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Rehab Measures: Executive Function Performance Test

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Executive Function Performance Test Protocol Booklet 

Title of Assessment

Executive Function Performance Test 

Acronym

EFPT

Instrument Reviewer(s)

Summary Date

 

Purpose

The EFPT examines the execution of four basic tasks that are essential for self-maintenance and independent living: simple cooking, telephone use, medication management, and bill payment.

Description

The EFPT is a top-down performance assessment designed to examine cognitive integration and functioning. The assessments requires participants to complete the following tasks (in order):

  • Hand Washing
    • Only use this task if the person has severe cognitive impairment and you want to see if they can follow directions. If they cannot, do not proceed.
  • Oatmeal Preparation
  • Telephone
  • Taking Medication
  • Paying Bills

Instructions: Please refer to the training manual available on the rehabmeasures.org website for details.

The EFPT serves three purposes:

  1. To determine which executive functions are impacting function
  2. To determine an individual’s capacity for independent functioning
  3. To determine the amount of assistance necessary for task completion

Area of Assessment

Activities of Daily Living; Behavior; Cognition; Coordination; Executive Function; Functional Mobility; Quality of Life 

Body Part

Not Applicable 

ICF Domain

Activity 

Domain

ADL; Cognition 

Assessment Type

Observer 

Length of Test

06 to 30 Minutes 

Time to Administer

30 to 45 minutes

Number of Items

4 tasks, 5 items per task 

Equipment Required

Please see the training manual available on the rehabmeasures.org website.

Training Required

No formal training but requires practice in delivering cues- see cue guidance sheet.  A colleague should observe and critique you.

Type of training required

Reading an Article/Manual 

Cost

Free 

Actual Cost

Free

Age Range

Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Geriatrics; Multiple Sclerosis; Stroke 

Populations Tested

Stroke
Multiple Sclerosis

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not needed, each person is observed to be independent or need various levels of help.

Normative Data

Chronic Stroke: (Baum et al 2008; n = 73; mean age = 64 (14) years; Barthel Index scores of ≥ 90, Modified Rankin Index scores of ≥ 2; > 6 months post stroke onset)
 
EFPT Normative Data:
 
Control
Mild Stroke
Moderate Stroke
 (N = 22)
(N = 59)
(N = 14)
NIHSS
--
2.00 (1.46)
10.64 (2.99)
EFPT total score
1.51 (2.27)
7.87 (8.42)
24.21 (5.39)
Cooking**
1.23 (2.81)

2.98 (4.90)

5.57 (7.27)
Using Telephone***
0.09 (0.29)
1.83 (2.27)
6.57 (9.00)
Medications***
0.42 (1.40)
0.92 (1.34)
5.50 (8.99)
Paying Bills**
0.23 (0.69)
1.92 (2.19)
4.43 (6.94)
Initiation
0.00 (0.00)
0.83 (1.67)
3.43 (7.14)
Organization***
0.13 (0.34)
1.77 (2.22)
6.21 (8.39)
Sequencing***

0.58 (1.05)

3.08 (3.20)

6.93 (7.87)

Safety & Judgment**

0.14 (0.47)

1.32 (2.19)

4.07 (6.67)

Completion**

0.11 (0.49)

0.88 (1.90)

3.57 (7.08)

**p < .005. ***p < .0001.
 
Multiple Sclerosis: (Kalmar, 2008; n = 74 MS & 35 healthy comparison; MS mean age = 44.69 (8.75) years)
 
EFPT Performance:
Variable
MS-with
MS-without
Healthy

p

EFPT total score
9.40 (8.01)
6.42 (4.81)
4.35 (3.42)

<.05

Handwashing
0.00 (0.00)
0.11 (0.49)
0.00 (0.00)

ns

Cooking oatmeal
2.78 (3.29) 1.84
1.84 (2.00)
1.74 (2.02)

ns

Telephone usage
0.83 (1.40)
0.80 (1.41)
0.32 (1.14)

ns

Medication management
0.65 (1.15)
0.22 (.52)
0.06 (0.24)

<.001

Bill payment
2.00 (2.35)
0.86 (1.56)
0.27 (0.52)

.001

Cooking casserole
3.45 (3.47)
2.80 (2.66)
2.62 (2.19)

ns

ms-with = with cognitive deficits

ms-without = without cognitive deficits

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Chronic Stroke: (Baum et al, 2008; 3 trained raters rating 10 participants (5 = mild stroke, 5 = healthy controls)
  • Excellent Interrater reliability for the overall EFPT (ICC = 0.91)
  • Excellent Interrater reliability for EFPT sub-scales
    • Cooking (ICC = 0.94)
    • Paying Bills (ICC = 0.89)
    • Medication (ICC = 0.87)
    • Using Phone (ICC = 0.79)

Internal Consistency

Chronic Stroke: (Baum et al, 2008)
  • Excellent: EFPT total sample scores (Cronbach's alpha = 0.94)
  • Excellent: EFPT Cooking subtest (Cronbach's alpha = 0.86)
  • Adequate: EFPT Paying Bills subtest (Cronbach's alpha = 0.78)
  • Excellent: EFPT Managing Medication subtest (Cronbach's alpha = 0.88)
  • Adequate: EFPT Telephone subtest (Cronbach's alpha = 0.77)

Criterion Validity (Predictive/Concurrent)

Chronic Stroke: (Baum et al, 2008)
 
Concurrent Validity:
Variable
EFPT Total Score (r)
p <
Digits forward
- 0.26
0.08
Digits backward
- 0.49*
 .0001
Trails A
  0.21
0.09
Trails B
  0.39*
0.001
Story Recall (Wechsler Memory Scale)
- 0.59*
0.0001
Animal Fluency
- 0.47*
0.0001
Short Blessed
  0.39*
0.001
FIM total

- 0.40*

0.001

FAM total

- 0.68**

0.0001

FIM = Functional Independence Measure

FAM = Functional Assessment

*adequate correlation; **excellent correlation

 

Construct Validity (Convergent/Discriminant)

Acute Stroke: (Wolf et al, 2010; n = 20; mean age = 58.8 (13.2) years; mean NIHSS score = 1.5 (2.4); recruited < 1 week post stroke)

 
EFPT & other measures of Executive Function
Measure
Strength
r
p
DKEFS Sorting adequate
Adequate
-0.511
0.030
DKEFS Verbal Fluency
Adequate
-0.474
0.035
DKEFS Color-Word Interference adequate
Adequate
-0.566
0.011
Short Blessed Test
Adequate
0.548
0.012
DKEFS = Delis-Kaplan Executive Function System
 
Chronic Stroke: (Baum et al, 2008)
 
Measure

Control

Mild Stroke
 Moderate Stroke
Trails A (seconds)

31.0 (10.8)

71.9 (63.6)

188.3 (114.5)

Trails B (seconds)***

73.8 (29.4)

184.1 (98.5)
279.6 (64.7)
Digits Forward**

9.2 (2.6)

6.5 (1.3)
6.1 (2.3)
Digits Backward**

5.3 (1.6)

3.5 (1.7)
3.1 (1.6)
Story Recall*

30.6 (6.9)

24.8 (8.1)
18.0 (9.1)
Animal Fluency***

22.6 (4.9)

14.8 (5.5)
8.8 (5.1)

*p  < .05. **p < .01. ***p < .001

note: Values are one-way analyses of variance comparing scores across groups.
Trails A & B from the Trailmaking Test (Reitan & Wolfson, 1995)
Digit Span Forward and Backward Test from the Wechsler Memory Scale–Revised (Wechsler, 1987)
Story Recall from the Logical Memory Total Recall Test (Wechsler, 1987)
Animal Fluency from the Animal Naming test (Barr & Brandt, 1996)
 
Multiple Sclerosis: (Goverover et al, 2009; n = 47; men age = 44.8 (8.2) years)
 
Self-awareness of Functional Status With the EFPT
Variable
r
Strength
FBP SA
.33*
adequate
BDI
-.08
poor
FAMS
.002
poor
* p < .05
EFPT = Executive Function Performance Test
FBP SA = self awareness of functional status
BDI = Beck Depression Inventory
FAMS = Functional Assessment of Multiple Sclerosis

Content Validity

The Executive Function Performance Task was developed at the Program in Occupational Therapy at Washington University Medical School based on Carolyn Baum's Kitchen Task Assessment (KTA) measure of functional ability.

Face Validity

Not statistically assessed

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Considerations

The EFPT should only be administered once per patient secondary to a learning effect that may confound the results of a second assessment.
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Baum, C., Connor, L., et al. (2008). "Reliability, validity, and clinical utility of the executive function performance test: A measure of executive function in a sample of people with stroke." The American Journal of Occupational Therapy 62(4): 446. Find it on PubMed

Baum, C., Morrison, T., et al. (2007). "Executive Function Performance Test: Test protocol booklet." Unpublished program in Occupational Therapy Washington University School of Medicine, St. Louis, MO.

Goverover, Y., Chiaravalloti, N., et al. (2009). "The relationship among performance of instrumental activities of daily living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis." Rehabil Psychol 54(1): 60-68. Find it on PubMed

Kalmar, J. H., Gaudino, E. A., et al. (2008). "The relationship between cognitive deficits and everyday functional activities in multiple sclerosis." Neuropsychology 22(4): 442-449. Find it on PubMed

Wolf, T., Stift, S., et al. (2010). "Feasibility of using the EFPT to detect executive function deficits at the acute stage of stroke." Work: A Journal of Prevention, Assessment and Rehabilitation 36(4): 405-412. Find it on PubMed

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
EFPT-September2013.zip    
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 2/10/2014 11:28 AM  by Jason Raad