Stroke-specific executive function assessment: a literature review of performance-based tools

Executive function should be an integral component of post-stroke assessment. However, a Canada-wide survey of occupational therapists on stroke rehabilitation practices found a rare use of executive function assessments. Performance-based executive function assessments that closely reflect real-world activities are useful in identifying individuals who will face difficulties when returning to home and community activities. To increase clinicians' awareness of these tools, a literature review was conducted to identify performance-based measures of executive function and their stroke-specific psychometric properties.

The review identified 17 performance-based tools and 41 studies that reported their psychometric properties specific to stroke. Each tool was critically appraised according to the executive function components assessed, the level of functioning assessed (i.e. impairment, activity or participation), the environment within which the assessment is conducted and the tool's psychometric properties and clinical utility. Standard criteria were used to evaluate the tools' psychometric properties. The findings were compiled in a Stroke-Specific Executive Function Toolkit.

The assessments that demonstrated the strongest evidence of reliability and validity were the Executive Function Performance Test, the Multiple Errands Test and the Assessment of Motor and Process Skills. Only the Assessment of Motor and Process Skills has been adequately evaluated for its ability to detect change. In terms of clinical utility, the Kettle Test has the shortest administration time (i.e. less than 20 minutes) and requires limited equipment. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY: The Stroke-Specific Executive Function Toolkit provides clinicians with useful information that should facilitate identification of appropriate executive function tools for use across the continuum of stroke care.