The Ecological Validity of Traditional Pen-and-paper, Ecologically Oriented, and Virtual Reality Neuropsychological Test Measures to Cognitive Impairment and Real-World Function after Mild Traumatic Brain Injury
Year: 2019
Type: dissertation
Abstract: A growing concern in neuropsychology is whether neuropsychological test measures (NTMs) can predict functional outcome (i.e., ecological validity). Ecological validity can be understood in two ways: veridicality (i.e., prediction of functional outcome is independent of how the test reflects the outcome being measured) and verisimilitude (i.e., tests resemble the functional outcome they are predicting). Historically, the veridicality approach has been utilized (i.e., by way of traditional, pen-and-paper NTMs), but there has been a movement to employ verisimilitude approaches (e.g., Behavioural Assessment for Dysexecutive Syndrome; BADS). These approaches were examined in patients experiencing ongoing cognitive complaints in the post-acute period of recovery (> 3 months) following a mild traumatic brain injury (mTBI). This was the principal inclusion criteria for the studies described here. A meta-analytic study was conducted and found that traditional NTMs were not sensitive to persistent cognitive complaints in this population across all domains. Studies 2 and 3 utilized archival data to determine whether NTMs could predict return to work (RTW) status. The BADS predicted employment status by way of medium-to-large effects, while traditional NTMs did not. Overall, these findings suggest the verisimilitude approach is more ecologically valid than the veridicality approach. As such, two virtual reality tests (VRTs) evaluating attention and executive function were developed to investigate their ability to predict RTW. Tests of attention (VR and traditional tests) significantly predicted group membership at 82% accuracy, with 82.6% sensitivity and 81.5% specificity. The attention shift trial of the VRT and to a lesser degree the total speed score of the Ruff 2 7 were predictive of employment status. Overall, this research provides empirical evidence for the verisimilitude approach when evaluating RTW status in patients who are in the post-acute period of recovery following mTBI. Moreover, it provides initial evidence for the clinical utility of VRTs to evaluate real-world functioning.
Source: TSpace (University of Toronto)
Author: Eliyas Jeffay
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3025731153