Development of a Multidimensional, Multigroup Measure of Cognitive-Communication for Inpatient Rehabilitation.

Abstract

Objective: To develop a comprehensive, repeatable measure of cognitive-linguistic function for use in inpatient rehabilitation facility (IRF) settings using contemporary methods and to compare the sensitivity of this measure to the FIM cognitive items.

Design: Retrospective analysis of clinician-reported assessment data collected as part of routine clinical operations.

Setting: Free-standing inpatient rehabilitation facility in the Midwestern United States.

Participants: A convenience sample of 12,245 inpatients with motor speech, voice, aphasia and/or cognitive-communicative diagnoses, 18 years of age and older who were admitted to an IRF.

Interventions: Standard of care rehabilitation services.

Main outcome measure: Cognitive-Communication Ability Quotient (AQ) composed of 10 standard measures used by speech-language pathologists.

Results: Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and non-normed fit indices ≥0.95) for 5 groups defined by primary communication impairment (Aphasia, Cognitive-Communication Disorder, Brain Injury, Right Hemisphere Dysfunction, Motor Speech/Voice). Re-estimation as a multigroup, MIRT model yielded scores more sensitive to change compared to the FIM cognitive score. True score equating analysis demonstrated a higher ceiling and lower floor for the Cognitive-Communication AQ compared to the FIM.

Conclusions: We constructed 5 forms of a novel cognitive-communication measure, the Cognitive-Communication AQ, that demonstrates superior measurement characteristics compared to the FIM cognition score with a lower floor and higher ceiling. The AQ can detect changes in cognitive-communicative function that typically occur during an IRF stay. Repeated measurement during the IRF stay allows clinicians to monitor patients' progress and modify rehabilitation plans accordingly.