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.

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    • "Accordingly, performance based measures, such as the UCSD Performance-based Skills Assessment (UPSA) and its brief version, the UPSA-B (Mausbach et al., 2007), have been developed to evaluate the ability to perform daily activities, including counting money, making calls, and managing medical appointments (Mausbach et al., 2007; Patterson et al., 2001). Social functioning generally means functioning in the real world, such as independent living, interpersonal relationships, and work (Harvey et al., 2011; Leifker et al., 2011). Employment status has been considered as a particularly important functional outcome of individuals with schizophrenia (Nuechterlein et al., 2011). "
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    ABSTRACT: Although impaired social functioning, particularly poor employment status, is a cardinal feature of patients with schizophrenia and leads to decreased quality of life (QOL), few studies have addressed the relationship between these two clinical issues. The aim of this study was to determine whether employment status predicts subjective QOL and to evaluate a model in which functional capacity mediates the relationship between general cognitive performance and employment status. Ninety-three patients with schizophrenia were administered a comprehensive battery of cognitive tests, the UCSD Performance-based Skills Assessment-Brief version (UPSA-B), the Social Functioning Scale (SFS), and the Subjective Quality of Life Scale (SQLS). First, we evaluated a model for predicting the employment/occupation subscale score of the SFS using path analysis, and the model fitted well (χ2 (4)=3.6, p=0.46; CFI=1.0; RMSEA<0.001, with 90% CIs: 0–0.152). Employment status was predicted by negative symptoms and functional capacity, which was in turn predicted by general cognitive performance. Second, we added subjective QOL to this model. In a final path model, QOL was predicted by negative symptoms and employment status. This model also satisfied good fit criteria (χ2 (7)=10.3, p=0.17; CFI=0.987; RMSEA=0.072, with 90% CIs: 0–0.159). The UPSA-B and SFS scores were moderately correlated with most measures of cognitive performance. These results support the notion that better employment status enhances subjective QOL in patients with schizophrenia.
    Full-text · Article · Mar 2016 · Schizophrenia Research: Cognition
    • "Functional capacity. Two different performance-based FC measures were administered, both of which had previous evidence of high psychometric quality (Keefe et al., 2011;Harvey et al., 2011Harvey et al., , 2013). These measures are related to both cognitive test performance and everyday functional disability in patients with SCZ and BPD. "
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    ABSTRACT: Objective: Impairments in cognition and everyday functioning are common in schizophrenia and bipolar disorder (BPD). In this article, we present factor analyses of cognitive and functional capacity (FC) measures based on 2 studies of schizophrenia (SCZ) and bipolar I disorder (BPI) using similar methods. The overall goal of these analyses was to determine whether performance-based assessments should be examined individually, or aggregated on the basis of the correlational structure of the tests, as well as to evaluate the similarity of factor structures of SCZ and BPI. Method: Veterans Affairs Cooperative Studies Program Study #572 (Harvey et al., 2014) evaluated cognitive and FC measures among 5,414 BPI and 3,942 SCZ patients. A 2nd study evaluated similar neuropsychological (NP) and FC measures among 368 BPI and 436 SCZ patients. Principal components analysis, as well as exploratory and CFAs, were used to examine the data. Results: Analyses in both datasets suggested that NP and FC measures were explained by a single underlying factor in BPI and SCZ patients, both when analyzed separately or as in a combined sample. The factor structure in both studies was similar, with or without inclusion of FC measures; homogeneous loadings were observed for that single factor across cognitive and FC domains across the samples. Conclusion: The empirically derived factor model suggests that NP performance and FC are best explained as a single latent trait applicable to people with SCZ and BPD. This single measure may enhance the robustness of the analyses relating genomic data to performance-based phenotypes. (PsycINFO Database Record
    No preview · Article · Dec 2015 · Neuropsychology
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    • "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. "
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    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.
    Full-text · Article · Jul 2015
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