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Development of a Multidimensional, Multigroup Measure of Cognitive-Communication for Inpatient Rehabilitation.

Julia Carpenter¹, Caitlin Deom², Andrew Bodine³

¹Shirley Ryan AbilityLab, Chicago, IL.

Archives of Physical Medicine and Rehabilitation

|March 5, 2025

Summary

A new Cognitive-Communication Ability Quotient (AQ) offers a more sensitive measure of cognitive-linguistic function in inpatient rehabilitation than the FIM. This tool helps track patient progress and tailor rehabilitation plans for better outcomes.

Keywords:

Cognition Communication Inpatients Outcome assessment Rehabilitation research

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Area of Science:

Neuroscience
Rehabilitation Medicine
Speech-Language Pathology

Background:

Cognitive-linguistic deficits are common in patients undergoing inpatient rehabilitation.
Existing measures, like the Functional Independence Measure (FIM) cognitive items, may lack sensitivity to detect subtle changes in function.
There is a need for a comprehensive and repeatable measure tailored for inpatient rehabilitation settings.

Purpose of the Study:

To develop and validate a comprehensive, repeatable measure of cognitive-linguistic function for inpatient rehabilitation facilities (IRFs).
To compare the sensitivity of this novel measure against the FIM cognitive items.
To establish a tool that can effectively monitor patient progress during rehabilitation.

Main Methods:

Retrospective analysis of clinician-reported data from 12,245 inpatients in a Midwestern IRF.
Development of the Cognitive-Communication Ability Quotient (AQ) using 10 standard speech-language pathology measures.
Confirmatory factor analysis and multidimensional item response theory (MIRT) modeling to assess measurement properties.

Main Results:

Confirmatory factor analysis supported good model fit for 5 patient groups based on primary communication impairment.
The Cognitive-Communication AQ demonstrated higher sensitivity to change compared to FIM cognitive scores.
True score equating revealed a lower floor and higher ceiling for the AQ, indicating a wider range of measurable function.

Conclusions:

The developed Cognitive-Communication AQ, with 5 forms, exhibits superior measurement characteristics over the FIM cognition score.
The AQ is capable of detecting functional changes typical during an IRF stay.
Repeated AQ measurements enable clinicians to monitor patient progress and adapt rehabilitation strategies effectively.