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  2. Executive Function Performance Test

Executive Function Performance Test

Last Updated

Purpose

The EFPT examines the execution of four basic tasks that are essential for self-maintenance and independent living: simple cooking, telephone use, medication management, and bill payment.

Link to Instrument

Instrument Details

Acronym EFPT

Area of Assessment

Activities of Daily Living
Behavior
Cognition
Coordination
Executive Functioning
Functional Mobility
Quality of Life

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis
  • Stroke Recovery

Populations

Stroke
Multiple Sclerosis
Mental Health
Brain Injury

Key Descriptions

  • The EFPT is a top-down performance assessment designed to examine cognitive integration and functioning.
  • The EFPT serves three purposes:
    1) To determine which executive functions are impacting function
    2) To determine an individual’s capacity for independent functioning
    3) To determine the amount of assistance necessary for task completion
  • The assessments requires participants to complete the following tasks (in order):
    1) Hand Washing - only use this task if the person has severe cognitive impairment and you want to see if they can follow directions. If they cannot, do not proceed.
    2) Oatmeal Preparation
    3) Telephone
    4) Taking Medication
    5) Paying Bills
  • Instructions: Please refer to the training manual available at the Washington University at St. Louis link above for details.

Number of Items

20

Equipment Required

  • Please see the training manual available on the Washington University at St. Louis website link above at "Instrument Details".

Time to Administer

30-45 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Updated by Bridget Hahn, OTD, OTR/L; Michelle Sivak, OTS, Megan Westendorf, OTS, Jessi Zuba, OTS; Rush University, 2019.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Cognition

Considerations

  • The EFPT should only be administered once per patient secondary to a learning effect that may confound the results of a second assessment.
  • A Korean version of the EFPT, the EFPT-K,  was created in order to be more culturally appropriate (Kim, H., Lee, Y., Jo, E., Lee, E., 2017).
  • The EFPT has also been translated into Swedish. (Cederfeldt, M., Carlsson, G., Dahlin–Ivanoff, S., & Gosman–Hedstrom, G., 2015).

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Stroke

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Cut-Off Scores

Not needed, each person is observed to be independent or need various levels of help.

Normative Data

Chronic Stroke: (Baum et al 2008; n = 73; mean age = 64 (14) years; Barthel Index scores of ≥ 90, Modified Rankin Index scores of ≥ 2; > 6 months post stroke onset)

EFPT Normative Data:

 

 

 

 

Control

Mild Stroke

Moderate Stroke

 

 (N = 22)

(N = 59)

(N = 14)

NIHSS

--

2.00 (1.46)

10.64 (2.99)

EFPT total score

1.51 (2.27)

7.87 (8.42)

24.21 (5.39)

Cooking**

1.23 (2.81)

2.98 (4.90)

5.57 (7.27)

Using Telephone***

0.09 (0.29)

1.83 (2.27)

6.57 (9.00)

Medications***

0.42 (1.40)

0.92 (1.34)

5.50 (8.99)

Paying Bills**

0.23 (0.69)

1.92 (2.19)

4.43 (6.94)

Initiation

0.00 (0.00)

0.83 (1.67)

3.43 (7.14)

Organization***

0.13 (0.34)

1.77 (2.22)

6.21 (8.39)

Sequencing***

0.58 (1.05)

3.08 (3.20)

6.93 (7.87)

Safety & Judgment**

0.14 (0.47)

1.32 (2.19)

4.07 (6.67)

Completion**

0.11 (0.49)

0.88 (1.90)

3.57 (7.08)

**p < .005. ***p < .0001.

 

 

 

Interrater/Intrarater Reliability

Chronic Stroke: (Baum et al, 2008; 3 trained raters rating 10 participants (5 = mild stroke, 5 = healthy controls)

  • Excellent Interrater reliability for the overall EFPT (ICC = 0.91)
  • Excellent Interrater reliability for EFPT sub-scales
    • Cooking (ICC = 0.94)
    • Paying Bills (ICC = 0.89)
    • Medication (ICC = 0.87)
    • Using Phone (ICC = 0.79)

Internal Consistency

Chronic Stroke: (Baum et al, 2008)

  • Excellent: EFPT total sample scores (Cronbach's alpha = 0.94)
  • Excellent: EFPT Cooking subtest (Cronbach's alpha = 0.86)
  • Adequate: EFPT Paying Bills subtest (Cronbach's alpha = 0.78)
  • Excellent: EFPT Managing Medication subtest (Cronbach's alpha = 0.88)
  • Adequate: EFPT Telephone subtest (Cronbach's alpha = 0.77)

Criterion Validity (Predictive/Concurrent)

Chronic Stroke: (Baum et al, 2008)

 

Concurrent Validity:

 

 

Variable

EFPT Total Score (r)

p <

Digits forward

- 0.26

0.08

Digits backward

- 0.49*

 .0001

Trails A

  0.21

0.09

Trails B

  0.39*

0.001

Story Recall (Wechsler Memory Scale)

- 0.59*

0.0001

Animal Fluency

- 0.47*

0.0001

Short Blessed

  0.39*

0.001

FIM total

- 0.40*

0.001

FAM total

- 0.68**

0.0001

FIM = Functional Independence Measure

FAM = Functional Assessment

*adequate correlation; **excellent correlation

 

 

 

Concurrent Validity:

Acute Mild Stroke (Cederfeldt, M., Widell, Y., Andersson, E. E., Dahlin-Ivanoff, S., & Gosman-Hedstrom, G., 2011; n = 23, mean age = 72 (10.9) years, mean time since onset of stroke = 4 days)

  • Adequate concurrent validity of the four different tasks of the EFPT at predicting the Assessment of Motor and Process Skills (AMPS) process skills (r=0.54-0.60)
  • Excellent concurrent validity of the total sum of all of the tasks of the EFPT and the Assessment of Motor and Process Skills (AMPS) process skills (r=0.61)

Construct Validity

Acute Stroke: (Wolf et al, 2010; n = 20; mean age = 58.8 (13.2) years; mean NIHSS score = 1.5 (2.4); recruited < 1 week post stroke)

 

EFPT & other measures of Executive Function

 

 

 

Measure

Strength

r

p

DKEFS Sorting adequate

Adequate

-0.511

0.030

DKEFS Verbal Fluency

Adequate

-0.474

0.035

DKEFS Color-Word Interference adequate

Adequate

-0.566

0.011

Short Blessed Test

Adequate

0.548

0.012

DKEFS = Delis-Kaplan Executive Function System

 

 

 

Chronic Stroke: (Baum et al, 2008)

Measure

Control

Mild Stroke

 Moderate Stroke

Trails A (seconds)

31.0 (10.8)

71.9 (63.6)

188.3 (114.5)

Trails B (seconds)***

73.8 (29.4)

184.1 (98.5)

279.6 (64.7)

Digits Forward**

9.2 (2.6)

6.5 (1.3)

6.1 (2.3)

Digits Backward**

5.3 (1.6)

3.5 (1.7)

3.1 (1.6)

Story Recall*

30.6 (6.9)

24.8 (8.1)

18.0 (9.1)

Animal Fluency***

22.6 (4.9)

14.8 (5.5)

8.8 (5.1)

*p  < .05. **p < .01. ***p < .001

 

 

 

note: Values are one-way analyses of variance comparing scores across groups.

 

 

 

Trails A & B from the Trailmaking Test (Reitan & Wolfson, 1995)
Digit Span Forward and Backward Test from the Wechsler Memory Scale–Revised (Wechsler, 1987)
Story Recall from the Logical Memory Total Recall Test (Wechsler, 1987)
Animal Fluency from the Animal Naming test (Barr & Brandt, 1996)

 

 

 
 
 

Content Validity

The Executive Function Performance Task was developed at the Program in Occupational Therapy at Washington University Medical School based on Carolyn Baum's Kitchen Task Assessment (KTA) measure of functional ability.

Multiple Sclerosis

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Cut-Off Scores

Not needed, each person is observed to be independent or need various levels of help.

Normative Data

Multiple Sclerosis: (Kalmar, 2008; n = 74 MS & 35 healthy comparison; MS mean age = 44.69 (8.75) years)

EFPT Performance:

 

 

 

 

Variable

MS-with

MS-without

Healthy

p

EFPT total score

9.40 (8.01)

6.42 (4.81)

4.35 (3.42)

<.05

Handwashing

0.00 (0.00)

0.11 (0.49)

0.00 (0.00)

ns

Cooking oatmeal

2.78 (3.29) 1.84

1.84 (2.00)

1.74 (2.02)

ns

Telephone usage

0.83 (1.40)

0.80 (1.41)

0.32 (1.14)

ns

Medication management

0.65 (1.15)

0.22 (.52)

0.06 (0.24)

<.001

Bill payment

2.00 (2.35)

0.86 (1.56)

0.27 (0.52)

.001

Cooking casserole

3.45 (3.47)

2.80 (2.66)

2.62 (2.19)

ns

ms-with = with cognitive deficits

 

 

 

 

ms-without = without cognitive deficits

 

 

 

 

 

Multiple Sclerosis (Voelbel, Goverover, Gaudino, Moore, Ghiaravalloti, & DeLuca, 2011; n = 68, mean age = 44.49 (9.26) years; mean time since onset MS = 13.09 (9.51))

 

Test

MS

EFPT tasks

Simple cooking

2.16 (2.33)

Telephone use

0.82 (1.55)

Complex cooking

2.96 (2.87)

Medications

0.18 (0.54)

Bill payment

1.12 (1.74)

EFPT components

Initiation

0.074 (0.26)

Organization

0.76 (1.24)

Sequencing

3.71 (3.52)

Completion

0.32 (0.78)

Judgement and safety

2.37 (2.42)

Total score

7.24 (6.20)

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis  (Voelbel et al., 2011)

  • Adequate criterion validity of the EFPT for the bill payment task at predicting TOL-DX total move scores (r = .379).

Construct Validity

Multiple Sclerosis: (Goverover et al, 2009; n = 47; men age = 44.8 (8.2) years)

 

Self-awareness of Functional Status With the EFPT

 

 

Variable

r

Strength

FBP SA

.33*

adequate

BDI

-.08

poor

FAMS

.002

poor

* p < .05

 

 

EFPT = Executive Function Performance Test
FBP SA = self awareness of functional status
BDI = Beck Depression Inventory
FAMS = Functional Assessment of Multiple Sclerosis

 

 

Content Validity

The Executive Function Performance Task was developed at the Program in Occupational Therapy at Washington University Medical School based on Carolyn Baum's Kitchen Task Assessment (KTA) measure of functional ability.

Responsiveness

Multiple Sclerosis: (Voelbel et al., 2011)

  • Statistically significant, lower EFPT scores were found for participants with MS compared to healthy individuals (F1,103 = 8.69, p = .004).

Mental Health

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Standard Error of Measurement (SEM)

Acute Schizophrenia (calculated from Katz, Tedmor, Felzen, & Hartman-Maeir, 2007; n = 30; mean age = 34.13(11.24) years)

  • SEM for entire group (n=30): 1.92

Chronic Schizophrenia (calculated from Katz et al., 2007; n = 31; mean age = 42.26(10.88) years)

  • SEM for entire group (n=31): 1.35

Minimal Detectable Change (MDC)

Acute Schizophrenia (calculated from Katz et al., 2007)

  • MDC for entire group (n=30): 5.32

Chronic Schizophrenia (calculated from Katz et al., 2007)

  • MDC for entire group (n=31): 3.74

Normative Data

Acute and Chronic Schizophrenia (Katz et al., 2007)

 

Test

Acute Schizophrenia

Chronic Schizophrenia

EFPT tasks

Simple cooking

6.03 (6.93)

18.13 (3.52)

Telephone use

4.83 (6.87)

9.03 (7.02)

Medication management

0.73 (7.16)

17.87 (5.41)

Bill payment

7.37 (7.16)

17.87 (5.41)

EFPT components

Initiation

0.97 (1.92)

1.81 (2.59)

Planning

4.67 (4.58)

8.00 (3.80)

Shifting

5.20 (4.34)

9.93 (3.13)

Error detection

2.63 (3.86)

11.68 (2.53)

Error correction

3.00 (3.92)

9.64 (4.09)

Safety

3.20 (3.53)

11.19 (3.52)

Completion

0.57 (1.48)

3.22 (2.12)

Total score

19.77 (20.37)

55.39 (17.30)

Internal Consistency

Acute and Chronic Schizophrenia (Katz et al., 2007)

  • Excellent Cronbach’s alpha = .88
  • Pearson correlation coefficients between executive function component and total score: initiation = .71, planning = .81, transfer between stages = .87, error detection = .80, error correction = .88, completion = .53, safe performance = .82

Criterion Validity (Predictive/Concurrent)

Acute Schizophrenia (Katz et al., 2007)

  • Excellent criterion validity of the EFPT (r = .669, p < .000) at predicting BADS profile scores (r = .433, p = .017).

Chronic Schizophrenia (Katz et al., 2007)

  • Excellent criterion validity of the EFPT (r = .764, p < .000) at predicting BADS profile scores (r = .719, p < .000).

Construct Validity

Acute versus Chronic Schizophrenia (Katz et al., 2007)

  • A significant overall group effect was found between the acute and chronic schizophrenia groups (F = 12.57, p < .000).

Responsiveness

Acute and Chronic Schizophrenia (Katz et al., 2007)

  • Statistically significant differences for all tasks except the EFPT initiation component and telephone task were found among all variables between the two groups (p = .045, .000).

Brain Injury

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Normative Data

Mild/Moderate TBI (Baum et al., 2017; n=83; mean age = 44.2 (2.05) years; mean time post injury = 3 years)

Severe TBI (Baum et al., 2017; n=99; mean age = 34.9 (1.44) years; mean time post injury = 5 years)

 

Test

Mild/Moderate TBI

Severe TBI

EFPT tasks

Simple cooking

1.17 (1.73)

2.20 (1.69)

Telephone use

0.81 (1.82)

1.61 (1.89)

Medication management

1.08 (1.37)

1.39 (1.39)

Bill payment

2.00 (1.91)

2.27 (1.99)

EFPT components

Initiation

0.34 (1.28)

0.36 (1.29)

Organization

0.35 (1.09)

0.89 (1.09)

Sequencing

2.54 (2.37)

3.54 (2.39)

Safety and Judgement

1.35 (1.64)

1.88 (1.69)

Completion

0.16 (0.73)

0.36 (0.80)

Total score

4.74 (4.65)

7.03 (4.78)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Severe TBI (Baum et al., 2017)

  • Adequate predictive validity of total task score independence with beta of −0.53 (p < .006).

Construct Validity

Construct validity:

Entire TBI group (Baum et al., 2017; n=182)

  • Adequate construct validity of the EFPT and the Total Composite Score of the NIH Toolbox Cognitive Function Battery (r=-.479).
  • Adequate construct validity between the EFPT and the NIH Toolbox Cognitive Function Battery Crystallized Tests (r = −.479).
  • Adequate construct validity of the EFPT and the Total Composite Score of the NIH Toolbox Cognitive Function Battery Fluid Tests (r = −.420).

 

Discriminant validity:

Entire TBI group (Baum et al., 2017)

  • The total task score significantly discriminated the control, mild/moderate TBI, and severe TBI groups (p < .001).
  • A significant and moderate group effect was found between the control and mild/moderate TBI groups (Cohen’s d = -0.562, p < .01).
  • A significant and large group effect was found between the control and severe TBI groups (Cohen’s d = -1.041, p < .01).
  • A significant and moderate group effect was found between the mild/moderate TBI and severe TBI groups (Cohen’s d = -0.486, p < .01).

Responsiveness

Mild/Moderate and Severe TBI: (Baum et al., 2017)

  • Statistically significant differences between mild/moderate and severe TBI were found for total EFPT scores, cooking, telephone use, organization, and sequencing (p < .01, .01, .05, .01, .05 respectively).
  • Statistically significant differences between mild/moderate TBI and control group were found for total EFPT scores, medications, sequencing, and safety and judgement (p < .01, .01, .05, .01 respectively).
  • Statistically significant differences between severe TBI and control group were found for total EFPT scores, cooking, telephone use, medications, paying bills, organization, sequencing, and safety and judgement (p < .01, .01, .01, .01, .05, .01, .01, .01 respectively).

Bibliography

Baum, C., Connor, L., et al. (2008). "Reliability, validity, and clinical utility of the executive function performance test: A measure of executive function in a sample of people with stroke." The American Journal of Occupational Therapy 62(4): 446. Find it on PubMed

Baum, C., Morrison, T., et al. (2007). "Executive Function Performance Test: Test protocol booklet." Unpublished program in Occupational Therapy Washington University School of Medicine, St. Louis, MO.

Baum, C. M., Wolf, T. J., Wong, A. W. K., Chen, C. H., Walker, K., Young, A. C., Carlozzi, N. E., Tulsky, D. S., Heaton, R. K., & Heinemann, A. W. (2017). Validation and clinical utility of the executive function performance test in persons with traumatic brain injury. Neuropsychological Rehabilitation, 27(5), 603–617.Find on PubMed

Cederfeldt, M., Widell, Y., Andersson, E. E., Dahlin-Ivanoff, S., & Gosman-Hedstrom, G. (2011). Concurrent validity of the executive function performance test in people with mild stroke. British Journal of Occupational Therapy, 74(9), 443. Retrieved from http://lup.lub.lu.se/record/2179988

Goverover, Y., Chiaravalloti, N., et al. (2009). "The relationship among performance of instrumental activities of daily living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis." Rehabil Psychol 54(1): 60-68. Find it on PubMed

Kalmar, J. H., Gaudino, E. A., et al. (2008). "The relationship between cognitive deficits and everyday functional activities in multiple sclerosis." Neuropsychology 22(4): 442-449. Find it on PubMed

Katz, N., Tadmor, I., Felzen, B., & Hartman-Maeir, A. (2007). Validity of the Executive Function Performance Test in individuals with schizophrenia. OTJR: Occupation, Participation and Health, 27(2), 44–51.    

Kim, H., Lee, Y., Jo, E., Lee, E. (2017). Reliability and validity of culturally adapted executive function performance test for koreans with stroke. Journal of Stroke and Cerebrovascular Diseases, 26(5). Find on PubMed

Voelbel, G. T., Goverover, Y., Gaudino, E. A., Moore, N. B., Ghiaravalloti, N., & DeLuca, J. (2011). The relationship between neurocognitive behavior of executive functions and the EFPT in individuals with multiple sclerosis. OTJR: Occupation, Participation and Health, 31(Suppl 1), S30–S37. Find on PubMed.

Wolf, T., Stift, S., et al. (2010). "Feasibility of using the EFPT to detect executive function deficits at the acute stage of stroke." Work: A Journal of Prevention, Assessment and Rehabilitation 36(4): 405-412. Find it on PubMed

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