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Open access publications by faculty, staff, postdocs, and graduate students from the Center for Health Assessment Research and Translation.
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Item Near vision assessment for adults using the NIH Toolbox(Frontiers in Neurology, 2025-01-19) Finley, John-Christopher A.; Slotkin, Jerry; Nowinski, Cindy J.; Bedjeti, Katy; Volpe, Nicholas; Weintraub, Sandra; Gershon, RichardIntroduction: The National Institutes of Health (NIH) Toolbox Near Visual Acuity Test is a novel digitized measure designed to provide an assessment of near vision in a time-and cost-effective manner. This study is the first to report the psychometric properties of the NIH Toolbox Near Visual Acuity Test in a sample of community-dwelling middle-aged and older adults. Methods: Ninety-eight adults (ages 40–81) completed the tablet-based near vision test and the gold standard chart-based near vision test. Performance on the tablet-and chart-based near vision tests was expressed in logarithmic units. Chart-and tablet-based administration order was counterbalanced. To assess test–retest reliability, the NIH Toolbox Near Visual Acuity Test was administered twice within the same day. Additionally, two equivalent versions of the chart-based test were randomly assigned to participants. Results: Analyses revealed that test–retest reliability of the NIH Toolbox Near Visual Acuity Test was good (intraclass correlation = 0.87, p < 0.001). Concurrence between the NIH Toolbox Near Visual Acuity Test and gold standard chart-based test was also good (r = 0.79, p < 0.001). Discussion: Findings provide support for the reliability and validity of the NIH Toolbox Near Visual Acuity Test as a near vision assessment for middle-aged to older adult populations. With further research, the integration of this test within the widely used NIH Toolbox may provide a more efficient means to understanding how near visual acuity influences neurocognitive test performance and brain function in middle-aged to older adult populations.Item Development and Validation the Mobile Toolbox (MTB) Spelling Test(The Journal of Prevention of Alzheimer's Disease, 2024-09-09) LaForte, E.; Young, Stephanie Ruth; Dworak, E. M.; Novack, M. A.; Kaat, A. J.; Adam, H.; Nowinski, C. J.; Hosseinian, Z.; Slotkin, J.; Amagai, S.; Diaz, M. V.; Correa, A. A.; Alperin, K.; Camacho, M.; Landavazo, B.; Nosheny, R.; Weiner, M. W.; Gershon, R. M.Background Spelling assessments can provide a valuable marker of cognitive change in Alzheimer’s disease and related dementias (ADRD) and play an important role in ADRD research. However, most commercial assessments are not well-suited to the needs of researchers or participants; they are expensive and often require face-to-face administration by a trained examiner. To help overcome these barriers and foster progress in ADRD research, the National Institute on Aging (NIA)-funded Mobile Toolbox (MTB) offers a library of cognitive measures that can be self-administered remotely on a participant’s own smartphone, including a brand-new Spelling test. Objective The goal of this paper is to describe the design, piloting, calibration, and validation of the MTB Spelling test. Design We describe a pilot study, calibration study, and three validation studies, all of which use a cross-sectional design. Setting The pilot study, calibration study, and validation studies 2 and 3 were conducted remotely, while validation study 1 was conducted in the lab. Participants Participants for all of the studies were recruited from the general population by a thirdparty market research firm and the samples were stratified by age, gender, race, ethnicity, and education to represent the U.S. population. The pilot sample included 1,950 participants and the calibration study included 1335 participants over the age of 8. Validation study 1 included 92 participants ages 20 to 84, validation study 2 included 1021 participants ages 18 to 90, and validation study 3 included 168 participants ages 28 to 87. Measurements Participants in each of the studies completed the MTB Spelling test. Participants in validation studies 1 and 2 completed measures from the NIH Toolbox including Oral Reading Recognition as a measure of convergent validity, and Visual Reasoning and the Rey Auditory Verbal Learning as measures of divergent validity. As an additional measure of convergent validity, participants in study 1 also completed the Spelling subtest from the Wechsler Individual Achievement Test, 4th Edition. Results The MTB Spelling test demonstrated evidence of internal consistency (r=.79 to.83) convergent validity (r=.56 to.81, p<.01), discriminant validity (r =.23 to.36, p <.01), test-retest reliability (ICC=.63), and correlations with normal cognitive aging (r = −.06 to −.04, p >.01). Conclusion Findings suggest the MTB Spelling test is a reliable and valid measure of English spelling abilities in general population samples, and has potential in ADRD research.Item Exploring symptom clusters in mild cognitive impairment and dementia with the NIH Toolbox(Journal of the International Neuropsychological Society, 2024-02-16) Tyner, Callie E.; Boulton, Aaron J.; Slotkin, Jerry; Cohen, Matthew L.; Weintraub, Sandra; Gershon, Richard C.; Tulsky, David S.Objective: Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations. Method: Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer’s type. Results: The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor. Conclusion: This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.Item Identifying Health-Related Quality of Life Domains After Upper Extremity Transplantation(Archives of Physical Medicine and Rehabilitation, 2023-06-01) Tulsky, David S.; Kisala, Pamela A.; Tyner, Callie E.; Slotkin, Jerry; Kaufman, Christina; Dearth, Christopher L.; Horan, Annamarie D.; Talbot, Simon G.; Shores, Jaimie T.; Azari, Kodi; Cetrulo, Curtis Jr.; Brandacher, Gerald; Cooney, Carisa M.; Victorson, David; Dooley, Mary; Levin, L. Scott; Tintle, Scott M.Objective To identify the most important health-related quality of life (HRQOL) domains and patient-reported outcomes after upper extremity transplantation (UET) in individuals with upper extremity amputation. Design Verbatim audio-recordings of individual interviews and focus groups were analyzed using qualitative, grounded theory-based methods to identify important domains of HRQOL and provide guidance for outcomes measurement after UET. Setting Individual interviews were conducted by phone. Focus groups were conducted at 5 upper extremity vascularized composite allotransplantation (VCA) centers in the US and at an international conference of VCA experts. Participants Individual phone interviews were conducted with 5 individuals with lived experience of UET. Thirteen focus groups were conducted with a total of 59 clinical professionals involved in UET. Interventions Not applicable. Main Outcome Measures Not applicable. Results Twenty-eight key HRQOL domains were identified, including physical functioning and medical complications, positive and negative emotional functioning, and social participation, relations, and independence. We identified key constructs for use in evaluation of the potentially substantial physical, medical, social, and emotional effects of UET. Conclusions This study provides an overview of the most important issues affecting HRQOL after UET, including several topics that are unique to individuals with UET. This information will be used to establish systematic, comprehensive, and longitudinal measurement of post-UET HRQOL outcomes.Item Establishing severity levels for patient-reported measures of functional communication, participation, and perceived cognitive function for adults with acquired cognitive and language disorders(Quality of Life Research, 2022-12-27) Cohen, Matthew L.; Harnish, Stacy M.; Lanzi, Alyssa M.; Brello, Jennifer; Hula, William D.; Victorson, David; Nandakumar, Ratna; Kisala, Pamela A.; Tulsky, David S.Purpose: To empirically assign severity levels (e.g., mild, moderate) to four relatively new patient-reported outcome measures (PROMs) for adults with acquired cognitive/language disorders. They include the Communicative Participation Item Bank, the Aphasia Communication Outcome Measure, and Neuro-QoL’s item banks of Cognitive Function (v2.0) and Ability to Participate in Social Roles and Activities (v1.0). Method: We conducted 17 focus groups that comprised 22 adults with an acquired cognitive/language disorder from stroke, Parkinson’s disease, or traumatic brain injury; 30 care partners of an adult with an acquired cognitive/language disorder; and 42 speech-language pathologists who had experience assessing/treating individuals with those and other cognitive/language disorders. In a small, moderated focus-group format, participants completed “PROM-bookmarking” procedures: They discussed hypothetical vignettes based on PROM item responses about people with cognitive/language disorders and had to reach consensus regarding whether their symptoms/function should be categorized as within normal limits or mild, moderate, or severe challenges. Results: There was generally good agreement among the stakeholder groups about how to classify vignettes, particularly when they reflected very high or low functioning. People with aphasia described a larger range of functional communication challenges as “mild” compared to other stakeholder types. Based on a consensus across groups, we present severity levels for specific score ranges for each PROM. Conclusion: Standardized, stakeholder-informed severity levels that aid interpretation of PROM scores can help clinicians and researchers derive better clinical meaning from those scores, for example, by identifying important clinical windows of opportunity and assessing when symptoms have returned to a “normal” range.