-order CFA was conducted to investigate whether the 12 subdomains reflected the 3 domains of healthcare, disease prevention, and health promotion correspondingly. RESULTS: A total of 475 women with breast cancer participated in this study. The first-order CFA fitted with the HLS-EU-Q containing 47 items. However, item 29, with a low factor loading (-0.05), was deleted. The modified first-order CFA adequately fitted the data of the HLS-EU-Q with 46 items. The second-order CFA model acceptably fitted with the data, but the 3 domains with high correlations (0.92-1.00) were merged into a single domain, health literacy. CONCLUSIONS: Our results supported the factorial validity of the 12-subdomain HLS-EU-Q with 46 items in women with breast cancer. It is recommended that the 12 subdomain scores be summed up to represent overall health literacy. IMPLICATIONS FOR PRACTICE: The HLS-EU-Q with 46 items is recommended for use in capturing the diverse health literacy competencies of women with breast cancer in different health contexts.

Test-Retest Reliability and Minimal Detectable Change of the D2 Test of Attention in Patients with Schizophrenia.

OBJECTIVE: The d2 Test of Attention (D2) is a commonly used measure of selective attention for patients with schizophrenia. However, its test-retest reliability and minimal detectable change (MDC) are unknown in patients with schizophrenia, limiting its utility in both clinical and research settings. The aim of the present study was to examine the test-retest reliability and MDC of the D2 in patients with schizophrenia. METHOD: A rater administered the D2 on 108 patients with schizophrenia twice at a 1-month interval. Test-retest reliability was determined through the calculation of the intra-class correlation coefficient (ICC). We also carried out Bland-Altman analysis, which included a scatter plot of the differences between test and retest against their mean. Systematic biases were evaluated by use of a paired t-test. RESULTS: The ICCs for the D2 ranged from 0.78 to 0.94. The MDCs (MDC%) of the seven subscores were 102.3 (29.7), 19.4 (85.0), 7.2 (94.6), 21.0 (69.0), 104.0 (33.1), 105.0 (35.8), and 7.8 (47.8), which represented limited-to-acceptable random measurement error. Trends in the Bland-Altman plots of the omissions (E1), commissions (E2), and errors (E) were noted, presenting that the data had heteroscedasticity. CONCLUSIONS: According to the results, the D2 had good test-retest reliability, especially in the scores of TN, TN-E, and CP. For the further research, finding a way to improve the administration procedure to reduce random measurement error would be important for the E1, E2, E, and FR subscores.

Test-retest reliability and minimal detectable change of the Beck Depression Inventory and the Taiwan Geriatric Depression Scale in patients with Parkinson's disease.

BACKGROUND: The Beck Depression Inventory II (BDI-II) and the Taiwan Geriatric Depression Scale (TGDS) are self-report scales used for assessing depression in patients with Parkinson's disease (PD) and geriatric people. The minimal detectable change (MDC) represents the least amount of change that indicates real difference (i.e., beyond random measurement error) for a single subject. Our aim was to investigate the test-retest reliability and MDC of the BDI-II and the TGDS in people with PD. METHODS: Seventy patients were recruited from special clinics for movement disorders at a medical center. The patients' mean age was 67.7 years, and 63.0% of the patients were male. All patients were assessed with the BDI-II and the TGDS twice, 2 weeks apart. We used the intraclass correlation coefficient (ICC) to determine the reliability between test and retest. We calculated the MDC based on standard error of measurement. The MDC% was calculated (i.e., by dividing the MDC by the possible maximal score of the measure). RESULTS: The test-retest reliabilities of the BDI-II/TGDS were high (ICC = 0.86/0.89). The MDCs (MDC%s) of the BDI-II and TGDS were 8.7 (13.8%) and 5.4 points (18.0%), respectively. Both measures had acceptable to nearly excellent random measurement errors. CONCLUSIONS: The test-retest reliabilities of the BDI-II and the TGDS are high. The MDCs of both measures are acceptable to nearly excellent in people with PD. These findings imply that the BDI-II and the TGDS are suitable for use in a research context and in clinical settings to detect real change in a single subject.

Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia.

The minimal detectable change (MDC) of the Personal and Social Performance scale (PSP) has not yet been investigated, limiting its utility in data interpretation. The purpose of this study was to determine the MDCs of the PSP administered by the same rater or different raters in individuals with schizophrenia. Participants with schizophrenia were recruited from two psychiatric community rehabilitation centers to complete the PSP assessments twice, 2 weeks apart, by the same rater or 2 different raters. MDC values were calculated from the coefficients of intra- and inter-rater reliability (i.e., intraclass correlation coefficients). Forty patients (mean age 36.9 years, SD 9.7) from one center participated in the intra-rater reliability study. Another 40 patients (mean age 44.3 years, SD 11.1) from the other center participated in the inter-rater study. The MDCs (MDC%) of the PSP were 10.7 (17.1%) for the same rater and 16.2 (24.1%) for different raters. The MDCs of the PSP appeared appropriate for clinical trials aiming to determine whether a real change in social functioning has occurred in people with schizophrenia.

Relative and Absolute Reliabilities of the Conners' Continuous Performance Test II in Schizophrenia.

OBJECTIVE: The Conners' Continuous Performance Test II (CCPT-II) is one of the most commonly used tests of sustained attention in schizophrenia. To manage and monitor sustained attention deficits in schizophrenia, clinicians have to reliably assess the degree of attention impairment. The purpose of our study was to determine the relative and absolute reliability of the CCPT-II in schizophrenia. METHOD: The final sample was a total of 108 patients with schizophrenia. The primary measures in this study were the CCPT-II and the Clinical Global Impression-Severity (CGI-S). The CCPT-II was administered twice, 1 month apart, by a specially trained occupational therapist. We assessed two types of reliability: relative and absolute reliability. Relative reliability was determined with the intra-class correlation coefficient (ICC). Absolute reliability was quantified with standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman's 95% limits of agreement (LOA). RESULTS: The ICCs for the five CCPT-II indexes (Omissions, Commissions, Hit RT, Hit RT Std Error, and Variability) ranged from 0.66 to 0.79. The MDCs (MDC%) of the five indices were 13.53 (156.78), 10.67 (47.85), 122.10 (34.16), 8.15 (106.82), and 25.81 (162.63), respectively. CONCLUSIONS: According to the results, the CCPT-II has limited reliability in monitoring the sustained attention function of patients with schizophrenia. Our results can be used as a reference for the measurement error of CCPT-II to help clinicians and researchers determine the true change between successive assessments of patients with schizophrenia.

Intrarater and Interrater Reliability of the Hierarchical Balance Short Forms in Patients With Stroke.

OBJECTIVE: To examine the intrarater and interrater reliability of a quick balance measure, the Hierarchical Balance Short Forms (HBSF), in outpatients with stroke receiving rehabilitation. DESIGN: A repeated-assessments design (1wk apart) was used to examine the intrarater and interrater reliability of the HBSF. The HBSF was administered by a single rater in the intrarater reliability study and by 2 raters in the interrater reliability study. The raters had sufficient working experience in stroke rehabilitation. SETTING: Seven teaching hospitals. PARTICIPANTS: Two independent groups of outpatients (N=106; each group, n=53) with stroke in chronic stages and in stable medical condition were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: HBSF. RESULTS: For the intrarater reliability study, the values of the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and percentage of minimal detectable change (MDC%) were .95, 1.02, and 16.3%, respectively, for the HBSF. The 95% limits of agreement (LOA) of the HBSF ranged from -.69 to 1.19. For the interrater reliability study, the values of the ICC, MDC, and MDC% were .91, 1.22, and 18.3%, respectively, for the HBSF. The 95% LOA of the HBSF ranged from -1.01 to 1.35. CONCLUSIONS: Our results suggest that the HBSF has satisfactory intrarater and interrater reliability for assessing balance function in outpatients with stroke. The MDC values of the HBSF are useful for both researchers and clinicians to determine whether the change in balance function of an individual patient is real when administered by an individual rater or by different raters.

Trajectories of quality of life in patients with traumatic limb injury: a 2-year follow-up study.

PURPOSE: Traumatic limb injury (TLI) can have a negative impact on a patient's quality of life (QOL), and the patient's QOL may fluctuate over time. However, the longitudinal change patterns of QOL in patients with TLI are largely unknown. The aim of this study was to investigate the QOL trajectories in patients with TLI in 4 QOL domains: physical capacity, psychological well-being, social relationships, and environment. METHODS: The patients' QOL was assessed within 14 days and at 1, 3, 6, 12, and 24 months after injury. In each QOL domain, 4 latent growth curve models (LGMs, including non-growth, linear growth, quadratic growth, and cubic LGM) were adopted to examine the QOL trajectories across the 6 time points. RESULTS: A total of 499 patients completed the 6 assessments. For all 4 QOL domains, the cubic LGM had the best model fitting (root-mean-square error of approximation < 0.01) revealing that the patients' 4 QOL domains changed with cubic trajectories: QOL improved in the first 6 months, deteriorated in the second 6 months, and improved smoothly at 12-24 months after injury. CONCLUSIONS: This study found that the trajectories in the 4 QOL domains were cubic trajectories in patients with TLI. These findings indicate that clinicians should pay additional attention to improve the patients' QOL in the first 6 months after injury and to prevent or reduce QOL deterioration at 6-12 months.

Convergent validity and responsiveness of the EQ-5D utility weights for stroke survivors.

OBJECTIVE: This prospective study examined the convergent validity and responsiveness of the EuroQoL-5 Dimensions Health Questionnaire (EQ-5D) utility weights in stroke survivors at the subacute stage. METHODS: Repeated assessments were conducted in rehabilitation wards of a medical centre. A study cohort was recruited from inpatients (n = 478). A total of 342 participants (71.5%) completed 2 assessments; 1 at ward admission and 1 before hospital discharge. Outcome measures, including the Barthel Index (BI), Patient Health Questionnaire (PHQ-9) and EQ-5D, were administered at ward admission and before hospital discharge. RESULTS: The validity of the EQ-5D utility weights was assessed by comparison with the scores of the BI and PHQ-9. The absolute values of Pearson correlation coefficients ranged from 0.40 to 0.52 for the association of EQ-5D utility weights with BI scores and PHQ-9 scores at admission and before hospital discharge. The EQ-5D utility weights had a moderate effect size (0.76), moderate standardized response mean (0.74), and a significant difference (paired t-value = 13.7, p < 0.001) between baseline and follow-up in their ability to detect changes in the health status of stroke survivors staying in a rehabilitation ward. CONCLUSION: This study supports the use of the EQ-5D utility weights as a valid and responsive instrument for performing cost-utility analyses of stroke survivors, including those with higher levels of dependence, at the subacute stage.

Validation and Establishment of an Interval-Level Measure of the Balance Assessment in Sitting and Standing Positions in Patients With Stroke.

OBJECTIVE: To validate the psychometric properties of the Balance Assessment in Sitting and Standing Positions, including validity (unidimensionality and concurrent validity), reliability (Rasch reliability), and responsiveness (compared with the Postural Assessment Scale for Stroke Patients [PASS]) and to transform the Balance Assessment in Sitting and Standing Positions from an ordinal-level measure into an interval-level measure. DESIGN: Retrospective cross-sectional study. SETTING: Medical records from a medical center. PARTICIPANTS: Patients with stroke (N=1193). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4-item Balance Assessment in Sitting and Standing Positions was used, assessing static sitting balance, dynamic sitting balance, static standing balance, and dynamic standing balance. RESULTS: Data of 1193 patients with stroke were included for Rasch analysis. The 4 items of the Balance Assessment in Sitting and Standing Positions constituted a unidimensional construct (infit/outfit mean square, .75-1.05), had good concurrent validity (r=.70-.90), and had sufficient Rasch reliability (.93). The Balance Assessment in Sitting and Standing Positions had large responsiveness (effect size, 1.20; standardized response mean, 1.51) and was comparable with the PASS (effect size, .90; standardized response mean, 1.32). CONCLUSIONS: The Balance Assessment in Sitting and Standing Positions has sound psychometric properties. The transformed-Rasch scores of the Balance Assessment in Sitting and Standing Positions can be used to identify patients' balance function and detect patients' changes.

Psychometric properties of the Balance Computerized Adaptive Test in residents in long-term care facilities.

PURPOSE: To validate the psychometric properties and efficiency of the Balance Computerized Adaptive Testing (Balance CAT) when applied to residents in long-term care (LTC) facilities. DESIGN AND METHODS: A cohort study was conducted in central Taiwan. The Balance CAT, the Berg Balance Scale (BBS), and the Barthel Index (BI) were administered to each participant with the ability to follow simple instructions by a trained rater in two days. The Pearson's correlation coefficient (r) was used to determine the concurrent validity of the Balance CAT. ANOVA and post hoc analysis were employed to investigate the discriminative ability of the Balance CAT. The paired t test was used to validate the efficiency. RESULTS: A total of 120 participants completed assessments of the Balance CAT, the BBS, and the Barthel Index (BI). The Pearson's r between the scores of the Balance CAT and the BBS was 0.90. Groups with different levels of dependence had significantly different mean scores of the Balance CAT. The mean IRT reliability of the Balance CAT scores was 0.93. The mean administration time of the Balance CAT was about 28% of that of the BBS, and the mean number of items used in the Balance CAT was 3.4. CONCLUSIONS: The Balance CAT had excellent concurrent and discriminative validity, reliability, and efficiency in residents of LTC facilities. These results indicate that the Balance CAT is a sound and practical measure for assessing the balance function of residents of LTC facilities.

Validation of the EQ-5D in Patients with Traumatic Limb Injury.

PURPOSE: The measurement properties of the EQ-5D have not been explored for patients with traumatic limb injuries. The purpose of this study was to examine the construct validity, predictive validity, and responsiveness of the EQ-5D in patients with traumatic limb injuries. METHODS: A consecutive cohort of 1,167 patients was assessed with the EQ-5D and the World Health Organization Quality of Life instrument (WHOQOL-BREF) at baseline while the patients were hospitalized because of the injury, and the patients were followed up at 3 months (1,003 patients), 6 months (1,010 patients), and 12 months (987 patients) after injury via telephone interview. RESULTS: The utility and visual analogue scale (VAS) scores of the EQ-5D had moderate to high association with the physical and psychological domains and the two general questions (overall QOL and overall health) of the WHOQOL-BREF at all time points except baseline (Pearson's correlation coefficient >0.3), but the EQ-5D profiles were weakly associated with the social and environment domains of the WHOQOL-BREF (absolute value of Spearman's correlation coefficient <0.3). These results indicate that the EQ-5D has satisfactory construct validity. The utility and VAS scores of the EQ-5D at 3 and 6 months after injury can predict (with moderate to large relationships) the four domains and two general questions of the WHOQOL-BREF administered at 12 months after injury. The responsiveness of the utility and VAS of the EQ-5D were high (effect sizes >0.9) at 0-3, 0-6, and 0-12 months after injury. CONCLUSIONS: The EQ-5D has sufficient construct validity, predictive validity, and responsiveness, and also provides evidence for using the utility of the EQ-5D for cost-utility analyses of patients with traumatic limb injuries in the future.

A controlled pilot trial of two commercial video games for rehabilitation of arm function after stroke.

OBJECTIVES: To investigate the acceptability and potential efficacy of two commercial video games for improving upper extremity function after stroke in order to inform future sample size and study design. DESIGN: A controlled clinical trial design using sequential allocation into groups. SETTING: A clinical occupational therapy department. SUBJECTS: Twenty-four first-stroke patients. INTERVENTIONS: Patients were assigned to one of three groups: conventional group, Wii group, and XaviX group. In addition to regular one-hour conventional rehabilitation, each group received an additional half-hour of upper extremity exercises via conventional devices, Wii games, or XaviX games, for eight weeks. MAIN MEASURES: The Fugl-Meyer Assessment of motor function, Box and Block Test of Manual Dexterity, Functional Independence Measure, and upper extremity range of motion were used at baseline and postintervention. Also, a questionnaire was used to assess motivation and enjoyment. RESULTS: The effect size of differences in change scores between the Wii and conventional groups ranged from 0.71 (SD 0.59) to 0.28 (SD 0.58), on the Fugl-Meyer Assessment of motor function (d = 0.74) was larger than that between the XaviX and conventional groups, ranged from 0.44 (SD 0.49) to 0.28 (SD 0.58) (d = 0.30). Patient enjoyment was significantly greater in the video game groups (Wii mean 4.25, SD 0.89; XaviX mean 4.38, SD 0.52) than in the conventional group (mean 2.25, SD 0.89, F = 18.55, p < 0.001), but motivation was not significantly different across groups. CONCLUSION: Patients were positive to using video games in rehabilitation. A sample size of 72 patients (24 per group) would be appropriate for a full study.

Practice effects and test-re-test reliability of the Five Digit Test in patients with stroke over four serial assessments.

OBJECTIVES: To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. DESIGN: Single-group repeated measures design. METHODS: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'. RESULTS: The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2]. CONCLUSIONS: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

The test-retest reliability and the minimal detectable change of the Purdue pegboard test in schizophrenia.

BACKGROUND/PURPOSE: The Purdue pegboard test is widely used in measuring the hand dexterity of patients with schizophrenia. In patients with schizophrenia, the test-retest reliability and minimal detectable change (MDC) of this test remain largely unknown, limiting the interpretability of this popular measure. The purpose of this study was to estimate the test-retest reliability and the MDC of the Purdue pegboard test for patients with schizophrenia. METHODS: A total of 147 patients with schizophrenia participated in this study. The participants were administrated the five subtests of the Purdue pegboard test, three trials in a row at both of the two sessions 1 week apart. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability and the MDC was calculated on the basis of standard error of measurement. RESULTS: The test-retest reliabilities of the five subtests were moderate to good (ICC = 0.73-0.88). The MDC (MDC%) was 3.0 (22.9%) for the dominant hand subtest, 3.1 (26.1%) for the nondominant hand subtest, 3.0 (31.7%) for the both hands subtest, 6.1 (17.7%) for the dominant + nondominant + both hands subtest, and 8.5 (35.3%) for the assembly subtest. CONCLUSION: Our results reveal that the Purdue pegboard test has moderate-to-good test-retest reliability but substantial random measurement error. These findings should enable clinicians and researchers to monitor and interpret the changes in the hand dexterity of patients with schizophrenia more accurately and confidently.

Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke.

OBJECTIVE: To estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [FAI]) in patients with chronic stroke. DESIGN: Test-retest reliability study. SETTING: Physical rehabilitation units of 5 hospitals. PARTICIPANTS: Chronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Both measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 × âˆš2 × Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs). RESULTS: The SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89). CONCLUSIONS: Because of substantial SRD values of the NEADL and the FAI, prospective users should be cautious in using both measures to detect real change for a single subject.

Test-retest reliability and practice effect of the oral-format Symbol Digit Modalities Test in patients with stroke.

The Symbol Digit Modalities Test (SDMT) is commonly used to evaluate an individual's switching attention and processing speed. However, its test-retest reliability and practice effect are not well known in patients with stroke, limiting its utility in both clinical and research settings. The present study examined the two aforementioned psychometric properties of the oral-format SDMT on a group of 30 outpatients with stroke. The oral-format SDMT demonstrated excellent test-retest reliability (ICC = 0.89) and a small practice effect (Cohen's d = 0.26) within a 1-week interval. A practice effect-corrected reliable change index [-5.29, 10.89] was also provided to help clinicians and researchers interpret their clients' test results. Patients' characteristics and the test-retest interval should be considered before applying the findings of the present study to clinical settings.