Executive Function Performance Test for Stroke Patients

Introduction to the EFPT

The Executive Function Performance Test (EFPT) is an assessment instrument designed for healthcare practitioners who work with mild and moderate-severity stroke patients. Executive function is important to overall health because it allows individuals to regulate their actions, plan their behavior, and set goals. Stroke patients frequently suffer from executive-function-related losses; this study proposes a measure that will help quantify the extent of that loss.

The EFPT is noticeably different from other performance-based measures because, unlike the Kitchen Task Assessment (its closest relative), it records cues from experimenters that support patient performance. Support cues may be offered as physical assistance or as verbal prompts. Also, unlike other popular instruments that measure performance of day-to-day tasks, the EFPT formalizes this record of support cues as progressive — just as in real life, caretakers or companions start by offering minimal support and progressively move toward performing instrumental support (without which the task could not be completed). This introduces a necessary element of realism to the measure.

Especially with recovering stroke patients, the amount of help offered and accepted can be a critical distinction between different levels of post-stroke healing. The EFPT is also better suited to accommodating people with motor impairment, whether or not they are stroke survivors, because those individuals routinely ask for and receive assistance with daily tasks.

Study Design and Variables

The design of this study was a basic experimental 3×1 design. The authors compared three groups on their performance of the EFPT: mild stroke, moderate stroke, and an age-matched control group (no stroke). All participants completed the EFPT, and stroke-group participants were tested six months after their stroke event to allow for a consistent amount of healing time.

The independent variables in this study were stroke condition (mild, moderate, or none), gender, age, education (in years), and race (African-American or White). Two levels of dependent variables were described: actual EFPT tasks — Cooking, Using the Telephone, Medicine Management, and Paying Bills — and executive function (EF) components, which included Initiation, Organization, Sequencing, Safety and Judgment, and Completion.

Participants' scores were computed according to both sets of variables. The task variables were operationalized as the sum of scored or coded items during each task. The component variables were operationalized as the sum of items coded according to each component. Actions and events performed during the Using the Telephone task, for example, could be coded under any one of the components, and each component was included across all EF tasks.

Reliability and Validity

Reliability for this instrument can be measured through both inter-coder reliability and internal consistency. The authors used Inter-Coder Coefficients (ICCs) as a measure of coder reliability and obtained high values for these ICCs across all EFPT tasks. Internal consistency was measured using Cronbach's alpha, which yielded a value of 0.94 — indicating strong internal consistency. In other words, there was a high degree of correlation between participants' performance across each task.

Validity for this instrument had already been established for normal aging populations in prior studies. For stroke populations, however, the construct validity of the instrument is not entirely consistent. For example, the instrument fails to effectively discriminate between mild and moderate stroke patients' ability in the Cooking task. To assess criterion validity, the authors compared the EFPT to a battery of neuropsychological tests. The EFPT's results corresponded closely with those neuropsychological tests, confirming the criterion validity of the instrument.