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In inpatient rehabilitation, measuring and tracking changes in cognitive and linguistic function over time presents a significant challenge, with no standardized method currently in use. To address this gap, researchers at Shirley Ryan AbilityLab developed a new, composite rehabilitation outcome measure called the Cognitive-Communication Ability Quotient. The new measure is made up of items from 10 existing standardized assessments administered by speech-language pathologists and offers the potential to detect changes in cognitive-communicative function that typically occur during an inpatient rehabilitation stay.
The new measure is described in Archives of Physical Medicine and Rehabilitation.
“Cognitive communication function is hugely impactful for both inpatient outcomes and longitudinal outcomes,” explains Julia Carpenter, MA, CCC-SLP, clinical practice leader for speech-language pathology at Shirley Ryan AbilityLab and first author of the paper.
Cognitive and communication impairments are common in patients admitted to inpatient rehabilitation facilities, especially among patients with stroke, traumatic brain injury and other neurologic conditions. These impairments are linked to poorer outcomes, including longer stays, higher disability levels at discharge, and reduced quality of life.
In the inpatient rehabilitation setting, mobility, self-care, and cognitive function skills were once measured using a multi-part instrument called the Functional Independence Measure (FIM). But the Centers for Medicare & Medicaid Services no longer requires inpatient rehabilitation facilities to use the FIM and now captures mobility and self-care outcomes with the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). Now, only general information related to cognition and communication is collected at admission only. This has resulted in a lack of ability to measure how cognition and communication change in response to therapy, or how these domains affect outcomes.
“The outcomes that CMS wants to track for mobility and self-care are important to patients and institutions, but they aren’t enough to capture the whole picture of the patient and what can be lasting changes to functional ability,” says Carpenter.
The researchers examined outcome measure data from more than 12,000 patients to determine which specific outcome items were important for comprehensively tracking patient progress. Next, they combined those items into a measure called the Cognitive-Communication Ability Quotient (Cog-Comm AQ), which provides a single score to evaluate progress. The items that comprise the Cog-Comm AQ depend on the patient’s communication or cognitive-communication diagnosis, making it more specific to the challenges they have.
“The Cognitive-Communication Ability Quotient provides clinicians with a tool that helps them track a patient’s progress, make treatment decisions and evaluate whether or not the patient is on target for certain outcomes,” says Allen Heinemann, PhD, director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and an author on the paper.
The Cog-Comm AQ joins the Self-Care Ability Quotient and the Mobility Ability Quotient, also developed by researchers and clinicians at Shirley Ryan AbilityLab. The Ability Quotient measures are given on an ongoing basis during each patient’s stay at Shirley Ryan AbilityLab.
“When you look at the values of the three Ability Quotients together, you have the entire picture of the patient,” says James Sliwa, DO, chief medical officer at Shirley Ryan AbilityLab and senior author on the paper. “You get a snapshot of how the patient is doing and you can predict outcomes for each of those domains, allowing the therapists to determine if the patient is on target compared to what is expected, and make treatment decisions based on that information.”
