Validation and clinical utility of the executive function performance test in persons with traumatic brain injury

ABSTRACT

This study examined the relationships between the Executive Function Performance Test (EFPT), the NIH Toolbox Cognitive Function tests, and neuropsychological executive function measures in 182 persons with traumatic brain injury (TBI) and 46 controls to evaluate construct, discriminant, and predictive validity. Construct validity: There were moderate correlations between the EFPT and the NIH Toolbox Crystallized (r = −.479), Fluid Tests (r = −.420), and Total Composite Scores (r = −.496). Discriminant validity: Significant differences were found in the EFPT total and sequence scores across control, complicated mild/moderate, and severe TBI groups. We found differences in the organisation score between control and severe, and between mild and severe TBI groups. Both TBI groups had significantly lower scores in safety and judgement than controls. Compared to the controls, the severe TBI group demonstrated significantly lower performance on all instrumental activities of daily living (IADL) tasks. Compared to the mild TBI group, the controls performed better on the medication task, the severe TBI group performed worse in the cooking and telephone tasks. Predictive validity: The EFPT predicted the self-perception of independence measured by the TBI-QOL (beta = −0.49, p < .001) for the severe TBI group. Overall, these data support the validity of the EFPT for use in individuals with TBI.

KEYWORDS:

• Executive function
• NIH Toolbox
• traumatic brain injury
• performance-based testing

Acknowledgements

We thank our skilful and dedicated research assistants for their efforts in recruiting our sample and administering the tests required to carry out this study: Ana Miskovic, Arielle Goldsmith, Sue Tucker, Jessica Dashner, Cathy Crawley, Ben Aziz, Julie Grech, Livia Vanden Belt, and Angela Miciura.

We would also like to acknowledge our participants. The test battery we used required a major commitment of time, transportation, some family support and a lot of effort. We found our participants were happy to tell and show us their strengths and vulnerabilities for the sake of science and for this we are very grateful.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) was formerly known as National Institute on Disability and Rehabilitation Research (NIDRR) [grant number H133B090024, Allen Heinemann, PI]; the Craig H. Neilsen Foundation [grant number 290474, Alex Wong, PI]; and the James. S. McDonnell Foundation [JSMF 220020087, Carolyn M. Baum, PI].