A novel assessment of participation and executive functions (A-PEX) for traumatic brain injury: a validity study.
Rotem Eliav, Yael Lugassy, Rachel Kizony
PMID 37083100WHAT IT FOUND
The A-PEX tool reliably scores executive function deficits by observing a patient's actual participation in daily inpatient tasks.
It distinguishes TBI patients from controls and correlates with standard cognitive tests. Scoring takes 30 to 45 minutes and does not fatigue the patient.
Key findings
01The A-PEX demonstrated excellent internal consistency (Cronbach’s alpha 0.83-0.96) and moderate-to-good test-retest reliability for key domains like treatment-schedule management.
02Patients with TBI scored significantly lower than controls on all A-PEX functional domains and executive function scales, with large effect sizes for most areas.
03A-PEX scores showed moderate-to-strong correlations with the Multiple Errands Test-Hospital Version and moderate correlations with the Montreal Cognitive Assessment in the TBI group.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study had a small sample size, particularly in the TBI group (n=26), which was smaller than the calculated target due to COVID-19 restrictions. Participants were recruited from a single rehabilitation center, limiting generalizability to other settings. The study excluded patients with severe cognitive deficits or behavioral issues, so the tool's validity in these populations is unknown. The test-retest interval was one month, which may be longer than ideal for assessing stability in early rehabilitation. Interrater reliability was only preliminarily established with a small number of assessments.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Loewenstein Rehabilitation Center, but the authors stated the sponsor had no involvement in the research.
The easy way to misread this
Do not assume the A-PEX is equally reliable for all domains. The leisure and social interaction domains showed poor test-retest stability, likely because patients adapt to the inpatient routine over time. Use the tool primarily for domains like treatment-schedule management where stability is higher.