Profiles of executive functioning following traumatic brain injury and stroke using the assessment of participation and executive functions: combined cross-sectional and longitudinal designs.
Rotem Eliav, Sivan Hason, Rachel Kizony
PMID 38235968WHAT IT FOUND
The A-PEX assessment identified worse executive functioning in traumatic brain injury patients compared to stroke patients during inpatient rehabilitation.
Standard tests failed to detect these differences. The A-PEX also tracked patient progress over one month, offering a more sensitive view of daily participation deficits.
Key findings
01The A-PEX assessment showed traumatic brain injury patients scored significantly lower than stroke patients on executive functioning and most daily participation domains at the first time-point, while standard tests like the Multiple Errands Test and Color Trails Test found no significant differences between the groups.
02At the second time-point, traumatic brain injury patients continued to score significantly lower than stroke patients in social interaction and both executive functioning scales, whereas differences in other functional domains were no longer significant.
03Both groups showed significant improvement in all A-PEX functional domains and executive functioning cognitive scales between the first and second time-points, with medium-to-large effect sizes.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The sample size was smaller than calculated due to the COVID-19 pandemic, limiting statistical power. The study excluded patients with low functioning or severe behavioural deficits who could not undergo demanding cognitive tests, creating a recruitment bias that may not represent the full spectrum of brain injury patients. The assessors were not blind to the patient's injury type, which could introduce bias. The groups differed significantly in age and time since injury, which are confounding factors. Improvements in scores could be due to spontaneous recovery, learning effects, or the rehabilitation itself, rather than just changes in executive functioning. The study did not collect data on upper extremity function, which could affect performance on timed tests like the Color Trails Test.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume the A-PEX is a validated diagnostic tool for differentiating brain injury types in routine practice. The study found differences between groups, but the small sample size and lack of blinding mean these findings require confirmation in larger, more rigorous trials before changing standard assessment protocols.