Is Rehabilitation Neuropsychology an Evidence-Based Practice? Insights From a Continuous Quality Improvement Perspective
Bibliographic record
Abstract
Neuropsychological assessment has traditionally been used to aid in the diagnosis of diseases of the central nervous system. Within a rehabilitation context however, neuropsychological assessment is playing an increasing role in delineating patients' cognitive strengths and weaknesses in order to address applied functional issues. The majority of related research in rehabilitation neuropsychology has been conducted with a young adult population, typically patients with acquired brain injuries. Rehabilitation of the elderly, however, is a quickly growing component of professional rehabilitation services. Given the current aging trend of the population, demand for such services is expected to parallel this growth pattern. At this time, relatively little is known empirically about geriatric rehabilitation programs and the role of neuropsychological assessment for geriatric rehabilitation applications. Within a context of Continuous Quality Improvement in clinical practice, the present study investigated patterns of neuropsychology referrals on a 36-bed geriatric rehabilitation unit, with frail and comorbidly complex patients. The prevalence of referrals made to neuropsychology and the specific referral questions posed are outlined, subsequent to tabulation over a 12-month period. The study further examined the test selection utilized and the extent to which recommendations made by neuropsychologists covaried with test results. Findings revealed that referrals involved 1 or more of 3 issues to be addressed. The most frequent question was related to the patient's competency to live independently. Results further revealed that varying recommendations regarding the level-of-care required were associated with significant differences on some test scores, but not others. Score patterns and recommendations made for each referral question are outlined. The discussion addresses the need for further research aimed at identifying predictors of instrumental daily living skills in seniors, and related functional cutoff scores on psychometric tests, in order to facilitate evidence-based practices in geriatric neuropsychology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.206 | 0.424 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.009 | 0.014 |
| Science and technology studies | 0.003 | 0.011 |
| Scholarly communication | 0.025 | 0.010 |
| Open science | 0.006 | 0.007 |
| Research integrity | 0.008 | 0.008 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".