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

European Journal of Physical and Rehabilitation Medicine, 2023 · DOI: 10.23736/S1973-9087.23.07868-1 · Published: June 1, 2023

Neurology Rehabilitation Brain Injury

Simple Explanation

Executive function deficits are a significant cause of participation limitations after traumatic brain injury (TBI). The A-PEX tool was created to evaluate executive function deficits through actual participation in daily activities during inpatient rehabilitation following TBI. The A-PEX assessment involves observing patients in leisure, social, and instrumental activities of daily living within the rehabilitation facility. Scoring is based on clinical observations and interviews, focusing on consistency and efficiency in performing tasks. This study found the A-PEX to be a reliable and valid measure for assessing executive functions in TBI patients during inpatient rehabilitation. It offers insights into the relationship between executive functions and participation, aiding in treatment planning and monitoring progress.

Study Duration

March 2020 and August 2022

Participants

56 participants: 26 with TBI, 30 with orthopedic or spinal cord injuries

Evidence Level

Cross-sectional with a longitudinal component

Key Findings

1
The A-PEX demonstrated excellent internal consistency, with Cronbach’s alpha coefficients ranging from 0.83 to 0.96 for its domains and scales.
2
Participants with TBI scored significantly lower on all A-PEX components compared to those with orthopedic or spinal cord injuries (P<0.001).
3
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).

Research Summary

This study validated the Assessment of Participation and Executive Functions (A-PEX) as a tool for evaluating executive function deficits through actual participation in the inpatient rehabilitation context during the subacute phase following TBI. The A-PEX demonstrated excellent internal consistency and moderate test-retest reliability. Participants with TBI scored significantly lower than those with orthopedic or spinal cord injury. Significant correlations were found between A-PEX, MET-HV and CTT scores. The A-PEX provides valuable clinical insight into the interrelationship between executive functions and participation in the post-TBI subacute phase by evaluating actual everyday participation.

Practical Implications

Clinical Assessment

The A-PEX can be used to systematically quantify a patient’s actual everyday participation and executive function abilities during inpatient rehabilitation.

Treatment Planning

The A-PEX provides a structured method for tailoring treatments to individual patient needs based on specific executive function deficits.

Progress Monitoring

The A-PEX results are useful in tailoring treatments to each patient’s needs

Study Limitations

1
Small sample size in the TBI group.
2
The A-PEX depends heavily on the setting; future research should recruit a larger number of participants from several facilities to establish validity across settings.
3
This study did not include low-functioning patients or patients with behavioral deficits following TBI.

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