Test-retest reliability and practice effects of shape trail test in stroke patients.

Abstract

Objective: Executive dysfunction after stroke greatly affects stroke prognosis, so clinicians need to urgently focus on screening for it. This study aims to offer valuable data for research on post-stroke executive dysfunction by evaluating the test-retest reliability of the Shape Trail Test (STT) and the influence of the practice effect on scores among stroke patients.

Methods: A total of 75 subacute stroke patients were included in the study. Based on the cutoff value for mild cognitive impairment(MCI) in the Chinese version of the Montreal Cognitive Assessment-Basic, the patients were divided into an MCI group and a cognitively normal (CN) group. The patients were asked to complete the Shape Trail Test (STT) on two different occasions within three days. The time taken to complete Part A and Part B were denoted as STT-A and STT-B respectively. The intraclass correlation coefficient(ICC), Pearson and Spearman correlation coefficients were used as metrics, and a paired t test was employed to evaluate the practice effect.

Results: (1) The actual number of patients who completed the research was 71. The STT showed great test-retest reliability in stroke patients (ICC, STTA: 0.927 VS STTB: 0.881; Spearman, STTA: 0.824 VS STTB: 0.713, n = 71). The test-retest reliability of STTA is higher than that of STTB (ICC, STTA = 0.927＞STTB = 0.881; Spearman, STTA = 0.824＞STTB = 0.713; n = 71). The reliability of the MCI group was higher than that of the CN group (ICC, STTA:MCI = 0.94＞CN = 0.71; STTB:MCI = 0.87＞CN = 0.64). (2) Subgroup analysis revealed distinct practice effects between the MCI and CN groups. The MCI group showed no practice effect, while the CN group had a partial one. In the CN group, practice did not significantly impact STT-A scores (p = 0.782), but did affect STT-B scores (p = 0.035). In contrast, in the MCI group, no significant practice effects on the STT were observed (p > 0.05).

Conclusions: STT's test-retest reliability was moderate to high in stroke patients and varied by cognitive function. Subgroup analyses should precede assessments of STT's test-retest reliability in stroke patients. Patients with cognitive dysfunction showed no significant practice effects. Given that this research is carried out specifically within the Chinese context, extreme care should be taken in extending the study's findings to other populations.

Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.