Authors:
Yejin Lee, Samantha B. Randolph, Moon Young Kim, Erin R. Foster, Jessica Kersey, Carolyn Baum, Lisa Tabor Connor
Course learning objectives:
- Identify key psychometric properties relevant to performance-based assessments of functional cognition, including construct validity, reliability, and responsiveness.
- Explain the strengths and limitations of existing performance-based assessments of functional cognition based on their psychometric evidence.
- Apply knowledge of psychometric properties to evaluate the appropriateness of assessments for clinical and research use in occupational therapy.
Course Credit: .1 AOTA CEU (1 contact hour/1.25 NBCOT PDU)
Importance: It is crucial to understand the psychometric properties of performance-based assessments of functional cognition to support their use and the interpretation of the outcomes.
Objective: To investigate the psychometric properties of performance-based assessments of functional cognition in adults.
Data Sources: A literature search was conducted in the MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Scopus databases from inception to July 2022.
Study Selection and Data Collection: We searched for studies that investigated the psychometric properties of the 25 assessments identified in Part 1 of this review. The included studies examined at least one psychometric property in adults older than age 18 yr. We evaluated psychometric evidence using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) approach.
Findings: The most extensively researched psychometric property was hypothesis testing for construct validity, including convergent and discriminative validity. The original Allen Cognitive Level Screen, the Kitchen Task Assessment, the Menu Task, and the original Observed Tasks of Daily Living have high evidence of sufficient construct validity. The hospital-based Multiple Errands Test has moderate evidence for sufficient reliability. However, the reported evidence for other psychometric properties, including structural validity, is limited. Additionally, no studies investigated measurement error and responsiveness. No studies were deemed to satisfy the standards for establishing cross-cultural validity suggested by the COSMIN approach.
Conclusions and Relevance: Although several assessments demonstrate sufficient construct validity, additional studies are needed to elucidate other psychometric properties, including structural validity, reliability, and responsiveness, to support the use and interpretation of assessments of functional cognition in adults.
Plain-Language Summary: Functional cognition refers to the integration of cognitive skills during the performance of everyday activities. We investigated whether the existing performance-based assessments of functional cognition in adults are valid and reliable. The findings of this review indicate that certain assessments, such as the original Allen Cognitive Level Screen, the Kitchen Task Assessment, the Menu Task, and the original Observed Tasks of Daily Living, may be valid. However, additional studies are needed to elucidate other psychometric properties, including reliability, structural validity and responsiveness, to support the use and interpretation of the assessments of functional cognition in adults.
Lee, Y., Randolph, S. B., Kim, M. Y., Foster, E. R., Kersey, J., Baum, C., & Connor, L. T. (2025). Performance-based assessments of functional cognition in adults, part 2—Psychometric properties: A systematic review. American Journal of Occupational Therapy, 79, 7904205140. https://doi.org/10.5014/ajot.2025.050949
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