Reliability and internal consistency of the Danish version of Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II/D)

Abstract

Objective: To evaluate the intra-rater and inter-rater reliability and internal consistency of the Danish version of the Loewenstein Occupational Therapy Cognitive Assessment, second edition (LOTCA-II/D), an instrument designed to assess and evaluate cognitive functioning. Methods: A reliability study was conducted at neurological acute care and rehabilitation units at three Danish hospitals. Fifty-four neurological patients participated in the study. Patients were tested with LOTCA-II/D by occupational therapists, and video recordings were made for reliability assessments. Intra-rater assessments were performed at least two weeks after the first assessment, and all occupational therapists were blinded to previous assessments. Intra-rater and inter-rater reliability were evaluated using percentage agreement and weighted kappa. Internal consistency was evaluated using Cronbach’s alpha, and floor and ceiling effects were evaluated by calculating the proportion of observations in minimum and maximum categories of subtests. Results: The results showed a lack of intra-rater and inter-rater reliability and a large variation of agreement due to a substantial ceiling effect. Internal consistency was below the acceptable value in half of the cognitive areas. Conclusion: The study found that LOTCA-II/D is not reliable in acute clinical practice, and it could thus not be validated for use in this setting.

Key words::

• validity
• rehabilitation
• occupational therapy
• instrument
• Cognition

Acknowledgements

The authors would like to thank the Physiotherapy and Occupational Therapy Department, Regional Hospitals Viborg and Skive, Hospitalsenhed Midt, Denmark, and the Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark, for their contribution to the study; and especially the occupational therapists involved in the study for their support and effort. The authors would also like to thank the Health Science Research Forum for Western Denmark for statistical help, and Maddak Inc. for the donation of two LOTCA-II batteries. The study was supported by the Danish Association of Occupational Therapist Research and Development Funds (grant number PP 2/11-14).

Contributors

All authors contributed substantially to the article and met the conditions for authorship. KL is the guarantor of the study and contributed with the conception and design of the study, analysis and interpretation of data, drafting of the article, and final approval. TM contributed with analysis and interpretation of data, critical revision, and final approval. LGO contributed with the design of the study, critical revision, and final approval.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.