Section 7 Neuropsychological Rehabilitation

Question 1

What is the purpose of assessing patient functioning?

Answer 1

The purpose of assessing patient functioning is for diagnosis, prognosis and evaluation.

Question 2

Why is it less common to measure outcome systematically after treatment in clinical practice?

Answer 2

Because neuropsychologists often conduct extensive testing during pre-treatment assessment.

Question 3

What are some important aspects to consider when choosing an outcome measure?

Answer 3

Psychometric properties (reliability, validity, responsiveness), assessment criteria for outcome measures, and the ICF framework.

Question 4

What is the definition of rehabilitation according to the British Society of Rehabilitation Medicine (BSRM) and Royal College of Physicians (RCP)?

Answer 4

“Rehabilitation is defined as a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological, and social function and the use of all means to minimize the impact of disabling conditions.”

Question 5

Measuring the level of …. in society is considered important in rehabilitation contexts.

Answer 5

Participation

Question 6

What is the purpose of knowing about bias in research?

Answer 6

To ensure the validity and scientific quality of a study and the robustness of the evidence to guide clinical practice.

Question 7

What are some strategies to avoid or minimize bias in research methodologies?

Answer 7

Randomised controlled trials (RCTs), single-case designs, systematic reviews, and clinical practice guidelines.

Question 8

What is bias in research methodology and what does it refer to according to Higgins and Altman (2008)?

Answer 8

“a systematic error, or deviation from the truth, in results” = incorrect estimate of the association between exposure and the health outcome.

Bias occurs when an estimated association (odds ratio, difference in means, etc.) deviates from the true measure of association.

systematic error is introduced into sampling or testing by selecting or encouraging one outcome or answer over others

Question 9

What are the five types of bias enumerated by Sackett (1979) in regards to the interpretation and reporting of results in research?

Answer 9

1) bias of rhetoric – use of arguments that are not based on evidence;
(2) all’s well literature bias – publishing studies that ignore or minimise conflicting results;
(3) one-sided references bias – citing references that support only one side of the argument;
(4) positive result bias – the more likely submission by investigators, and acceptance by editors, of studies reporting positive results; and
(5) hot stuff bias – When a topic is fashionable (‘hot’) investigators may be less critical in their approach to their research, and investigators and editors may not be able to resist the temptation to publish the results.

Question 10

What is a critical appraisal (or methodological quality) instrument used for in research?

Answer 10

It is necessary to evaluate whether a report meets scientific standards and identifies biases in the planning and conduct of a study.

Examples of such instruments include the AMSTAR for systematic reviews, PEDro Scale for RCTs, and RoBiNT Scale for single-case research.

Question 11

What are the four major classes of validity in research?

Answer 11

Internal validity; construct validity; statistical conclusion validity; and external validity.

Question 12

What is internal validity in research?

Answer 12

Internal validity reflects the degree to which changes in the dependent variable are attributable to the effect of the independent variable rather than some other factor or confounder.

Question 13

What is the goal of internal validity in research?

Answer 13

To ensure that changes in the dependent variable are solely the result of the intervention being studied.

Question 14

What are some common threats to internal validity in research?

Answer 14

History, maturation, assignment, attrition, instrumentation, testing, regression, participant reactivity, and investigator-related expectancy effects.

Question 15

What are history and maturation?

Answer 15

“History” refers to the influence of environmental factors (including historical events) that are not under the control of the investigator, such as changes in a participant’s personal circumstances.

“Maturation” refers to changes within a participant over time, such as spontaneous recovery or adjustment to disability.

Question 16

What are assignment, attrition and instrumentation?

Answer 16

“Assignment” refers to the potential for important differences among participants in a study that may be related to performance on the dependent variable. For example, age.

“Attrition” refers to the loss of participants from a study sample, which can bias results if it is greater in one group than in another.

“Instrumentation” refers to the measurement tools used to assess the dependent variable. The reliability of these instruments must be considered and improved.

Question 17

What are testing, regression, participant reactivity, and investigator-related expectancy effects?

Answer 17

“Testing” refers to the potential for practice effects on tests or familiarity with testing procedures to impact performance.

“Regression” refers to the tendency for extreme scores to return to the mean on subsequent testing occasions, in the absence of real changes in function.

“Participant reactivity” refers to the ways in which participants may respond in a way that complies with what they think the investigator expects. This can result from self-report measures or from the participant’s perceptions of the investigator’s expectations.

“Investigator-related expectancy effects” refers to the influence of an investigator’s expectations on a participant’s outcome. This can include compensatory equalization of treatments, where an investigator gives additional attention to participants.

Question 18

What is construct validity and what are two core features of it?

Answer 18

Construct validity refers to how well the variable being measured reflects the higher order construct the variable is meant to represent. Two core features of construct validity are clarity regarding the construct under investigation and how the construct is measured.

Question 19

What are some common threats to construct validity?

Answer 19

Poorly defined constructs, construct under-representation, and treatment-sensitive factorial structure bias.

Question 20

What is construct explication and why is it important?

Answer 20

Refers to the process of defining or operationally defining the construct under investigation.

Question 21

What is construct confounding and what is an example of it?

Answer 21

Construct confounding refers to the extent to which constructs either overlap with or are independent of each other. In other words, two variables are so closely related that it is difficult to determine which one is responsible for the observed relationship.

An example of construct confounding would be assuming a general construct (e.g. memory) from a specific construct (e.g. prospective memory) that is being studied, leading to inaccurate conclusions.

Question 22

What is mono-operation bias and what is an example of it?

Answer 22

Mono-operation bias refers to a single operation (i.e. a measure) that may under-represent a construct, only capturing a single facet of a complex multidimensional construct. An example of mono-operation bias would be measuring anxiety only by documenting the frequency of episodes of agitation.

Question 23

What is mono-method bias and what is an example of it?

Answer 23

Mono-method bias refers to the possibility of measuring a construct using the same method, resulting in the method of measurement becoming part of the construct. An example of mono-method bias would be if several measures of a construct were taken using ratings by independent observers, the construct would become “performance as rated by independent observers.”

Question 24

What is poorly defined constructs

Answer 24

Poorly defined constructs refer to a lack of clarity in the definition or operationalization of the construct being studied. This can lead to inaccurate conclusions because elements that are irrelevant to the construct are also being measured.

Question 25

What is construct under-representation?

Answer 25

Mono-method bias = measuring a construct using the same method, resulting in the method of measurement becoming part of the construct
& mono-operation bias= a single measure (or operation) is used to assess a construct. When a single measure is inadequate to capture all the components of a construct.

Question 26

What is treatment-sensitive factorial structure bias and what is an example of it?

Answer 26

Treatment-sensitive factorial structure bias refers to the idea that when someone receives an intervention or treatment, it can change the way they think about or experience the thing being measured. For example, if a treatment made people more aware of their memory failures, they might report more memory failures than they would have otherwise, even if their memory hasn’t actually gotten worse. This can make it harder to compare the results of people who received the treatment with people who didn’t, because they might be reporting different things, even though they’re being measured using the same tool.

Question 27

What does statistical conclusion validity refer to?

Answer 27

To the extent to which analytic techniques used in a study influence the risk of Type I or Type II errors.

Question 28

What impact does the integrity of data have on statistical conclusion validity = the degree to which conclusions about the relationship among variables based on the data are correct?

Answer 28

The range of variability, heterogeneity of the sample, and confounding factors can threaten the validity of statistical conclusions.

Question 29

What is the main reason for low statistical power in a study?

Answer 29

The main reason for low statistical power in a study is a sample size that is too small, which occurs due to inadequate planning, low recruitment rates, and high attrition.

Question 30

What happens if the assumptions of statistical tests are not met by the data being examined?

Answer 30

The results of statistical analyses may be unreliable.

Question 31

How can the effectiveness of an intervention be overestimated?

Answer 31

If multiple statistical tests are conducted without correcting for the number of comparisons, which will inflate the risk of Type I error.

Question 32

What is a type I error and a type II error?

Answer 32

A Type I error occurs when a null hypothesis is rejected when it is actually true.

A Type II error occurs when a null hypothesis is not rejected when it is actually false.

Question 33

What are threats to statistical conclusion validity?

Answer 33

1. Low sample size: A small sample size can increase the risk of making a Type II error
2. Violated assumptions of statistical tests: Some statistical tests have assumptions that need to be met in order for the results to be valid.
3. Multiple comparisons: If multiple statistical tests are conducted without correcting for the number of comparisons, this can increase the risk of making a Type I error

Question 34

What is external validity?

Answer 34

External validity refers to the extent to which results of a study are applicable in other contexts.

Question 35

What is the generality of findings in external validity?

Answer 35

Refers to the extent to which the results of a study can be applied to other participants, practitioners, settings, timeframes, and variations of intervention components.

Question 36

How does single-case research impact external validity?

Answer 36

Single-case research with a sample size of n=1 can impact external validity as it can be challenging to claim applicability of an intervention beyond the single individual.

Question 37

What is the problem with selection criteria in terms of external validity?

Answer 37

Overly restrictive inclusion and exclusion criteria for a study can pose a threat to external validity as it can result in a homogeneous sample that may not be representative of the general population.

Question 38

How can the setting pose a threat to external validity?

Answer 38

If the intervention that was successful in one setting may not be applicable to another setting.

Question 39

What is a practical strategie to evaluate validity?

Answer 39

The use of critical appraisal tools that evaluate bias and threats to validity. (a low mean score on a critical appraisal tool can indicate that the study is subject to bias and threats to validity.)

Question 40

What is an RCT, and why is it considered the gold standard in research design?

Answer 40

An RCT, or a randomized controlled trial, is a research design where participants are randomly assigned to different groups. It is considered the gold standard in research design because it has the capacity to minimize the risk of bias in the experimental design.

Question 41

What are the main strategies to reduce risks of bias in the randomized controlled trial (RCT)?

Answer 41

Randomization and blinding are the main strategies to reduce risks of bias in the RCT.

Question 42

How does randomization control for bias in the randomized controlled trial (RCT)?

Answer 42

Randomization controls for bias by ensuring that differences among participants that could significantly influence the outcome will, theoretically, be equally distributed between the groups.

Question 43

What is blinding in the RCT, and what does it primarily address?

Answer 43

Blinding refers to the practice of keeping participants and/or researchers unaware of the group to which participants have been allocated. Blinding primarily addresses the risk of bias from some components of internal validity (e.g. investigator expectancies, diffusion, compensatory equalisation of treatments).

Question 44

What are critical appraisal instruments?

Answer 44

Critical appraisal instruments are tools used to assess the quality and validity of published research studies

Question 45

What are some strategies to reduce the risk of bias in single-case research?

Answer 45

Ensuring adequate sampling (accurately captures the variation in the variable) of the dependent variable (variable that is being predicted), establishing high inter-rater agreement on observations, and using experimental designs with sufficient experimental control

Question 46

What are reporting guidelines and what is their purpose?

Answer 46

Reporting guidelines are standards that describe the details of interventions in studies, such as the rationale, content, process, dose, and fidelity of behavioural interventions. Their purpose is to provide a systematic listing of such details to make it easier to compare the effects of different treatments.

Question 47

What is the Rehabilitation Treatment Taxonomy (RTT)?

Answer 47

Is a framework for characterizing rehabilitation treatments. It includes specifying the treatment target, active ingredients, and mechanism of action.

Question 48

What are the disadvantages of randomized controlled trial (RCTs)?

Answer 48

The complexity and expense. Trials that are tightly focused on internal validity (efficacy) must exclude patients with comorbidities and tend to be weak in external validity

Question 49

What are practical clinical trials (PCTs)?

Answer 49

Practical clinical trials (PCTs) compare clinically relevant alternative interventions that may be widespread in practice, using more diverse samples than an RCT and more distal measures of outcome (e.g. satisfaction with life)

Designed to evaluate the effectiveness of interventions in real-life routine practice conditions, rather than focusing on proving causative explanations for outcomes

Question 50

What is the difference between Pragmatic Control Trials and RCTs?

Answer 50

PCTs use more diverse samples than an RCT and more distal measures of outcome.

Question 51

What are adaptive and multi-component treatment trials?

Answer 51

Adaptive treatment trials are clinical trials that use a flexible treatment approach, where the treatment is modified or adjusted based on the individual participant’s response to the treatment.

Multi-component treatment trials, on the other hand, involve using more than one type of treatment intervention to address a particular condition or disease.

Question 52

Why is it important to mask the person who assesses the outcomes of a trial to the participants’ group assignment?

Answer 52

To minimize bias in the study results. If outcome assessors know which treatment a participant received, they may be more likely to rate their outcomes positively, leading to overestimation of treatment effects.

Question 53

What is the difference between multidisciplinary and interdisciplinary teams?

Answer 53

Members of multidisciplinary teams work in parallel but have clear role definitions and tasks, whereas interdisciplinary teams collaboratively discuss and set treatment goals and jointly carry out treatment plans.

Question 54

What is the role of assessment in neuropsychological rehabilitation and where does it consists of?

Answer 54

Assessment is the basis of neuropsychological rehabilitation, and includes not only standardised testing but also behavioural observations, functional tasks, interviews and questionnaires

Question 55

What is the goal of outcome measurement in neuropsychological rehabilitation?

Answer 55

Special emphasis is placed on the measurement of participation after brain injury, since participation in society is one of the major goals of rehabilitation

Question 56

What are some cons of the more novel forms of rehabilitation, such as computer-based cognitive retraining and non-invasive brain stimulation?

Answer 56

They are mostly restricted to trained tasks and generalization to daily life is limited.