Comparability of iPad and Web-Based NIH Toolbox Cognitive Battery Administration in Veterans

The purpose of this study was to evaluate the comparability of National Institutes of Health Toolbox Cognitive Battery test scores across iPad application and web-based personal computer administration platforms. Original test norms were developed using a personal computer-based administration and no previous studies assessing platform comparability have been published.

Participants (N = 62; final analyzed sample n = 49) were combat-exposed post-deployment veterans without neurologic disorder, severe mental illness, current substance use disorder, or a history of moderate or severe traumatic brain injury. All participants completed both iPad and web-based versions of tests on the same day in an experimental within-subjects crossover design. Standalone validity measures were incorporated to exclude invalid performance. Outcome measures included the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test, and Pattern Comparison Processing Speed Test.

Score differences between platforms were found on the Flanker Inhibitory Control and Attention Test. Scores were moderately correlated across tests, with the exception of low correlations for the Pattern Comparison Processing Speed Test. Most participants preferred iPad to web administration, regardless of administration order.

Results suggest caution when interpreting iPad-acquired scores, particularly for the Flanker Inhibitory Control and Attention Test. iPad-based testing offers valuable improvements; however, the development of iPad-specific norms may be necessary to ensure valid interpretation of acquired data.