Author(s): Baum, C.M., Morrison, T., Hahn, M., & Edwards, D.F.
Year of Publication: -
Publisher: Program in Occupational Therapy at Washington University Medical School in St. Louis, MO
Type of Assessment:
Standardized
Performance-based
Observation-based
Criterion-referenced
Cost: Free for the assessment (authors request that when used, you email to report the reason for use) but costs for items varies
How to Access: https://www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308
Age: Adolescents (13-17), Adults (18-64), Geriatrics (65+)
Diagnoses: stroke, MS, brain injury, mental health challenges, neurocognitive disabilities
Setting: home health, outpatient rehab, SNFs, (*areas with a stove top)
The top-down performance assessment examines cognitive integration and functioning to: 1) determine which executive functions are impacting function; 2) determine an individual's capacity for independent functioning; and 3) determine the amount of assistance necessary for task completion
Self-maintenance & independent living
Handwashing *only if severe cognitive impairment applies
Simple cooking (oatmeal)
Telephone use
Medication management
Bill payment
Time: 30-45 mins
Group/Individual: Individual
Subtests: 20 items within 4 subtests
Instructions: Complete pre-test checklist and item preparation while using the script to describe the assessment and conduct pre-test questions. Refer to the training manual to instruct IADL tasks
1) making oatmeal
2) looking up a grocery store phone # and calling to ask if they deliver groceries
3) taking proper dosage of correct medication
4) paying two bills
*Activities must be completed in the order that was described
Provide assistance only after attempt has occur and curing should start at the lowest level throughout steps of each task
Conversations & +/- feedback to clients cannot happen so other individuals are not permitted to be involved
*Can only be administered once per client (learning effect can impact results after repeated completion)
Materials: manual, 32 designated household items plus several distracter items stored in a box including a bowl, salt-shaker, phone book, magnifying glass, etc.
User Qualifications: Manual review
How to Score: There will be a total of 3 scores
The highest level of cueing needed for each of the 5 components of executive function is recorded in each task
EF scores range from 0-5
All levels of cueing should be totaled to range from 0-25
A total of all 4 task scores are summed
In addition to cueing, the duration of each task (in minutes) should be recorded
Score Indications:
Higher EF scores = higher levels of cueing needed
Reliability:
Interrater reliability: Excellent
Overall: ICC =0.91
Cooking: ICC = 0.94
Paying Bills: ICC = 0.89
Medication: ICC = 0.87
Using Phone: ICC = 0.79
Internal consistency: Mixed
Excellent - Overall: Cronbach's alpha = 0.94
Excellent - Cooking: Cronbach's alpha = 0.86
Excellent - Med Management: Cronbach's alpha = 0.88
Adequate - Paying Bills: Cronbach's alpha = 0.78
Adequate - Telephone: Cronbach's alpha = 0.77
Validity:
Concurrent Validity: Mixed
Excellent - FAM: r=-0.68
Excellent - AMPS: r=0.61
Adequate - FIM: r=-0.40
Adequate - Short Blessed: r=0.39
Adequate - Wechsler Memory Scale: r=-0.59
Construct Validity:
Adequate - DKEFS Sorting: r=-0.51
Adequate - DKEFS Color-Word: r=-0.566
Adequate - Short Blessed: r=0.548
Criterion Validity:
Adequate - TOL-DX: r=.379
Content Validity: developed based on C. Baum's KTA measure of functional ability
Strengths:
Observes capabilities and cognitive deficits through a top-down approach, assessing how this impact actual occupational performance
Allows the test administrator to actively assess the type of assistance needed during task completion, rather than having the client fail portions of the assessment
It can be used with adolescents, adults, and elderly adults, including those with motor impairments
It uses a standardized cueing system that enables use with individuals of varying abilities
Assesses performance on four functional tasks (cooking, telephone use, medication management, and bill payment), which are relevant to daily life
Korean version available (EFPT-K) to be more culturally appropriate & translated into Swedish
Weaknesses:
Time-consuming
Can only be administered once due to confounds of a learning effect during second administration
It does not provide adjustments for visual impairments or hearing limitations
Does not have standardized equipment that has been tested with a variety of populations
Not suitable for use with individuals with severe cognitive impairment who are unable to follow directions
Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press
Baum, C.M., Connor, L.T., Morrison, T., Hahn, M., Dromerick, A.W., Edwards, D.F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62(4), 446-455.
Shirley Ryan Ability Lab. (2019, August 1). Executive function performance test. https://www.sralab.org/rehabilitation-measures/executive-function-performance-test
WashU Program in Occupational Therapy. (n.d.). Executive Function Performance Test (EFPT). Washington University Medicine. https://www.ot.wustl.edu/about/resources/executive-function-performance-test-efpt-308