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592 September/October 2009, Volume 63, Number 5
Kettle Test—A Brief Measure of Cognitive Functional
Performance: Reliability and Validity in Stroke Rehabilitation
KEY WORDS
• cognition
• reproducibility of results
• stroke
• task performance and analysis
Adina Hartman-Maeir, PhD, OT, is Lecturer,
School of Occupational Therapy, Hadassah and Hebrew
University, Mount Scopus, POB 24026, Jerusalem 91240
Israel; amaeir@mscc.huji.ac.il
Hagit Harel, MSc, OT, is Clinician, Rehabilitation
Department, Sheba Medical Center, Tel Aviv, Israel.
Noomi Katz, PhD, OTR, is Director, Research Institute
for Health and Medical Professions, Ono Academic
College, Israel, and Professor Emeritus, School of
Occupational Therapy, Hadassah and Hebrew University,
Jerusalem, Israel.
OBJECTIVES. We examined the reliability and validity of the Kettle Test, a brief performance measure based
on a complex everyday task designed to tap into basic and higher level cognitive processes.
METHOD. Participants included 21 people attending stroke rehabilitation and 4 occupational therapists for
the reliability analysis, 36 people at discharge from stroke rehabilitation, and 36 age-matched healthy control
participants for the validity analyses. Instruments included a battery of conventional cognitive measures and
functional outcomes.
RESULTS. Interrater reliability was found to be high. Stroke survivors at discharge from rehabilitation were
found to require significantly more assistance on the Kettle Test than control participants (p < .000); their scores
on the Kettle Test were significantly and moderately correlated with the conventional cognitive and functional
outcome measures.
CONCLUSIONS. The results support the reliability and validity of the Kettle Test as a top-down measure of
cognition-in-function in people at discharge from stroke rehabilitation.
Hartman-Maeir, A., Harel, H., & Katz, N. (2009). Kettle Test—A brief measure of cognitive functional performance: Reliability
and validity in stroke rehabilitation. American Journal of Occupational Therapy, 64, 592–599.
Adina Hartman-Maeir, Hagit Harel, Noomi Katz
People with acquired brain injury are at high risk for cognitive impairments that
have a detrimental impact on occupational performance (Cicerone et al., 2005;
Donnovan et al., 2008; Hershkovitz & Brill, 2007; Zinn et al., 2004). Occupational
therapy has developed a unique body of knowledge regarding the relationship
between cognition and occupation involving occupation-based, client-centered
intervention (Gillen, 2009; Katz, 2005). Conventional “tabletop” measures of
cognition are valuable diagnostically but have limited ecological validity and do
not fully address the functional implications of cognitive deficits. Moreover, the
interdisciplinary rehabilitation community has emphasized the need for ecologi-
cally valid measures of cognition in function (Burgess et al., 2006). This current
emphasis is an important milestone in the conceptualization of measurement in
health-related professions. Instruments that follow these directives are essential and
are integral to the occupational therapy philosophy and practice (American
Occupational Therapy Association, 2008). Occupational therapy is in a unique
position to fulfill a central role in this development and is establishing its expertise
in the development of top-down assessments (Hartman-Maeir, Katz, & Baum,
2009; Law, Baum, & Dunn, 2005).
Evaluation of outcomes in stroke rehabilitation, beyond basic activities of daily
living (BADLs), has become extremely important as more people survive stroke and
return to their homes in the community. One primary concern at discharge from
rehabilitation is predicting the ability to function independently in the community
or the degree of assistance required to do so. Instrumental activities of daily living
The American Journal of Occupational Therapy 593
(IADLs) are more complex than BADLs and thus require
basic and higher-level cognitive functions such as executive
functioning (Cahn-Weiner et al., 2007; Coster, Haley, Jette,
Tao, & Seibens, 2007; MacNeill & Lichtenberg, 1997).
Thus, to address this important outcome during stroke reha-
bilitation, occupational therapists have a need for top-down,
performance-based assessments that will incorporate the cog-
nitive complexity involved in IADLs. A small number of
performance-based measures in occupational therapy fulfill
these requirements and incorporate cognitive challenges in
functional IADL contexts; these measures include the
Cognitive Performance Test (CPT; Burns, 2006), the
Assessment of Motor and Process Skill (AMPS; Fisher,
2006a, 2006b), and the Executive Function Performance
Test (EFPT; Baum, Morrison, Hahn, & Edwards, 2003;
Baum et al., 2008). These instruments are valuable top-
down measures that address cognitive and process skills in
IADLs. The CPT and EFPT each have four or five IADL
tasks that provide a wide range of activities in this domain.
The scores on the CPT measure the six cognitive levels
according to the Cognitive Disabilities Model (Allen,
Earhart, & Blue, 1992; Levy & Burns, 2005), and the scores
of the EFPT measure executive functioning components.
The AMPS is an extensively researched, reliable, and valid
measure of motor and process skills in IADLs; however, it
requires intensive and expensive training, which is not avail-
able for all occupational therapists.
The focus of this study is on the development of the
Kettle Test (Hartman-Maeir, Armon, & Katz, 2005), a brief
performance measure that is based on a complex everyday
task and is designed to tap into basic and higher-level cogni-
tive processes. The aim of the test is to evaluate the ability
for independent community living of people with identified
or suspected cognitive disabilities.
Development of the Kettle Test
The Kettle Test (Hartman-Maeir et al., 2005) was developed
to provide a brief performance-based assessment of an IADL
task that can be conducted in a clinical setting or at home.
The test was designed to tap into a broad range of cognitive
skills within a functional context to assist in the clinical deci-
sion-making process regarding the need for assistance in daily
living skills of adults with suspected cognitive disabilities.
The basic task of preparing a hot beverage was chosen
because of its functional significance, broad cultural rele-
vance, and feasibility (in terms of tools and time require-
ments) in multiple settings (e.g., clinic, home). The task
complexity was elevated to enable the assessment of basic
and higher-level cognitive–functional skills that are required
for IADLs, with the following elaborations:
1. The essential task of preparing oneself a hot beverage
was expanded to include preparing an additional cup of
hot beverage for the therapist; the additional cup differs
in two ingredients from that requested by the client,
providing additional load on working memory.
2. The electric kettle is emptied and disassembled (lid and
electric cable are disconnected from the body of the
kettle) to challenge problem-solving skills and safety
judgment regarding the use of electricity.
3. Additional kitchen utensils and ingredients are placed
in the immediate task environment (on a tray) as dis-
tracters to increase attention demands.
This design creates a brief task using familiar objects and
settings that are presented in a manner that targets cognitive
skills underlying complex ADLs. The observation is struc-
tured so that the rater is required to score the performance
on 13 discrete steps of the task (e.g., turning on the faucet,
filling the kettle with 2 cups of water). Clear guidelines for
cueing are provided, and the rater scores each step according
to the degree of cueing that was necessary to complete the
step (0 through 4). Total scores range from 0 to 52 (higher
scores indicate more assistance) and can be transformed to
clinically meaningful categories of independence on the task
(independent, mild assistance, considerable assistance).
Initial research to examine convergent and ecological
validity was conducted on the Kettle Test in a sample of 41
elderly clients (mean age = 75.2) referred to a geriatric
assessment clinic because of suspected cognitive disabilities
(Hartman-Maeir, Katz, & Armon, 2004). Small to moder-
ate significant correlations were found between Kettle Test
scores with conventional measures of cognition (r = .56 with
Mini-Mental Status Evaluation [MMSE; Folstein &
Folstein, 1975]; r = .59 with Clock Drawing Test [CDT;
Freedman et al., 1994]; and r = .32 with the visual attention
Star Cancellation subtest of the Behavioral Inattention Test
[BIT; Wilson, Cockburn, & Halligan, 1987), and moderate
correlations were found with caregiver ratings of ADLs (r =
.53) and IADLs (r = .58). This initial study provided sup-
port for the validity of the instrument. Therefore, the pur-
pose of this study was to further examine the reliability and
validity of the Kettle Test in a geriatric stroke population
faced with similar concerns regarding the impact of cogni-
tive deficits on daily living abilities at discharge from
rehabilitation.
The study was divided into two stages: (1) The first
consisted of the study of interrater reliability of the Kettle
Test between two sets of raters in two rehabilitation set-
tings, and (2) the second consisted of the study of different
aspects of validity in a sample of people at discharge from
stroke rehabilitation and healthy elderly control partici-
pants. The objective of the first stage was to examine the
594 September/October 2009, Volume 63, Number 5
interrater reliability of the Kettle Test scores as administered
by certified occupational therapists to stroke patients in
rehabilitation. The objectives of the second stage were to
examine
• The construct validity of the Kettle Test, in terms of its
ability to differentiate between scores of people after
stroke at discharge from rehabilitation and scores of age-
matched healthy control participants who live indepen-
dently in the community;
• The convergent validity of the Kettle Test, calculating
relationships between Kettle Test scores with conven-
tional measures of cognition; and
• The ecological validity of the Kettle Test, examining the
relationship of safety level and BADL status at discharge
and IADL status at home, 1 month after discharge
Method
Stage 1: Interrater Reliability Study
Participants were recruited from two centrally located geri-
atric rehabilitation hospitals in Jerusalem and Tel Aviv.
Inclusion criteria required participants to be admitted to a
rehabilitation hospital within 1 month after stroke, be ages
60 or older, be alert and without receptive aphasia, and live
independently in the community before stroke. Twenty-one
patients consecutively admitted to each rehabilitation hos-
pital who met inclusion criteria participated in the reliability
study (Hospital 1: n = 10; 4 men, 6 women; mean age =
79.3, standard deviation [SD] = 5.8. Hospital 2: n = 11; 6
men, 5 women; mean age = 77.82, SD = 5.1). The study
was approved by the Human Rights Helsinki Committee
of each hospital, and all participants signed informed con-
sent. Four certified and experienced occupational therapists
(two in each hospital) rated patient performance on the
Kettle Test. The test was administered by one of the raters
while the other observed the assessment. Independent rat-
ings were then conducted immediately after the assessment.
Interrater reliability (Spearman correlation coefficient) was
found to be high for the Kettle Test total scores for both
sets of raters (Hospital 1: r =.851, p = .001; Hospital 2: r =
.916, p = .000).
Stage 2: Validity Study
Participants. Thirty-six stroke patients (18 with right
hemisphere stroke and 18 with left hemisphere stroke) were
recruited from a geriatric rehabilitation hospital before their
discharge (mean length of stay = 63.1 days, SD = 29.2).
Inclusion criteria were the same as delineated in the reliabil-
ity study. In addition, 36 healthy control participants were
recruited from a convenience sample of healthy elderly vol-
unteers. The inclusion criteria for the control participants
were age 60 or older, living independently in the commu-
nity, and scoring >23 on the MMSE; see Table 1 for demo-
graphic data). The study was approved by the Human Rights
Helsinki Committee of the hospital, and all participants
signed informed consent.
Instruments. A short battery of conventional standard-
ized measures of cognition recommended in geriatric stroke
rehabilitation (Adunsky, Fleissig, Levenkrohn, Arad, & Noy,
2002) was used in this study. The battery included the fol-
lowing measures:
• The MMSE is a universal measure of cognitive status that
assesses a broad range of basic cognitive abilities including
orientation, attention, recall, working memory, spatial
abilities, and language. Scores range from 0 to 30, and
scores >23 are considered the cutoff for cognitive
impairment.
• The CDT is widely used in cognitive screening for many
neurological conditions (Freedman et al., 1994). In the
stroke population, several scoring systems of a free-style
drawing of a clock with hands at 10 past 11 have been
shown to have construct validity and correlate with mul-
tiple cognitive domains, such as abstract thinking, execu-
tive functioning, and visuospatial construction (Suhr,
Grace, Allen, Nadler, & McKenna, 1998). In this study,
we used the scoring system of Rouleau, Salmon, Butters,
Kennedy, and McGuire (1992), with a score range from
0 to 10, which was found to be reliable and valid in stroke
rehabilitation (Suhr et al., 1998).
• The Star Cancellation subtest of the BIT was used to
measure visual attention, as recommended for use in
stroke rehabilitation practice (Edwards et al., 2006).
• The Cognitive scale of the FIM™ (CognFIM; Granger,
1998) was used as a measure of cognitive–functional sta-
tus as expressed in daily activities (based on general obser-
vation) in five areas of cognition (expressive and receptive
language, problem solving, social interaction, and mem-
ory). Each area is rated on a 7-point scale; total score
ranges from 5 to 35. Reliability and validity have been
extensively established in the stroke population (Heruti,
Lusky, & Dankner, 2002).
• The functional outcome battery included the areas of
BADLs, IADLs, and safety—outcomes necessary for
independent community living.
• BADLs were measured with the Motor scale of the FIM
(Granger, 1998) because it is a universal, reliable, and
valid measure of rehabilitation outcome. The FIM Motor
scale includes 13 items of basic self-care rated on a 7-point
scale (total scale score range = 13–91).
• IADLs were measured with the IADL scale (Lawton &
Brody, 1969; Lawton, Moss, Fulcomer, & Kleban, 1982),
The American Journal of Occupational Therapy 595
a widely used measure for independence in extended areas
of ADLs, including telephone use, shopping, food prepara-
tion, housekeeping, laundry, transportation, taking medica-
tion, and financial management (total score range = 0–23).
• Safety was measured with the Safety Rating scale, which
is part of the Routine Task Inventory (RTI–E), a struc-
tured observation used to rate cognitive levels in daily
routine activities (Allen et al., 1992; Katz, 2006). The 4-
point scale ranges from 3 (unable to recognize the need for
safety precautions) to 6 (anticipates hazards and plans safety
procedures). The reliability and validity of the RTI–E has
been studied in populations with cognitive disabilities
(Katz, 2006).
• The Fugl-Meyer Motor Assessment (FMA; Fugl-Meyer,
Jääsko, Leyman, Olsson, & Steglind, 1975; Rabadi &
Rabadi, 2006) Upper-Extremity scale was used to mea-
sure motor status to evaluate the possible confounding
relationship between motor function after stroke with
performance on the Kettle Test.
Procedure
The assessment battery was administered within the last
week before discharge from the rehabilitation hospital. The
Kettle Test was administered by Hagit Harel. The other
assessments were administered by experienced occupational
therapists and rehabilitation professionals as part of the rou-
tine discharge assessment battery of the rehabilitation depart-
ment. In addition, to examine IADL status 1 month after
discharge, study group follow up included a telephone inter-
view administered to caregivers. The follow-up assessment
was completed on 29 participants, because 7 participants
could not be reached. The Kettle Test scores of the 7 partici-
pants that were lost to follow-up were not significantly
different from those of the other participants (t[34] = .892,
p = .403)
Data Analysis
Data were analyzed with SPSS (Version 15.0; SPSS, Inc.,
Chicago). Descriptive statistics and analysis of covariance
(ANCOVA) were used to examine the group effect on the
Kettle Test while controlling for years of education, which
were found to differ significantly between groups. Pearson
correlation analyses were used to examine the relationships
among the cognitive and functional measures and motor and
demographic variables. No significant differences were found
between participants with right- and left-hemisphere stroke
on the Kettle Test (t[34] = 0.178, p = .860); therefore, the
analyses were conducted on the entire stroke group.
Results
Before studying validity, we examined the relationships of
the Kettle Test with demographic and motor variables. The
correlations between the Kettle Test scores and age, years of
education, and FMA were all low and nonsignificant (rs =
.04, –.14, and –.19, respectively). Regarding gender, no sig-
nificant differences were found between men and women on
the Kettle Test (t [34] = .435, p = .67).
Table 1. Demographic Variables and Performance on the Kettle Test by Group
Stroke Control
Demographics n (%) n (%) Results and Significance
Gender
Male 22 (61) 7 (19) χ2(1) = 12.99
p = .000
Female 14 (39) 29 (81)
Total 36 (100) 36 (100)
Range M (SD) Range M (SD)
Age (years)
Education (years)
60–89
0–19
74.81 (7.32)
10.44 (5.28)
60–84
0–19
72.67 (6.59)
10.44 (5.28) t(70) = 1.30, ns
t(70) = –2.31
p = .02413.10 (4.05)
Kettle Test scores
Total scorea1–29 9.34 (5.79) 0–3 0.42 (0.91) F(1,60)b = 63.53
p = .000
Assistance level n (%) n (%)
Independent 5 (17) 35 (97) χ2(3) = 43.53 and 3.53
t = .000
Mild assistance 13 (45) 1 (3)
Considerable assistance 11 (38) 0 (0)
Note. m = mean; SD = standard deviation; ns = not significant.
aHigher scores represent more assistance needed.
bAnalysis of covariance, controlling for years of education.
596 September/October 2009, Volume 63, Number 5
Construct Validity
As seen in Table 1, the Kettle Test scores of the stroke group
were significantly higher than those of the control group,
showing the need for more assistance on the test. ANCOVA,
controlling for years of education (because a significant dif-
ference was found between groups on this variable), demon-
strated a large significant group effect on the test (F[1, 60]
= 63.53, p = .000). The study group showed a wide range of
performance on the Kettle Test (1–29), whereas the control
group showed a narrow range (0–3), and only 1 control
participant required mild assistance, demonstrating a floor
effect on the test for this group.
Convergent Validity
The mean scores of the study group on the conventional
battery of cognitive measures are presented in Table 2.
Results show a wide range of performance on all measures.
The Kettle Test, which targets cognitive abilities in a func-
tional context, was found to moderately significantly corre-
late with these conventional cognitive measures (Table 2).
The correlations of the Kettle Test with the four cognitive
measures ranged from .478 to .659 (all significant at p < .01),
the highest being with the CognFIM, which is a measure
based on observation in ADLs.
Ecological Validity
The mean scores of the stroke group on the functional out-
comes were as follows: 76.09 (SD =12.19) on the FIM Motor
scale, 4.94 (SD = 0.75) on the Safety Rating scale, and 10.70
(SD = 5.07) on the IADL scale at follow-up. The correlations
of the Kettle Test and the other cognitive measures with
these functional outcomes are presented in Table 3. The
Kettle Test scores were significantly correlated with all three
outcome measures, FIM Motor (r = –.759), Safety (r =
–.571), and IADL 1 month after discharge at home (r =
–.505). The correlations between the other cognitive mea-
sures and functional outcomes were lower, and no single
measure correlated significantly with all three outcomes.
Discussion
The findings of this study provide initial support for the
reliability and validity of the Kettle Test in stroke rehabilita-
tion. We demonstrated that the Kettle Test—a structured
observation of performance in a complex task—can be scored
consistently among professional occupational therapists. In
addition, participants after stroke required significantly more
assistance than healthy control participants, who scored
almost perfectly on the test. Moreover, the test performance
of participants after stroke was not related to their motor
status or educational background, but it was moderately
correlated with their conventional cognitive test scores.
Finally, Kettle Test scores were found to be significantly
correlated with functional outcomes at the time of discharge
from the rehabilitation hospital and at home.
The results concerning interrater reliability were encour-
aging, considering the difficulty of reliably assessing complex
functional tasks. This positive finding can be attributed to
the structured scoring scale of the observation (divided into
discrete steps) and the expertise of the raters, who were occu-
pational therapists trained in observations of functional per-
formance. Further reliability analysis is in progress using
videotape recordings that will enable comparisons among
multiple raters. Another aspect of reliability pertaining to the
stability of performance (test–retest reliability) was not
deemed relevant for the test. Because the test incorporates
an element of novel everyday problem solving, we hypothe-
sized that immediate learning would occur from the expo-
sure to the task and examiner cueing. Thus, similar to other
tests that incorporate novel problem solving, performance is
not expected to be identical in a subsequent immediate retest
(Wilson, Alderman, Burgess, Emslie, & Evans, 1996).
The construct validity of the test was highly supported
by the significant differences that were found between the
stroke and control groups. This group effect could not be
attributed to the difference in education because the effect
Table 2. Conventional Cognitive Measures: Descriptive Statistics
and Pearson Correlation Coefficients With Kettle Test Scores
Cognitive Measures
Minimum–
Maximum M (SD )
r With
Kettle Test
Mini-Mental Status Evaluation 15–30 26.11 (3.96) –.478*
Clock Drawing Test 2–10 8.16 (1.85) –.566*
BIT Star Cancellation subtest 44–54 52.94 (2.33) –.578*
FIM Cognitive scale 15–35 30.38 (4.44) –.659*
Note. M = mean; SD = standard deviation; BIT = Behavioral Inattention Test.
*p < .01.
Table 3. Pearson Correlation Coefficients of Functional Outcomes
With the Kettle Test and Conventional Cognitive Measures
BADLs
(FIM Motor
Scale)
Safety Level
(RTI Safety
Rating Scale)a
IADLs
(IADLs Scale)
Kettle Test –.759** –.571** –.505**
Mini-Mental Status Evaluation .261 .122 .401*
Clock Drawing Test .365* .112 .182
Star Cancellation subtest of BIT .462** .102 .237
FIM Cognitive scale .435** .446** .287
Note. BADLs = basic activities of daily living; RTI = Routine Task Inventory;
BIT = Behavioral Inattention Test; IADLs = instrumental activities of daily living.
aSpearman correlation analysis was performed on this variable because of its
ordinal 4-point scale.
*p < .05. **p < .01.
The American Journal of Occupational Therapy 597
remained when controlling for years of education. Moreover,
education was not found to be significantly related to per-
formance on the Kettle Test, and no difference was found
between the performance of men and women on the test.
Therefore, the differences between the groups support the
construct validity of the test to differentiate between known
groups with identified differences in cognitive functional
status. We expected that healthy adults who are living inde-
pendently in the community would succeed on the Kettle
Test; this expectation was indeed confirmed by the floor
effect among the control group, in which only 1 participant
needed mild assistance on the test. The findings suggest that
the test can detect cognitive–functional deficits in adults
with neurological dysfunction; however, the test is not sensi-
tive to possible variance in cognitive–functional performance
of normative healthy adults. Further research is required on
larger, more representative samples of different diagnostic
groups with identified cognitive disabilities.
The significant moderate correlations that were found
with conventional established measures of cognition support
the convergent validity of the Kettle Test, demonstrating the
expected strength of association (r = .50) between measures
with overlap of construct (Gregory, 2000). The correlations
with the “table-top” tests (MMSE, CDT, and Star Cancella-
tion) suggest that common underlying cognitive abilities,
including attention, memory, praxis, and executive functions,
are being tapped by these measures. However, the moderate
degree of association supports the contention that the Kettle
Test is also tapping into additional aspects of performance
not addressed by these conventional cognitive measures.
These findings are similar to the initial findings regarding
the Kettle Test in adults with suspected dementia (Hartman-
Maeir et al., 2004) and to those of other studies of top-down
assessments such as the AMPS and the EFPT, where moder-
ate associations were found with table-top measures of cogni-
tion (Baum et al., 2008; Fisher, 2006a). The significant cor-
relation that was found between the Kettle Test scores and the
FIM supports the validity of the test as a measure of cognition
in function. The FIM Cognitive scale provides a valuable
measure of functional cognition in stroke rehabilitation; how-
ever, it relies on the day-to-day observations of clinicians in
the rehabilitation setting and has a high focus on BADLs. This
setting does not necessarily provide an opportunity to observe
the client in the more complex tasks that are essential for
independent living in the community after discharge. The
moderate association that was found may shed light on the
possible unique contribution of a short IADL performance
test, beyond a general observation in daily life.
The ecological validity of the Kettle Test was substan-
tially supported by the significant correlations with all func-
tional outcomes (ADLs, safety, and IADLs). Conversely, the
pattern of correlations between these outcomes and the con-
ventional cognitive measures showed fewer and smaller
effects, and no single measure correlated significantly with
all outcomes. The outcome measures that were chosen for
this study represent functional areas that are pertinent issues
for discharge planning after stroke and for independent com-
munity living. The findings clearly support the advantage of
the Kettle Test in its relation to these outcomes.
From our clinical experience, the ecological and face
validity of the Kettle Test for discharge planning has been
shown to be valuable for clients and their caregivers. On
discharge from hospital, the need for assistance in ADLs and
safety status is of major concern in planning for community
living. Questions such as “Can I return home alone?” or
“What type of assistance will I need to live independently in
the community?” are of vital importance. For example, study
participant A. R. is a 73-year-old married man who was liv-
ing independently in the community before his stroke. He
did not have any residual motor deficits at this stage of reha-
bilitation and was independent in BADLs, yet his conven-
tional cognitive test scores revealed some mild deficits in
measures of clock drawing and visual attention. A. R.’s per-
formance on the Kettle Test demonstrated a significant need
for assistance on multiple steps: He was baffled by the empty
kettle, had difficulty connecting the electrical cord, and only
prepared one cup of beverage (instead of two), using cold
water. The face validity of this assessment for the client and
his wife was useful in accepting the current need for assis-
tance on going home.
Conclusions, Limitations, and
Future Recommendations
The Kettle Test is a brief, cognitive–functional, top-down
measure that assesses actual performance on a familiar IADL
task with built-in complexity. The results of this study support
the reliability and validity of this measure in stroke rehabilita-
tion. The Kettle Test can be used in diverse settings; it is short,
easy to learn and administer, and provides meaningful infor-
mation pertaining to independent community living.
The study was limited by a relatively small sample size
that did not enable multiple regression analysis for examin-
ing the unique prediction of the Kettle Test to the explained
variance of functional outcomes beyond other conventional
measures commonly used in geriatric stroke rehabilitation.
In addition, the data regarding IADLs were collected by a
telephone interview with caregivers, which may not have
fully captured this area of functioning. Further studies should
include home visits to confirm and replicate the current
findings in the geriatric stroke population and in other diag-
nostic groups with cognitive disabilities. s
598 September/October 2009, Volume 63, Number 5
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