Validity of the Wisconsin Card Sorting Test in patients with stroke

Abstract

Background: The Wisconsin Card Sorting Test (WCST) is the most widely used measure for assessing executive functions in patients with stroke. However, no study has examined the ecological, discriminative and convergent validities of the WCST in patients with stroke. This study aimed to examine the above validities of the WCST in patients with stroke.

Methods: Ninety-eight patients were administered the WCST, two measures of activities of daily living and one cognitive measure. Seven indexes of the WCST were used in this study.

Results: Two WCST indexes (“total number correct” and “number of categories completed”) had moderate correlations with two measures of activities of daily living (Pearson’s r = 0.39–0.49). The other indexes showed low or moderate correlations with two measures of activities of daily living (r = 0.26–0.53). The results of independent t-test showed statistically significant difference between patients with and without disability for the seven WCST indexes (p = 0.001–0.013) and nonsignificant differences between patients with different affected regions of the brain (p > 0.05). Moderate correlations (r = 0.35–0.54) were found among the seven WCST indexes and one cognitive measure.

Conclusions: The WCST has poor to adequate ecological validity, acceptable discriminative validity and acceptable convergent validity in patients with stroke. The two WCST indexes (“total number correct” and “number of categories completed”) are recommended for use to reflect the degree of living independence in patients with stroke.

Implications for rehabilitation

• The Wisconsin Card Sorting Test showed poor to adequate ecological validity, acceptable discriminative validity, and acceptable convergent validity in patients with stroke.

• Two indexes of the Wisconsin Card Sorting Test (i.e., “total number correct” and “number of categories completed”) can adequately reveal the degrees of living independence in patients with stroke.

Keywords:

• Executive functions
• validity
• rehabilitation
• stroke

Acknowledgements

We thank Yi-Zhen Li, BS, for her help with data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.