Clinical Outcomes and Satisfaction following Neuropsychological Assessment for Adults: A Community Hospital Prospective Quasi-Experimental Study.

Abstract

Patients and other stakeholders generally report high satisfaction with neuropsychological evaluations (NPEs), but no research has examined effects of cognitive, emotional, and other factors that often prompt evaluations. A prospective, quasi-experimental study was conducted to examine self-reported cognitive and psychiatric symptoms, self-efficacy, motivation, and satisfaction following a NPE. Participants from a neuropsychology clinic who were diagnosed with AD/HD and/or a DSM-IV mood disorder based on a NPE were included, and excluded if diagnosed with dementia or failure on performance validity tests. To examine whether a NPE with an interventional feedback session was associated with outcomes, changes from baseline to post-feedback session were examined with repeated-measures analysis of variance. Pearson correlations determined whether changes in hypothesized mechanisms (i.e., self-efficacy, goal importance and confidence ratings, and use of cognitive strategies) were related to changes in cognitive or psychiatric symptom severity. At follow-up, participants reported reductions in psychiatric (change in Brief Symptom Inventory depression: M=-2.8, SD=4.4, range=-11 to 8, ${\eta}_p^2$=.30; anxiety: M=3.2, SD=6.6, range=-21 to 10, ${\eta}_p^2$=.20) and cognitive symptoms (change in Multiple Ability Self-Report Questionnaire attention: M=-0.3, SD=0.5, range=-1.6 to 0.5, ${\eta}_p^2$=.31; verbal memory: M=-0.3, SD=0.5, range=-1.1 to 0.5, ${\eta}_p^2$=.24; language: M=-0.4, SD=0.4, range=-1.3 to 0.4, ${\eta}_p^2$=.48), and improved cognition (change in Meta-Memory Questionnaire ability: M=4.4,SD=6.2, range=-10 to 16, ${\eta}_p^2$=.35; contentment: M=4.3, SD=4.5, range=-7 to 14, ${\eta}_p^2$=.49). Participants reported increased self-efficacy for general and evaluation-specific goals. Increased goal-specific self-efficacy was associated with large reductions in psychiatric symptoms. Participants reported high levels of satisfaction with the NPE. Results support the clinical utility of NPE and feedback, and underscore the importance of individualized goal setting as part of the evaluation process.