Executive Function Performance Test: transcultural adaptation, evaluation of psychometric properties in Brazil

Conti, Juliana; Brucki, Sonia Maria Dozzi

doi:10.1590/0004-282X20180127

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Article • Arq. Neuro-Psiquiatr. 76 (11) • Nov 2018 • https://doi.org/10.1590/0004-282X20180127 copy

Executive Function Performance Test: transcultural adaptation, evaluation of psychometric properties in Brazil

Teste de Desempenho da Função Executiva: adaptação transcultural, avaliação das propriedades psicométricas no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Executive dysfunction occurs in 18.5% to 39% of patients who present with cognitive impairment. Occupational therapy aims to facilitate independence and autonomy, hence improving quality of life. The Executive Function Performance Test – Brazilian version (EFPT-BR) has been developed to assess the need for assistance in performing four basic daily tasks.

Objectives:

The aims of this research were: (1) to offer cross-cultural adaptation in patients with stroke; (2) to assess the psychometric properties of the Brazilian version of the EFPT-BR in patients with stroke; (3) to assess the relationship between scores on the EFPT-BR in patients with stroke, and demographic variables, stroke location, symptoms of anxiety and depression.

Methods:

The transcultural adaptation and validation were performed based on standard procedures, and psychometric properties were assessed in 86 Brazilian patients who suffered a stroke.

Results:

The test has shown a good internal consistency (Cronbach's alpha: 0.819). The ICC for intra-rater reliability was 0.435 and for the inter-rater was 0.732. Significant correlations between scores in the EFPT-BR and executive measures (verbal fluency test, clock drawing test, digit span – forwards and backwards, zoo map test and Six Elements Test) were observed.

Conclusion:

The EFPT-BR is a valid and reliable tool for occupational therapists to assess executive dysfunction in daily routine tasks in patients with stroke in Brazil.

Keywords:
stroke; executive function; occupational therapy; cognition; validation studies

Characteristics	n = 86
Age (mean ± SD)	62.7 ± 10.9
Gender (F/M)	35/51
Educational level (years)	7.4± 4.93
Ethnic group (White/Black/Asian)	66/17/3
Lesion location	Right hemisphere – 23
	Left hemisphere – 37
	Right + Left hemisphere – 3
	Brainstem – 16
	Cerebellum – 7
Manual preference (left/right/ambidextrous)	3/82/1
MMSE: illiterates (n=11) mean (SD); median (interval)	19.4 (± 1.55);19 (17–22)
MMSE:1– 4 years of education (n=27) mean (SD); median (interval)	23.5 (± 3.40); 25 (20–30)
MMSE: 5– 8 years of education (n=13) mean (SD); median (interval)	24.5 (± 2.68); 24 (21–29)
MMSE: over 8 years of education (n=35) mean (SD); median (interval)	26.5 (± 2.78); 28 (20–30)
Naming^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	9.7 (± 0.89); 10 (3–10)
Visual perception^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	9.7 (± 0.90); 10 (3–10)
Incidental memory^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	5.4 (± 1.46); 5 (2–10)
Immediate Memory 1^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	7.5 (± 1.52); 8 (3–10)
Immediate Memory 2^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	8.2 (± 1.58); 8 (3–10)
Delayed recall^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	7.4 (± 1.96); 8 (0–10)
Recognition^* * subtest of the brief cognitive screening battery; mean (SD); median (interval)	9.5 (± 1.05); 10 (5–10)
NIHSS mean (SD); median (interval)	1.9 (± 1.75); 1 (0–6)
Modified Rankin Scale mean (SD); median (interval)	1.7 (± 1.05); 2 (0–4)
Barthel Index mean (SD); median (interval)	97.5 (± 7.22); 100 (40–100)
Questionnaire (FAQ) mean (SD); median (interval)	2.0 (± 3.50); 26 (11–27)

Executive function tests		Score (n = 86) means (SD); median (interval)
Semantic Verbal Fluency^* * Sub test of the brief cognitive screening battery.		9.1 (± 3.7); 1 (0–1)
0-1 years of education, n = 11		9.1 (± 3.7); 1 (0–1)
Semantic Verbal Fluency^* * Sub test of the brief cognitive screening battery.		13.6 (± 4.6); 4 (1–4)
1-4 years of education, n = 27		13.6 (± 4.6); 4 (1–4)
Semantic Verbal Fluency^* * Sub test of the brief cognitive screening battery.		13.4 (± 4.2); 6 (5– 8)
5-8 years of education, n = 13		13.4 (± 4.2); 6 (5– 8)
Semantic Verbal Fluency^* * Sub test of the brief cognitive screening battery.		15.2 (± 5.2); 12 (9 –22)
Over 8 years of education, n = 35		15.2 (± 5.2); 12 (9 –22)
Clock Drawing Test^* * Sub test of the brief cognitive screening battery.		6.3 (± 2.79); 7 (2–10)
Digit Span Forwards		5.8 (± 1.23); 6 (2–7)
Digit Span Backwards		3.0 (± 1.27); 3 (0–6)
Stroop Test for illiterates (interference score, time in seconds)		12.0 (± 16.0); 7 (-17–67)
0–4 years of education, n = 38		12.0 (± 16.0); 7 (-17–67)
Stroop Test for illiterates (interference score, time in seconds)		7.0 (± 7.7); 6 (-6–39)
More than 4 years of education, n = 48		7.0 (± 7.7); 6 (-6–39)
Zoo Map1 and 2 (BADS)		2.2 (± 0.73); 2 (1–4)
Modified six elements (BADS)		2.4 (± 0.94); 2 (0–4)
EFPT-BR
	Simple meal preparation (median; intervals)	1.0 (± 1.8); 0 (0–10)
	Phone call	0.7 (± 1.6); 0 (0–9)
	Medication	1.3 (± 1.3); 1 (0–7)
	Paying bills	1.7 (± 2.9); 3 (0–10)
	EFPT total ccore	5.9 (± 5.2); 5 (0–32)
	EFPT: total time in minutes	17.1 (± 5.5); 17 (9.4– 37.9)

EFPT-BR	Correlation of the task with the total score (Cronbach's alpha)
Simple meal preparation	0.564
Phone call	0.720
Medication	0.607
Paying bills	0.704

EFPT-BR	Total score in the 1^stevaluation	Total score in the 2^ndevaluation	ICC	ICC (95%)
	(median and range)	(median and range)		ICC (95%)
	(n = 30)	(n = 30)		Inferior	Superior
Simple meal preparation	0 (0–2)	0 (0–2)	0.000	0.000	0.362
Phone call	0 (0–3)	0 (0–2)	0.190	0.000	0.515
Medication	1 (0–4)	1 (0–4)	0.418	0.083	0.671
Paying bills	3 (0–5)	2 (0–5)	0.317	0.000	0.603
Total score	5 (0–12)	3 (0–10)	0.435	0.096	0.684
EFPT-BR	1^stOT	2^ndOT	ICC	ICC (95%)
	(median and range)	(median and range)		ICC (95%)
	(n = 40)	(n = 40)		Inferior	Superior
Simple meal preparation	1 (0–10)	0 (0–10)	0.750	0.577	0.859
Phone call	0 (0–8)	0 (0–9)	0.758	0.574	0.867
Medication	1 (0–5)	1.5 (0–7)	0.393	0.109	0.621
Paying bills	2.5 (1–6)	3 (1–9)	0.555	0.303	0.736
Total score	6 (1–25)	7 (1–29)	0.732	0.516	0.855

Correlation (Spearman's rank)		Simple meal preparation	Phone call	Medication	Paying bills	Total score
Animal verbal fluency^* * Brief cognitive screening battery; BADS: Behavioural assessment of the dysexecutive syndrome; FAQ: Functional activities questionnaire; IADL: Instrumental activities of daily living.	rho	-0.243	-0.358	-0.333	-0.365	-0.452
	p	0.024	0.001	0.002	0.001	< 0.001
Clock drawing test^* * Brief cognitive screening battery; BADS: Behavioural assessment of the dysexecutive syndrome; FAQ: Functional activities questionnaire; IADL: Instrumental activities of daily living.	rho	-0.214	-0.184	-0.271	-0.237	-0.324
	p	0.048	0.090	0.012	0.028	0.002
Digit span test	rho	-0.117	-0.181	-0.101	-0.319	-0.219
Foward	p	0.282	0.096	0.356	0.003	0.042
Digit span test	rho	-0.109	-0.355	-0.181	-0.384	-0.324
Backward	p	0.318	0.001	0.095	< 0.001	0.002
Stroop test (interference score)	rho	-0.077	0.035	0.207	0.163	0.116
Stroop test (interference score)	p	0.481	0.748	0.056	0.134	0.287
Zoo Map 1 and 2 BADS	rho	-0.333	-0.419	-0.228	-0.314	-0.388
Zoo Map 1 and 2 BADS	p	0.002	< 0.001	0.035	0.003	< 0.001
Modified 6 elements	rho	-0.178	-0.388	-0.347	-0.463	-0.463
BADS	p	0.101	< 0.001	0.001	< 0.001	< 0.001
Barthel index	rho	-0.197	-0.119	-0.331	-0.135	-0.263
Barthel index	p	0.068	0.275	0.002	0.216	0.014
FAQ	rho	0.380	0.219	0.303	0.295	0.420
FAQ	p	< 0.001	0.042	0.005	0.006	< 0.001
IADL scale	rho	-0.269	-0.148	-0.322	-0.186	-0.313
IADL scale	p	0.012	0.175	0.002	0.086	0.003

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[1] Correspondence: Juliana Conti; Avenida Dr. Enéas de Carvalho Aguiar, 255; 05403-000 São Paulo SP, Brasil; E-mail: juconti@yahoo.com.br.