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. 2025 Mar;35(2):382-407.
doi: 10.1080/09602011.2024.2343149. Epub 2024 Apr 24.

Development and content validity of the cognition in daily life scale (CDL)

Anne-Fleur Domensino  1   2 , Elyan Aarts  1   2 , Johanna M A Visser-Meily  3   4 , Jacoba M Spikman  5 , Caroline van Heugten  1   2   6
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Development and content validity of the cognition in daily life scale (CDL)

Anne-Fleur Domensino et al. Neuropsychol Rehabil. 2025 Mar.

Abstract

Cognitive impairment can negatively influence daily functioning. Current cognitive measures are essential for diagnosing cognitive impairment, but findings on these tests do not always represent the level of cognitive functioning in daily life. Therefore, this study aimed to design a structured measurement instrument to observe and rate the impact of cognitive impairment in daily life, named the cognition in daily life scale for persons with cognitive problems (CDL). In this paper we describe the development, expected usability, and psychometric properties (content and face validity) of the instrument. The CDL was established through three consecutive development phases: (1) item selection, (2) item categorization and comparison, and (3) item revision and manual construction. Subsequently, a panel of eleven international experts rated the relevance of the selected items and provided comments on the expected usability and face validity. Content validity was estimated with the content validity index, based on which four items were removed. The experts' comments led to minor adjustments of the manual, domains, and formulation of the maintained items. The final instrument consists of 65 items describing behaviour that relies on cognitive functions within six domains. Future research should focus on evaluating the construct validity and reliability of the CDL.

Keywords: Cognitive functioning; Content validity; Ecological validity; Neuropsychological assessment; Observation.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Flowchart depicting the selection process of items for the CDL. In phase 1, eligibility of the items in the item inventory were checked against inclusion criteria. Most items were deleted because they did not pertain to neurocognition. In phase 2, items were compared and categorised into cognitive domains. In phase 3, items were revised for the draft version of the CDL. Thirty-six items were removed because they did not meet clarity criteria.
Figure 1.
Flowchart of item selection for the CDL.
Screenshot of a questionnaire in the online survey programme 'Qualtrics'. The figure depicts two sample items: 'The patient dozes off as the day progresses.' and 'The patient is not alert during activities (misses relevant information on events.'). The Likert-scale scoring options are Irrelevant, Somewhat relevant, Quite relevant, and Highly relevant and are presented as radio buttons, which the participant has to select.
Figure A1.
Screenshot of Qualtrics questionnaire outlining item relevance per subdomain.
See this image and copyright information in PMC

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