Assessing instrumental activities of daily living (iADL) with a game-based assessment for individuals with schizophrenia

• Published in: Schizophrenia research 2020-09, Vol.223, p.166-172
• Main Authors: Lindenmayer, Jean-Pierre, Goldring, Abraham, Borne, Sophia, Khan, Anzalee, Keefe, Richard S.E., Insel, Beverly J., Thanju, Amod, Ljuri, Isidora, Foreman, Bronwen
• Format: Article
• Language: English
• Subjects: Assessment of discharge readiness; Chronic schizophrenia; Community functioning; Functional capacity assessment; Instrumental activities of daily living
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2020.07.001

The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an “applied” game-based assessment that uses a multi-level functional task to assess instrumental activities of daily living (iADL). This study examines the feasibility, convergent validity, and predictive ability of the VRFCAT in a sample of inpatients with chronic schizophrenia. Inpatients with a DSM-5 diagnosis of schizophrenia or schizoaffective disorder, completed the VRFCAT prior to discharge. The UPSA-B, SLOF, and PSP were administered, both at baseline and after four-weeks in the community. VRFCAT performance scores were compared to published data from the VRFCAT validation study. All 62 participants completed the VRFCAT. Compared to the performance of stable outpatients, participants performed 1.50 SDs below the VRFCAT mean adjusted total time (ATT) (Validation study: Mean T Score = 32.5, SD = 16.59) with more errors. The VRFCAT ATT T-score was significantly correlated with baseline UPSA-B total score (p = 0.005) and PSP Global score (p = 0.010). 34 participants completed the follow-up period (55%), and 28 were lost to follow-up. There were no statistically significant differences in VRFCAT scores between these two groups (all p > 0.29). The VRFCAT composite score at baseline was significantly associated with the UPSA-B total score (p = 0.010) and the PSP total score (p = 0.008) at four-weeks, as was the PSP Socially Useful Activities subscale score (p = 0.006). The VRFCAT is a valid measure of iADLs in inpatients with chronic schizophrenia. The VRFCAT predicted instrumental functioning four-weeks post-discharge. Future studies should examine other moderators of measures of functional capacity pre-discharge, predicting function later in the community.