AOTA

Authors:

Kelly Casey, OTD, OTR/L, BCPR, ATP, CPAM, is Acute Care Therapy Services Team Leader, Johns Hopkins Hospital, Baltimore, MD.

Erin Sim, OTD, OTR/L, PMP, is Acute Care Team Coordinator, Johns Hopkins Hospital, Baltimore, MD.

Annette Lavezza, OTR/L, is Director, Inpatient Therapy Services, Johns Hopkins Hospital, Baltimore, MD; Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; and Member, Outcomes After Critical Illness and

Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD.

Kristen Iannuzzi, OTD, OTR/L, BCPR, CPAM, is Occupational Therapist and Occupational Therapy Acute Care Fellow, Johns Hopkins Hospital, Baltimore, MD.

Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD.

Erik H. Hoyer, MD, is Assistant Professor and Vice Chair for Quality and Safety, Department of Physical Medicine and Rehabilitation, and Member, Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.

Daniel L. Young, PT, DPT, PhD, is Associate Professor, Department of Physical Therapy, University of Nevada; Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD; and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.

CE Credit: .1 CEU (1 credit hour/1.25 PDU)

Abstract:

Importance: Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment.

Objective: To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care.

Design: Prospective mixed methods.

Setting: Acute care hospital.

Participants: Fifty adults.

Outcomes and Measures: We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT–SF), the Activity Measure for Post-Acute Care “6-Clicks” Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT–SF and AM-PAC ACISF with those of the MoCA.

Results: Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT–SF, and .86 for the AM-PAC ACISF. The BCAT–SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT–SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was <22. Administration time of the AM-PAC ACISF (1.0 min) was significantly less than that of the

BCAT–SF (5.0 min) and the MoCA (13.3 min; p < .001).

Conclusions and Relevance: Each screen demonstrated acceptable reliability and construct validity. The AMPAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting.

What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.