Performance-Based Everyday Problem-Solving in Patients With TBI.

Abstract

The present study examined whether the everyday problems test (EPT), a performance-based measure of everyday problem-solving, can be considered a useful test in assessing functional independence in patients with traumatic brain injury (TBI). The relationship between EPT, cognitive abilities (i.e., selective attention, set switching, and working memory) and self-rated measures of everyday functioning and disability in these patients was also assessed. In this case-control study 25 postcomatose outpatients with TBI (age M=35.9, SD=14.21) from a neurorehabilitation unit and 25 matched controls were enrolled. Participants were administered the EPT along with neuropsychological tests of selective attention, set switching and working memory, and self-rated measures of everyday functioning and disability. Patients with TBI were less accurate and slower than controls in the EPT; the two groups were accurately classified based on EPT completion time (likelihood ratio test χ2=28.67, R2=0.72, p<.001). In the patient group education and selective attention explained a large portion of variance in EPT accuracy (R2=0.53, p=.001), while only selective attention explained a significant portion of variance in EPT time (R2=0.24, p<.01). Self-rated measures of everyday functioning and disability did not significantly contribute to EPT performance variance. Including performance-based measures as the EPT in a multifactorial approach to assessment can be useful for unraveling cognitive factors contributing to TBI's impact on everyday functioning. Since attentional processes seem to play a significant role in determining EPT performance, rehabilitation of functional independence should target this ability first.