Assessment Of Functional Ability Research Articles

Objective assessment of functional abilities in lysosomal diseases using structured at-home video recordings

Objective assessment of functional abilities in lysosomal diseases using structured at-home video recordings

Heuristic evaluation and usability testing of a functional dementia stages app for Hispanic family caregivers

AbstractBackgroundHispanic family caregivers of persons with Alzheimer’s disease and other dementias are not getting the anticipatory guidance they need about how functional abilities will change as dementia progresses. Existing informational resources are overwhelming to navigate and written at a high reading level. Furthermore, professional assessment of functional abilities is not universally available. Innovative, tailored approaches are needed. Our aim was to develop and test a mobile application, the Interactive Functional Assessment Staging Navigator (I‐FASTN), to support Hispanic family caregivers’ assessment of care recipients’ functional stage of dementia in either English or Spanish.MethodWe conducted heuristic evaluation with informatics experts (N = 5, English only) and usability testing with caregivers (n = 10 English, n = 10 Spanish). Participants attempted a series of tasks with the app using a think‐aloud protocol and then rate the usability of the app using mobile app heuristics (experts) and two usability instruments (caregivers). Sessions were recorded and transcribed. For heuristic evaluation, we tabulated the number of usability problems by category: cosmetic, minor, major, and catastrophic. For usability testing, recordings, notes, and transcripts were content analyzed to extract usability problems, suggestions for improvement, desired app features, and other feedback.ResultRefinements to the app were made after each of the five evaluations to address the problems encountered. Caregivers’ mean usability scores were high (4.6 and 4.7 out of 5.0), reflecting good usability overall. Chief usability problems were a confusing tutorial and difficulty finding the app’s side menu. These will be addressed by creating a video tutorial and moving all menu items to the home screen. The app was very well received by caregivers, who indicated that the concise, illustrated content met their informational needs. However, analog alternatives are still needed by caregivers unaccustomed to using apps as they had difficulty moving on from even the simplest screens (see Figure 1a).ConclusionCaregivers are not receiving informational support in a way that meets their needs. The focus should be on providing concise information that addresses the practical aspects of caregiving, tailored to the care recipient’s functional stage.

Importance of an Integrated Assessment of Functional Disability and Work Ability in Workers Affected by Low Back Pain

BackgroundThis study examines the relationship between functional disability and work ability in workers affected by low back pain (LBP) through an analysis of correlations between the Oswestry Disability Index (ODI) and Work Ability Index (WAI). The role of personal and work factors on functional disability/work ability levels has also been studied. LBP is the most common musculoskeletal problem and a major disabling health problem worldwide. Its etiology is multifactorial. Multidisciplinary approaches may help reduce the burden of pain and disability and improve job continuity and reintegration at work. MethodsA cohort of 264 patients affected by LBP from an Italian outpatient clinic were included in a clinical diagnostic/therapeutic trial aiming at rehabilitation and return to work through an integrated investigation protocol. Data were collected during the first medical examination using anamnestic and clinical tools. The final sample is composed of 252 patients, 57.1% man, 44.0 % blue collars, 46.4% with the high school degree, 45.6% married. ResultsWAI and ODI reported a negative and fair correlation (r = –0.454; p = .000). Workers with acute LBP symptoms have a higher probability of severe disability than those with chronic LBP symptoms. White collars without depressive symptoms reported higher work ability – even in chronic disability conditions-than those with depressive symptoms. ConclusionThe study found that ODI and WAI have a convergent validity and this suggests that the two tools measure capture distinctive aspects of disability related to personal, environmental, and occupational characteristics. The most important and modifiable prognostic factors found for ODI and WAI were depressive symptoms, workday absence, and intensity of back pain. The study also found a mild association between age and ODI. The study's findings highlight the importance of using a multidisciplinary approach to manage and prevent disability due to LBP.

A prospective study of MRI biomarkers in the brain and lower limb muscles for prediction of lower limb motor recovery following stroke.

The aim of this prospective observational longitudinal study was to explore and decipher the predictive value of prospective MRI biomarkers in the brain and lower limb muscles for 3-month lower limb motor recovery following stroke. In the brain, we measured the integrity of the corticospinal tract (fractional anisotropy/"FA"). In the muscles, we measured volume, fatty replacement (fat fraction analysis and proton spectroscopy) and oedema. Measurements were taken at two time points: (1) within 4 weeks of stroke (baseline measurement, clinical and imaging) and (2) 3 months following stroke (follow up measurement, clinical only). Clinical measurements consisted of assessments of functional ability and strength (Fugl-Meyer score, motor NIHSS, Functional Ambulation Category/"FAC", and muscle dynamometry). Twenty-three patients completed imaging and clinical assessments at baseline and follow-up; five patients had partial imaging assessment. The results provided some evidence that damage to the corticospinal tract would result in less motor recovery: recovery of the Fugl-Meyer score and dynamometric ankle plantarflexion, ankle dorsiflexion, and knee extension correlated positively and significantly with fractional anisotropy (0.406-0.457; p = 0.034-p = 0.016). However, fractional anisotropy demonstrated a negative correlation with recovery of the Functional Ambulation Category (-0.359, p = 0.046). For the muscle imaging, significant inverse correlation was observed between vastus lateralis fat fraction vs. NIHSS recovery (-0.401, p = 0.04), and a strong positive correlation was observed between ratio of intra- to extra-myocellular lipid concentrations and the recovery of knee flexion (0.709, p = 0.007). This study supports previous literature indicating a positive correlation between the integrity of the corticospinal tract and motor recovery post-stroke, expanding the limited available literature describing this relationship specifically for the lower limb. However, recovery of functional ambulation behaved differently to other clinical recovery markers by demonstrating an inverse relationship with corticospinal tract integrity. The study also introduces some muscle imaging biomarkers as potentially valuable in the prediction of 3-month lower limb motor recovery following stroke.

The Healthy Ageing Questionnaire Index: Validation in the Singapore Longitudinal Ageing Study

Introduction: Healthy ageing (HA) indices typically use full questionnaire, performance- or blood-based assessment of functional ability which are time-consuming and resource-intensive. We developed and validated a simple and brief Healthy Ageing Questionnaire (HAQ) index with comparable measurement accuracy. Methods: The 15-item HAQ (scored 0–100) was developed using data of 500 participants in the Singapore Study of Successful Ageing (SSOSA), a sub-cohort of the Singapore Longitudinal Ageing Study (SLAS-2). Its construct, concurrent, and predictive validity were evaluated in 2,161 participants in the SLAS-2 who were non-participants of the SSOSA. Results: The HAQ index (mean = 64.0, SD = 11.8) showed a coherent 3-factor structure (Cronbach’s alpha = 0.735). HAQ scores were higher among participants who were female, highly educated, not living alone, non-smoking, non-alcohol drinkers, not at risk of malnutrition, were robust or pre-frail, not disabled, had no or <5 medical conditions, and no recent fall or hospitalization. It was positively correlated with Mini-Mental State Examination and life satisfaction, and negatively correlated with age, logMAR vision, 5 times sit-and-stand, and timed-up-and-go. The HAQ index was significantly correlated but showed modest concordance with the Rowe-Kahn SA index. Increasing HAQ index quintiles were associated with decreased mortality risks from 40.6 to 9.7 deaths per 1,000 person-years; covariate-adjusted hazard ratio for the highest Q5 levels (HAQ score >70) was 0.44 (95% CI = 0.28–0.67). Using receiver operating characteristics analysis of predictive accuracy for survival, the area under the curve of HAQ was 0.675, and Rowe-Kahn SA index was 0.660 (p = 0.361). Conclusion: The HAQ is a brief and accurate HA index that is potentially useful across diverse settings and purposes in research, healthcare, and policy-making.

Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists

Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists’ practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.

Physical Functional Ability and Quantitative Assessment of the Multifidus Muscle of the Lumbar Spine in the Elderly.

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p < 0.05). However, degree of disc and multifidus muscle degeneration was not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc degeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

Lawton's Instrumental Activities of Daily Living for Greek-Speaking Adults with Cognitive Impairment: A Psychometric Evaluation Study with Additional Receiver Operating Characteristic Curve Analysis.

One of the components of a dementia diagnosis is the assessment of functional abilities. These abilities are measured via screeners, such as the Instrumental Activities of Daily Living (IADL) scale. The IADL scale is a valid tool that has been adapted in many languages. This study aimed to provide a cut-off point and validate the Greek version of the IADL scale in populations with cognitive impairment. IADL data were collected from 132 individuals: 24 PD patients, 24 Parkinson's disease dementia (PDD) patients, and 24 AD patients. The remaining 60 participants were cognitive healthy adults (CHAs). The CHA group and the PD group served as the cognitively unimpaired group (CUG), while the PDD and AD groups served as the cognitively impaired group (CIG). Additionally, the MMSE, the AMTS, the Clock Drawing Test CDT, the Arizona Battery for Communication Disorders of Dementia (ABCD), the NPI, and the GDS-15 were administered to the participants. Statistically significant differences in the IADL scores were exhibited between all subgroups. The IADL scale showed high internal consistency (Cronbach's alpha = 0.890). A threshold equal to 6.00 (AUC = 0.888, p < 0.001) was estimated between the CUG and the CIG. Significant positive correlations were observed between IADL and MMSE (r = 0.764, p < 0.001), IADL and AMTS (r = 0.724, p < 0.001), IADL and ABCD (r = 0.702, p < 0.001), and IADL and CDT (r = 0.627, p < 0.001) results. Given the obtained results, the IADL scale is a valid tool for clinical use with high reliability and sensitivity. Also, the IADL scale is a valuable instrument for screening functional abilities associated with cognitive impairment.

Functional Dementia Stages App for Hispanic Family Caregivers: Heuristic Evaluation and Usability Testing.

Hispanic family caregivers of persons with dementia are not getting the anticipatory guidance they need about how functional abilities will change as dementia progresses. Existing informational resources are overwhelming to navigate and written at a high reading level. Furthermore, professional assessment of functional abilities is not universally available. Innovative, tailored approaches are needed. Our aim was to develop and test a mobile application (app), the Interactive Functional Assessment Staging Navigator (I-FASTN), to support Hispanic family caregivers' assessment of care recipients' functional stage of dementia in either English or Spanish. We conducted heuristic evaluation with experts (N = 5) and usability testing with caregivers (N = 20). Chief usability problems were a confusing tutorial and difficulty finding the app's side menu. The app was well-received by caregivers, who indicated that the concise, illustrated content met their informational needs. However, analog alternatives are still needed by caregivers unaccustomed to using apps. [Journal of Gerontological Nursing, 49(7), 9-15.].

Functional assessment of all polyethylene tibial monoblock component in total knee arthroplasty

Background: In a developing country like India the cost effectiveness of all polyethylene tibial components is a major boon, without compromising the functional outcome. In this study we have attempted to evaluate the functional outcome of all polyethylene tibial monoblock component in total knee arthroplasty. Methodology: The study was carried out on 86 patients who are operated for total knee arthroplasty with all polyethylene tibial monoblock component. Demographic, surgical and follow up data was collected from case sheets of patients and copied in Performa. The patients were called for five years follow up and examined in the outpatient department. Results: The mean age of study population was 62.8 years (range 50 – 72 years) with mean BMI of 27.6 kg/m2. Statistically significant improvement was seen in the range of movements in all the age groups. Both male and female patients had insignificant difference in knee scoring. Assessment of clinical functional abilities of knee scoring have observed to be higher in patients with lower BMI. Conclusion: Significant improvement in range of motion as well as knee score in all age range, emphasizes the fact that total knee arthroplasty with all polyethylene design in osteoarthritis is an excellent surgery to restore near normal life style.

Functional assessment of all polyethylene tibial monoblock component in total knee arthroplasty

Background: In a developing country like India the cost effectiveness of all polyethylene tibial components is a major boon, without compromising the functional outcome. In this study we have attempted to evaluate the functional outcome of all polyethylene tibial monoblock component in total knee arthroplasty. Methodology: The study was carried out on 86 patients who are operated for total knee arthroplasty with all polyethylene tibial monoblock component. Demographic, surgical and follow up data was collected from case sheets of patients and copied in Performa. The patients were called for five years follow up and examined in the outpatient department. Results: The mean age of study population was 62.8 years (range 50 – 72 years) with mean BMI of 27.6 kg/m2. Statistically significant improvement was seen in the range of movements in all the age groups. Both male and female patients had insignificant difference in knee scoring. Assessment of clinical functional abilities of knee scoring have observed to be higher in patients with lower BMI. Conclusion: Significant improvement in range of motion as well as knee score in all age range, emphasizes the fact that total knee arthroplasty with all polyethylene design in osteoarthritis is an excellent surgery to restore near normal life style.

Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease.

Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.

Feasibility of at-home motor assessments using wireless technology in patients with myelopathy: year 1 follow up of CYGNET, an observational study of patients with adrenomyeloneuropathy (P6-6.006)

Feasibility of at-home motor assessments using wireless technology in patients with myelopathy: year 1 follow up of CYGNET, an observational study of patients with adrenomyeloneuropathy (P6-6.006)

Evaluating key performance indicators of the process of care in juvenile idiopathic arthritis

ObjectiveTo determine whether and how often the information to measure a set of key performance indicators (KPIs) in juvenile idiopathic arthritis (JIA) is found in data collected routinely in a Pediatric Rheumatology Clinic.MethodsA retrospective electronic chart review and administrative data analysis was conducted for a cohort of 140 patients with JIA at a tertiary Pediatric Rheumatology Clinic between 2016–2020. The set of KPIs include measuring patient outcomes (joint assessment, physician’s global assessment of disease activity, assessment of functional ability, composite disease activity measurement), access to care (waiting time between referral and first visit, visit with the rheumatologist within the first year of diagnosis, annual follow-up visits with the rheumatologist), and safety (tuberculosis screening, and laboratory monitoring). Documentation was assessed as a binary variable indicating whether the required information was ever found. Documentation frequency for each KPI was assessed with counts and percentages of the number of times the required information was documented for each clinic visit. Compliance with the safety KPI definitions was assessed using administrative databases.ResultsData for each KPI were found at least once in the cohort and documentation varied in frequency and consistency. Access to care and safety KPIs were documented more frequently than patient outcome KPIs. A joint assessment was documented at every visit for 95% of patients, 46% for an assessment of pain, and none for a physician’s global assessment of disease activity, an assessment of functional ability, or a composite disease activity measurement.ConclusionAlthough feasible to measure, there is an opportunity for improving the consistency of documentation. Having an active system of monitoring KPIs and tools to simplify measurement is a key step in the process toward improved patient care outcomes. Streamlining the collection of KPI data can increase the likelihood of compliance. Next steps should involve replicating this study in various centres.

Adaptive skills in children with mucopolysaccharidoses

Introduction. Mucopolysaccharidoses (MPS) are a group of rare lethal lysosomal storage disoders. The progress in pathogenetic and symptomatic treatment, achieved in the last two decades, has resulted in increased life expectancy of patients. Assessment of functional abilities of patients is necessary for optimization of medical, psychological, and pedagogical support. &#x0D; The aim of the study. To study the adaptive skills, measured with Vineland Adaptive Behavior Scales, and the impact of enzyme-replacement therapy on adaptive skills in MPS children.&#x0D; Materials and methods. A semi-structured interview for Vineland Adaptive Behavior Scales filling was carried out with one of the parents of 59 children with MPS. 41 patients had neuronopathic disease: 20 children received pathogenetic еnzyme replacement therapy (ERT), 21 patients didn’t receive ERT. 18 patients exhibited non-neuronopathic disease: 8 children received ERT, 10 — didn’t receive pathogenetic therapy. Dynamical changes in adaptive skills were investigated in 11 patients with neuronopathic MPS. &#x0D; Results. Low level of adaptive motor, communication, daily living and socialization skills and their dynamical regress, stagnation or decele­ration are characteristic for children with neuronopathic MPS. More than 75% of non-neuronopathic MPS patients have moderately low and low levels of adaptive behavior composite. ERT hasn’t demonstrated significant impact on adaptive skills in MPS patients. Non-significant tendency toward better level of communication skills has been noticed in children, receiving pathogenetic therapy. Necessity of weekly infusion may have a negative influence on patients’ socialization. &#x0D; Conclusion. Elaboration of motor, pedagogical, and social rehabilitation programs is needed for correction of deficiency in adaptive skills and achieving adequate social adaptation in MPS children with preserved cognitive abilities.

Self-Reported Questionnaire to Evaluate Functional Abilities in Middle Age: A Call for Delphi Expert Panel

Early detection of functional decline is important for promoting optimal aging. Self-reported questionnaires can efficiently assess functional abilities. Therefore, we aimed to highlight the lack of functional ability assessment questionnaires for the middle-aged population (MA, 45-65 years) and the need to develop such a questionnaire. An online search was performed to find questionnaires quantifying self-reported performance and functional abilities at MA. We also conducted an online survey of a group of the MA population and interviewed individuals who reported age-related functional decline. Eight potentially relevant questionnaires were found, and one hundred and twenty-three individuals responded to our survey, five of whom were interviewed. None of the questionnaires were specifically designed to assess functional capacity at MA, and most of the questionnaires are likely to have a ceiling effect in assessing the MA population. Furthermore, the questionnaires do not capture functions related to dynamic balance, flexibility, and maximum strength, which are reported as difficult by our respondents, making them less appropriate for assessing function at MA. There is a need to engage a Delphi expert panel of several relevant healthcare professionals to develop a functional capacity assessment questionnaire for MA.

Association of Sit-to-Stand Capacity and Free-Living Performance Using Thigh-Worn Accelerometers among 60- to 90-Yr-Old Adults.

Five times sit-to-stand (STS) test is commonly used as a clinical assessment of lower-extremity functional ability, but its association with free-living performance has not been studied. Therefore, we investigated the association between laboratory-based STS capacity and free-living STS performance using accelerometry. The results were stratified according to age and functional ability groups. This cross-sectional study included 497 participants (63% women) 60-90 yr old from three independent studies. A thigh-worn triaxial accelerometer was used to estimate angular velocity in maximal laboratory-based STS capacity and in free-living STS transitions over 3-7 d of continuous monitoring. Functional ability was assessed with short physical performance battery. Laboratory-based STS capacity was moderately associated with the free-living mean and maximal STS performance ( r = 0.52-0.65, P < 0.01). Angular velocity was lower in older compared with younger and in low- versus high-functioning groups, in both capacity and free-living STS variables (all P < 0.05). Overall, angular velocity was higher in capacity compared with free-living STS performance. The STS reserve (test capacity - free-living maximal performance) was larger in younger and in high-functioning groups compared with older and low-functioning groups (all P < 0.05). Laboratory-based STS capacity and free-living performance were found to be associated. However, capacity and performance are not interchangeable but rather provide complementary information. Older and low-functioning individuals seemed to perform free-living STS movements at a higher percentage of their maximal capacity compared with younger and high-functioning individuals. Therefore, we postulate that low capacity may limit free-living performance.

General practitioners’ description of functioning in sickness certificates

IntroductionIn Norway, general practitioners (GPs) are the gatekeepers who provide written assessment of patients' functional ability to provide documentation for the Norwegian Labor and Welfare Administration for decisions about welfare benefits. This article investigates the description of functioning in sickness certificates according to the bio-psycho-social model described in WHO's International Classification of Functioning, Disability and Health (ICF). In particular, the study focuses on medical sick notes for young patients with common mental disorders. MethodsThis study utilized directed content analysis, where codes were defined a priori. A simplified bio-psycho-social model with ICF as a framework was used to categorize functional assessment. 393 sick notes were analyzed in Norway between January 2018–January 2020. ResultsThe results show that more than half (50.4%) of the certificates contain no information about function on any level, and that the diagnosis was the only indication of a patient's function. The biological perspective was the most common description in 39,9% of the certificates, 13,5% had a description of the patient's functioning from an individual perspective. The social perspective was only adopted in 12.0% of certificates. Only 4 certificates (1.0%) described all three perspectives (biological, individual, and social) and mentioned what the individual could do despite the illness (resources). ConclusionsWe find that information on functional ability is limited on sickness certificates in Norway. The descriptions given were mainly from the biological perspective and without social context, which is consistent with prior research.

The Assessment of Functional Competence in a Clinical Sample of Older Adults along the Alzheimer’s Continuum

AbstractBackgroundDifficulties in performing “Instrumental Activities of Daily Living” (IADL) such as managing finances and medications can lead to loss of independence among older adults. Performance‐based assessments allow for an objective and systematic quantification of IADLs utilizing real life paradigms. In an ongoing NIA‐funded study, we evaluated the association of a recently developed performance‐based assessment of functional ability (Night Out Task, NOT, Schmitter‐Edgecombe, 2021) with a performance‐based measure of financial capacity and an informant‐based measure of functional and decision‐making capacity in non‐demented older adults with varying degrees of cognitive impairment.MethodParticipants (n = 22; mean age = 76) were classified as healthy control (HC, n = 4), subjective cognitive decline (SCD, n = 9), or mild cognitive impairment (MCI, n = 9) based on clinical criteria. The NOT was used to evaluate the ability to efficiently and accurately plan, multitask and complete eight activities in preparation for a night out. The primary outcome variable for the NOT was completion time. Additionally, participants completed the Financial Capacity Instrument (FCI‐SF‐short form), which assesses financial knowledge and problem‐solving skills (Marson, 2015). Meanwhile, informants completed the Assessment of Functional Capacity Interview (AFCI; Pare et al., 2020) which captures decision making related to home safety, financial, medical, and social competence.ResultNOT scores were normally distributed, as assessed by Shapiro‐Wilk’s test (p &gt; 0.05). We observed a statistical trend for group on NOT completion time such that greater clinical impairment was associated with greater completion time: MCI (M = 916.38s, SD = 218.54) &gt; SCD (M = 741.83s, SD = 212) &gt; HC (M = 728.05s, SD = 167.45). Similar trends were observed for other NOT variables. Correct sequencing and overall efficiency of NOT tasks were negatively correlated with AFCI Financial domain, r(21) = ‐0.606 and r(21) = ‐0.487, both P &lt;0.05, respectively. Overall NOT task accuracy was negatively correlated with FCI‐SF Total Score, r(21) = ‐0.528, P &lt;0.05.ConclusionThe NOT showed impressive associations with informant reports of functional and decision‐making capacity and objectively assessed financial capacity. The NOT can potentially distinguish among healthy controls and preclinical dementia groups, offering promise for early detection and characterization of cognitive changes.

98 PREPARING FOR THE COMMENCEMENT OF THE DECISION MAKING “CAPACITY” ACT (2015): REVIEWING CURRENT PRACTICE WITHIN AN OCCUPATIONAL THERAPY DEPARTMENT

Abstract Background The Decision Making ‘Capacity’ Act (2015) will commence in 2022. This will have significant implications for health care professionals. Occupational therapists undertake a wide range of assessments of cognitive, physical and functional ability. There is a need to streamline the recording of comprehensive and holistic assessment outcomes for easier access and interpretation during the interdisciplinary assessment of Decision Making Capacity (DMC) for independent living. A working group was established to review current practices and formulate a document to support the assessment. Methods The model for improvement was employed, which incorporates the plan, do, study, act methodology. Current practice of the occupational therapy team was reviewed in relation to assessments used, the format of recording and the knowledge of the DMC act. A working document was formulated and reviewed with medical staff. Team education on the DMC act was provided. A qualitative questionnaire was circulated among the occupational therapy staff to ascertain the educational needs of the department. Perceptions of current practice in DMC assessment of independent living were gathered. Results 100% of questionnaire respondents identified need for further training and education on the DMC Act 2015. No respondents agreed that the relevant assessment outcomes were easily accessible. 67% of respondents were unsatisfied with the current process in place for DMC assessment of independent living. 45% of respondents do not feel confident in completing assessments contributing to DMC assessment of independent living. There was no consistency in the format of recording assessment outcomes. Conclusion The group developed a clinical document to improve easy and consistent interpretation of occupational therapy assessment in relation the DMC assessment of independent living. This ensures person centred, comprehensive assessment to enhance the patient journey. The team are better prepared for the commencement of the DMC act and have identified future training needs.