Validating the Measurement of Real-World Functional Outcomes: Phase I Results of the VALERO Study

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, FL 33136, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 05/2011; 168(11):1195-201. DOI: 10.1176/appi.ajp.2011.10121723
Source: PubMed


Treatment of cognitive impairment has been proposed as an intervention to reduce disability in people with schizophrenia. The Validation of Everyday Real-World Outcomes (VALERO) study was conducted to evaluate functional rating scales and to identify the rating scale or scales most robustly related to performance-based measures of cognition and everyday living skills.
Adults with schizophrenia (N=198) were tested with the neurocognitive measures from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, the UCSD Performance-Based Skills Assessment-Brief Version, and the advanced finances subscale of the Everyday Functioning Battery. They and an informant (a friend, relative, clinician, or case manager) also reported their everyday functioning on six rating scales. Best judgment ratings were generated by an interviewer who administered the rating scales to patients and informants.
Statistical analyses developed an ability latent trait that reflected scores on the three performance-based (i.e., ability) measures, and canonical correlation analysis related interviewer ratings to the latent trait. The overall fit of the model with all six rating scales was good. Individual rating scales that did not improve the fit of the model were systematically deleted, and a final model with two rating scales was fitted to the data. A regression analysis found that the Specific Levels of Functioning Assessment was a superior predictor of the three performance-based ability measures.
Systematic assessments of real-world functioning were related to performance on neurocognitive and functional capacity measures. Of the six rating scales evaluated in this study, the Specific Levels of Functioning Assessment was the best. Use of a single rating scale provides an efficient assessment of real-world functioning that accounts for considerable variance in performance-based scores.

8 Reads
  • Source
    • "As a measure of real world functional performance, the Specific Levels of Functioning (SLOF) was used (Schneider and Struening, 1983). As we previously found in the initial phase of the VALERO study (Harvey et al., 2011), everyday functioning rated with multiple rating scales was related to performance-based assessments of cognition and functional capacity. Of those examined, the SLOF was shown to be the best measure of real world functioning due to its optimal individual correlation with the ability measures. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A substantial research literature implicates potential racial/ethnic bias in the diagnosis of schizophrenia and in clinical ratings of psychosis. There is no similar information regarding bias effects on ratings of everyday functioning. Our aims were to determine if Caucasian raters vary in their ratings of the everyday functioning of schizophrenia patients of different ethnicities, to find out which factors determine accurate self-report of everyday functioning in different ethnic groups, and to know if depression has similar effects on the way people of different ethnicities self-report their current functionality. We analyzed data on 295 patients with schizophrenia who provided their self-report of their everyday functioning and also had a Caucasian clinician rating their functionality. Three racial/ethnic groups (African American (AA), Hispanic and Caucasian) were studied and analyzed on the basis of neurocognition, functional capacity, depression and real-world functional outcomes. No differences based on racial/ethnic status in clinician assessments of patients' functionality were found. Differences between racial groups were found in personal and maternal levels of education. Severity of depression was significantly correlated with accuracy of self-assessment of functioning in Caucasians, but not in AAs. Higher scores on neurocognition and functional capacity scales correlated with reduced overestimation of functioning in AAs, but not in Hispanics. This data might indicate that measurement of everyday functionality is less subject to rater bias than measurement of symptoms of schizophrenia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    07/2015; 138(1-2). DOI:10.1016/j.psychres.2015.06.042
    • "The standardized instruments were the Brief Psychiatric Rating Scale (BPRS) (Ventura, Green, Shaner, & Liberman, 1993), the Health of Nation Outcome Scale (HoNOS) (Wing, Beevor, & Curtis, 1998), and the Personal and Social Performance (PSP) scale, a modified version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) (Morosini, Magliano, Brambilla, Ugolini, & Pioli, 2000). The Specific Levels of Functioning (SLOF), recently considered the 'gold standard' in this field (Harvey et al., 2011), was also administered to assess psychosocial functioning and disability. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People with severe mental disorders and a history of violence are often seen as a difficult-to-manage segment of the population. In addition, this group is usually characterized by a high risk of crime recidivism, and poor compliance with community and aftercare programs. To investigate a sample of male patients living in Residential Facilities (RFs) with a history of violent behavior against people and to compare their characteristics with those of never-violent residents; to analyze the associations between aggressive behaviors in the last two years and a history of previous violence; and, to assess the predictors of aggressive behaviors. This study is part of a prospective observational cohort study which involved 23 RFs in Northern Italy. A comprehensive set of sociodemographic, clinical, and treatment-related information was gathered, and standardized assessments were administered to each participant. Also a detailed assessment of aggressive behaviors in the past two years was carried out. The study involved 268 males: 81 violent and 187 never-violent. Compared to never-violent patients, violent patients were younger, with a higher proportion of personality disorders, and have displayed an increased number of aggressive behaviors in the last two years. The presence of a history of violent behavior in the past significantly increases the probability of committing aggressive acts in the future. Copyright © 2015. Published by Elsevier Ltd.
    International Journal of Law and Psychiatry 02/2015; 39. DOI:10.1016/j.ijlp.2015.01.020 · 1.19 Impact Factor
  • Source
    • "Fourth, some models of empathy include physiological and motor components that are not captured by the QCAE or other self-report measures; future studies may consider whether these can be assessed using self-report. Lastly, we used an interview-based version of the SLOF, which may have lower reliability than the informant version (Harvey et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: a b s t r a c t Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n ¼52) and healthy comparison (n ¼ 37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocog-nition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocogni-tion and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.
    Psychiatry Research 10/2014; 220(3). DOI:10.1016/j.psychres.2014.08.054 · 2.47 Impact Factor
Show more

Similar Publications


8 Reads
Available from