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Effect of Missed Items on the Reliability of the Kessler Foundation Neglect Assessment Process

  • Timothy J. Rich
    Correspondence
    Corresponding author Timothy Rich, PhD, OTR/L, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, New Jersey 07052.
    Affiliations
    Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, New Jersey

    Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
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  • Kimberly P. Hreha
    Affiliations
    Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina

    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
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  • A.M. Barrett
    Affiliations
    Department of Neurology, Emory University School of Medicine, Atlanta, Georgia

    Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, US Department of Veterans Affairs, Decatur, Georgia
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  • Devan Parrott
    Affiliations
    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana

    Research, Training, and Outcome Center for Brain Injury, Rehabilitation Hospital of Indiana, Indianapolis, Indiana
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  • Peii Chen
    Affiliations
    Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, New Jersey

    Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
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Published:March 16, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.165

      Abstract

      Objective

      To determine the maximum permissible number of missed items on the 10-item Catherine Bergego Scale administered after the Kessler Foundation Neglect Assessment Process (KF-NAP). Secondary objectives were to determine the frequency, characteristics, and most commonly cited reasons reported for missed items.

      Design

      Retrospective diagnostic accuracy study.

      Setting

      Sixteen inpatient rehabilitation facilities in the United States.

      Participants

      A consecutive clinical sample of 4256 patients (N=4256) with stroke or other neurologic deficits who were assessed for spatial neglect with the KF-NAP.

      Interventions

      Not applicable.

      Main Outcome Measures

      Catherine Bergego Scale via KF-NAP.

      Results

      The majority (69.7%) of patients had at least 1 missed item on their KF-NAP. Among those with missed items, it was most common to have 2 missed items (51.4%), and few had more than 3 missed items (11.3%). The most commonly missed items were Collisions (37.2%), Cleaning After Meals (36.1%), Meals (34.0%), and Navigation (19.7%). The most commonly reported reasons for missed items included time constraints, cognitive or communication deficits, and behavior or refusal of the therapy session. These reasons were reported for nearly all item types. Item-specific reasons were also commonly reported, such as a lack of a needed resource for task completion or low functional status of the patient. Prorated scoring of measures with up to 3 missed items maintained an acceptable level of concordance with complete measures (Lin's Concordance Correlation Coefficient=0.96, 95% CI, 0.9478-0.9626) for the combination of 3 missed items with lowest concordance.

      Conclusions

      Clinicians should make every effort to capture all items on the KF-NAP. However, missed items occur in the majority of cases because of patient factors and barriers inherent to the inpatient hospital setting. When missed items are necessary, clinicians can confidently interpret a prorated score when 7 or more items are scored.

      Keywords

      List of abbreviations:

      CBS (Catherine Bergego Scale), CCC (concordance correlation coefficient), IQR (interquartile range), KF-NAP (Kessler Foundation Neglect Assessment Process), PEG (percutaneous endoscopic gastrostomy), SN (spatial neglect)
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