Treatment of Mental Slowness: How to Evaluate Treatment Effects. A Systematic Review of Outcome Measures

Neuropsychological Rehabilitation

Winkens, I., Van Heugten, C. M., et al. (2011).

Neuropsychological Rehabilitation, 21(6), 860-883.

This systematic review investigates existing outcome measures for mental slowness, or speed of information processing, in adults, 19 years and older, after traumatic brain injury or stroke.

Not stated

<p>Each review author is also listed as an author on the publications cited in support of the Mental Slowness Observation Test and the Mental Slowness Questionnaire, two of the reviewed outcome measures of mental slowness/speed of information processing. This may affect risk of bias in reporting of review results.</p> <p>As noted in this systematic review's conclusions, further information on virtual reality assessment can be found in the following publication:</p> <ul> <li>Zhang, L., Abreu, B. C.,et al. (2001). Virtual Reality in the Assessment of Selected Cognitive Function After Brain Injury. <i>American Journal of Physical Medicine and Rehabilitation, 80</i>(8), 597-604. </li> </ul> <p>Additionally, further information on the use of attentional measures for evaluation of everyday consequences of mental slowness can be found in the following publication:</p> <ul> <li>Whyte, J., Hart, T., et al. (2004). Effects of Methylphenidate on Attention Deficits After Traumatic Brain Injury: A Multidimensional, Randomized, Controlled Trial. <i>American Journal of Physical Medicine and Rehabiliation, 8</i>(6), 401-420. </li> </ul>

From 1982 to February 2010

English-language studies, excluding theoretical or review articles

7

<p>Several types of outcome measures for mental slowness or information processing speed were found, including:</p> <ul> <li>Standardized neuropsychological tests: Symbol Digit Modalities Test, Symbol Digit Substitution Test, Paced Auditory Serial Addition Test, Stroop Color Word Task, Trail Making Test</li> <li>Tests/questionnaires of general cognitive impairment: ImPACT computerized test battery, Rivermead Post-Concussion Symptoms Questionnaire, Neurobehavioral Rating Scale</li> <li>Measures of general everyday functioning: Community Integration Questionnaire, driving tasks, Fatigue Severity Scale</li> </ul> <p>Nine measures were found for evaluation of everyday consequences of mental slowness (which was the authors' main interest), but they were "not well studied" (p. 874) and lacking in psychometric information. Those with psychometric data are summarized below:</p> <ul> <li>Rating Scale of Attentional Behaviors: quick and easy to administer, correlation with neuropsychological measures of attention, high internal consistency, strong test-retest reliability amongst similar raters (i.e., test-retest reliability was much lower for a speech-language pathologist and an occupational therapist than for two occupational therapists)</li> <li>Mental Slowness Observation Test: evaluates performance on tasks such as sorting money or making a telephone call, internal consistency is acceptable, interrater reliability (Cronbach's alpha)&nbsp;between .77 and .99, intra-class correlation coefficient between .86 and .99</li> <li>Mental Slowness Questionnaire: patient report of perceived consequences of mental slowness, good internal consistency, test-retest reliability correlation between .85 and .90, intra-class correlation coefficient between .91 and .95&nbsp;</li> <li>Virtual reality assessment: as described in Zhang (2001), see the Notes on This Article section for citation, "adequate reliability and construct validity as a method of assessment in persons with brain damage" (p. 871)</li> <li>Range of attentional measures: as described in Whyte et al. (2004), see the Notes on This Article section for citation, psychometrics range by measure, refer to full text for further detail</li> </ul> <p>In conclusion, several neuropsychological assessments measure information processing speed, but further research is needed in standardized, valid and reliable assessment of the patient's perspective and experience of mental slowness.&nbsp;</p>