Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Tom Edward Nightingale; Chloe Ah Ryung Lim; Rahul Sachdeva; Mei Mu Zi Zheng; Aaron Alexander Phillips; Andrei Krassioukov

doi:10.1002/pmrj.12161

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Tom Edward Nightingale, Chloe Ah Ryung Lim, Rahul Sachdeva, Mei Mu Zi Zheng, Aaron Alexander Phillips, Andrei Krassioukov

Rehabilitation Medicine

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

Background: Following spinal cord injury (SCI), up to 64% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by ~16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CV_intra) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CV_intra) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CV_intra in RAVLT interference recall scores (r = 0.43, P =.047), but was not a confounding factor for other measures. Education was not associated with CV_intra. Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLT recognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify “true” changes in cognitive function with repeated testing. Level of Evidence: III.

Original language	English
Pages (from-to)	1278-1286
Number of pages	9
Journal	PM and R
Volume	11
Issue number	12
DOIs	https://doi.org/10.1002/pmrj.12161
State	Published - Dec 1 2019

Bibliographical note

Publisher Copyright:
© 2019 American Academy of Physical Medicine and Rehabilitation

Funding

Dr. Nightingale is supported by a postdoctoral fellowship from Michael Smith Foundation for Health Research/International Collaboration On Repair Discoveries. Ms. Lim is supported by faculty of Medicine within the University of British Columbia via the Summer Student Research Program and Flexible and Enhanced Learning Program. Dr. Sachdeva is supported by the Craig H. Neilsen Foundation postdoctoral fellowship and the Bluma Tischler fellowship (University of British Columbia). Funding: Dr. Krassioukov’s laboratory is supported by funds from the Canadian Institute for Health Research, Heart and Stroke Foundation [G-16-00012571], Canadian Foundation for Innovation, BC Knowledge Development Fund, and the Craig H. Neilsen Foundation. Dr. Krassioukov's laboratory is supported by funds from the Canadian Institute for Health Research, Heart and Stroke Foundation [G-16-00012571], Canadian Foundation for Innovation, BC Knowledge Development Fund, and the Craig H. Neilsen Foundation.Dr. Nightingale is supported by a postdoctoral fellowship from Michael Smith Foundation for Health Research/International Collaboration On Repair Discoveries. Ms. Lim is supported by faculty of Medicine within the University of British Columbia via the Summer Student Research Program and Flexible and Enhanced Learning Program. Dr. Sachdeva is supported by the Craig H. Neilsen Foundation postdoctoral fellowship and the Bluma Tischler fellowship (University of British Columbia).

Funders	Funder number
Canadian Institute for Health Research, Heart and Stroke Foundation	G-16-00012571
Michael Smith Foundation for Health Research
Craig H. Neilsen Foundation
Michael Smith Foundation for Health Research
Univ. of Northern British Columbia

ASJC Scopus subject areas

Physical Therapy, Sports Therapy and Rehabilitation
Rehabilitation
Neurology
Clinical Neurology

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Cite this

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title = "Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury",

abstract = "Background: Following spinal cord injury (SCI), up to 64\% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by \textasciitilde{}16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A\&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CVintra) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CVintra) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CVintra in RAVLT interference recall scores (r = 0.43, P =.047), but was not a confounding factor for other measures. Education was not associated with CVintra. Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLT recognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify “true” changes in cognitive function with repeated testing. Level of Evidence: III.",

author = "Nightingale, \{Tom Edward\} and Lim, \{Chloe Ah Ryung\} and Rahul Sachdeva and Zheng, \{Mei Mu Zi\} and Phillips, \{Aaron Alexander\} and Andrei Krassioukov",

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AU - Nightingale, Tom Edward

AU - Lim, Chloe Ah Ryung

AU - Sachdeva, Rahul

AU - Zheng, Mei Mu Zi

AU - Phillips, Aaron Alexander

AU - Krassioukov, Andrei

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N2 - Background: Following spinal cord injury (SCI), up to 64% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by ~16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CVintra) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CVintra) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CVintra in RAVLT interference recall scores (r = 0.43, P =.047), but was not a confounding factor for other measures. Education was not associated with CVintra. Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLT recognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify “true” changes in cognitive function with repeated testing. Level of Evidence: III.

AB - Background: Following spinal cord injury (SCI), up to 64% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by ~16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CVintra) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CVintra) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CVintra in RAVLT interference recall scores (r = 0.43, P =.047), but was not a confounding factor for other measures. Education was not associated with CVintra. Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLT recognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify “true” changes in cognitive function with repeated testing. Level of Evidence: III.

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Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Abstract

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