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. 2023 Jun;59(3):317-326.
doi: 10.23736/S1973-9087.23.07868-1. Epub 2023 Apr 21.

A novel assessment of participation and executive functions (A-PEX) for traumatic brain injury: a validity study

Rotem Eliav  1   2 , Yael Lugassy  3   4 , Rachel Kizony  3   5
Affiliations

A novel assessment of participation and executive functions (A-PEX) for traumatic brain injury: a validity study

Rotem Eliav et al. Eur J Phys Rehabil Med. 2023 Jun.

Abstract

Background: Executive function deficits are a main cause of participation restrictions post-traumatic brain injury (TBI). Assessing executive functions through actual daily participation may provide valuable information for treatment planning and progress.

Aim: This study aimed to validate the Assessment of Participation and Executive Functions (A-PEX), a tool for evaluating executive function deficits through actual participation in the inpatient rehabilitation context during the subacute phase following TBI.

Design: A cross-sectional with a longitudinal component.

Setting: Inpatient rehabilitation facility.

Population: This study included 56 participants divided into two groups: 30 with orthopedic or spinal cord injuries and 26 with TBI.

Methods: Internal consistency was evaluated by Cronbach's alpha, and test-retest reliability was assessed using interclass correlation coefficients. Known-group construct validity was examined by comparing the A-PEX scores between the two groups, and A-PEX convergent construct validity for patients with TBI was examined using correlations between scores on the A-PEX, Multiple Errands Test-hospital version (MET-HV), and Color Trail Test (CTT).

Results: Cronbach's alpha coefficients for the A-PEX domains ranged between 0.83 and 0.96, indicating good-to-excellent internal consistency. Interclass correlations calculated for the control group indicated moderate test-retest reliability for most A-PEX components. Participants with TBI scored significantly lower than those with orthopedic or spinal cord injury for all A-PEX components (P<0.001). Within the TBI group, significant moderate-to-strong correlations were found between all A-PEX components and the MET-HV (0.52<r<0.73, P<0.05) and between the A-PEX executive function scales and the CTT (r=0.52, P<0.05).

Conclusions: The findings provide evidence for the initial reliability and validity of the A-PEX as a measure of post-TBI executive functions.

Clinical rehabilitation impact: By evaluating actual everyday participation, the A-PEX provides valuable clinical insight into the interrelationship between executive functions and participation in the post-TBI subacute phase.

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Conflict of interest statement

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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