More than meets the eye: how examiner training affects the reliability of the MacNeill-Lichtenberg decision tree in geriatric rehabilitation patients

Abstract

Objective: To examine the effect of examiner training on the test-retest reliability of the MacNeill-Lichtenberg Decision Tree (MLDT), a tool for guiding clinicians' decision making for referrals for mental health problems.

Design: Correlational analyses and chi-squares were used to examine the influence of demographic variables on MLDT performance and the test-retest reliability of its cognitive and affective components.

Setting: Rehabilitation unit of a large, freestanding, urban hospital.

Participants: In study 1, 39 older, medical rehabilitation patients consecutively referred to the neuropsychology service. In study 2, 57 older, consecutively admitted medical rehabilitation patients.

Interventions: In study 1, patients underwent testing with the MLDT by a novice examiner. In study 2, patients were tested by trained examiners. Both sets of results were compared with those obtained by experienced examiners.

Main outcome measures: The temporal stability of participants' performance on the cognitive and affective components of the MLDT was compared between the 2 studies.

Results: Training was associated with high test-retest reliability on both the cognitive and affective components. A lack of training was associated with reduced reliability in depression screening.

Conclusion: These findings support the use of the MLDT as a mental health triage tool for older adults in inpatient medical settings. Its use is dependent on training and accurate administration.