A novel assessment of participation and executive functions (A-PEX) for traumatic brain injury: a validity study.

Abstract

Executive function deficits are a main cause of participation restrictions post-traumatic brain injury (TBI). Assessing executive functions through actual daily participation may provide valuable information for treatment planning and progress. This study aimed to validate the Assessment of Participation and Executive Functions (A-PEX), a tool for evaluating executive function deficits through actual participation in the inpatient rehabilitation context during the subacute phase following TBI. A cross-sectional with a longitudinal component. Inpatient rehabilitation facility. This study included 56 participants divided into two groups: 30 with orthopedic or spinal cord injuries and 26 with TBI. Internal consistency was evaluated by Cronbach's alpha, and test-retest reliability was assessed using interclass correlation coefficients. Known-group construct validity was examined by comparing the A-PEX scores between the two groups, and A-PEX convergent construct validity for patients with TBI was examined using correlations between scores on the A-PEX, Multiple Errands Test-hospital version (MET-HV), and Color Trail Test (CTT). Cronbach's alpha coefficients for the A-PEX domains ranged between 0.83 and 0.96, indicating good-to-excellent internal consistency. Interclass correlations calculated for the control group indicated moderate test-retest reliability for most A-PEX components. Participants with TBI scored significantly lower than those with orthopedic or spinal cord injury for all A-PEX components (P<0.001). Within the TBI group, significant moderate-to-strong correlations were found between all A-PEX components and the MET-HV (0.52<r<0.73, P<0.05) and between the A-PEX executive function scales and the CTT (r=0.52, P<0.05). The findings provide evidence for the initial reliability and validity of the A-PEX as a measure of post-TBI executive functions. By evaluating actual everyday participation, the A-PEX provides valuable clinical insight into the interrelationship between executive functions and participation in the post-TBI subacute phase.