Cognitive Assessment in Occupational Therapy: A Qualitative Analysis.

Importance: Standardized evidence-based cognitive assessments, including functional cognitive assessments, are key to the identification of cognitive impairments and provision of occupational therapy services.

Objective: To explore the current practices related to cognitive assessments and barriers to their use in acute care and inpatient rehabilitation occupational therapy services.

Design: We used a cross-sectional, qualitative approach that included five focus groups conducted with occupational therapy practitioners and key informant interviews with occupational therapy supervisors (n = 5). Data were analyzed by two coders using an inductive content analysis approach.

Setting: Acute care and inpatient rehabilitation hospitals.

Participants: Occupational therapy practitioners (N = 31).

Results: Customary cognitive assessment included use of self- and proxy report measures, neurocognitive screening tools, and skilled observation. Use of standardized tests, including performance-based tests (PBTs), was limited. Barrier-related themes endorsed by most participants included organizational pressures, accessing and using evidence, conforming to the setting's culture, characteristics of the built environment, and assessment complexity. An outlier group that relied heavily on performance-based functional cognitive tests was identified.

Conclusions and relevance: Current occupational therapy practice primarily consists of informal, unstandardized methods of identifying cognitive impairments. Use of standardized assessment is infrequent. Personal and organizational barriers identified were consistent with those identified in the literature. Despite endorsing identified barriers that are perceived as constraining their use, an outlier group consistently used PBTs of functional cognition. This outlier group's negotiation of barriers presents opportunities for how to target evidence-based implementation efforts. Plain-Language Summary: This article describes occupational therapists' current practices related to the use of cognitive tests. We asked therapists about factors that affect their use of different types of formal cognitive tests; specifically, we looked at the use of pencil-and-paper cognitive tests versus tests that use simulated real-world activities to assess function. Occupational therapists reported many barriers to using cognitive tests of either type, including a lack of time, difficulty accessing tests, and unfamiliar tests that are hard to learn. Most therapists predominantly use informal methods of assessing client's cognition or pencil-and-paper screening methods. One group differed in that its members mostly used formal assessments of simulated real-world tasks to evaluate the ability to perform everyday life tasks.