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Lidwine B Mokkink,1,2 Iris Eekhout,1– 3 Maarten Boers,1,2 Cees PM van der Vleuten,4 Henrica CW de Vet1,2 1Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands; 2Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; 3Child Health, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands; 4Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the NetherlandsCorrespondence: Lidwine B Mokkink, Amsterdam UMC, AMC, J1B -225, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands, Tel +31 20 44 44474, Email w.mokkink@amsterdamumc.nlAbstract: Reliability and measurement error are measurement properties that quantify the influence of specific sources of variation, such as raters, type of machine, or time, on the score of the individual measurement. Several designs can be chosen to assess reliability and measurement error of a measurement. Differences in design are due to specific choices about which sources of variation are varied over the repeated measurements in stable patients, which potential sources of variation are kept stable (ie, restricted), and about whether or not the entire measurement instrument (or measurement protocol) was repeated or only part of it. We explain how these choices determine how intraclass correlation coefficients and standard errors of measurement formulas are built for different designs by using Venn diagrams. Strategies for improving the measurement are explained, and recommendations for reporting the essentials of these studies are described. We hope that this paper will facilitate the understanding and improve the design, analysis, and reporting of future studies on reliability and measurement error of measurements.Keywords: reliability, measurement error, classical test theory, generalizability theory, intraclass correlation coeffi

BACKGROUND: A frequent consequence of stroke is impaired mental function, which often affects the ability to perform activities and participate in life situation. In occupational therapy practice, performance-based instruments during activity and participation are often used. However, it is important to assess if the instruments used are valid, reliable and responsive.OBJECTIVE: The objective of this systematic review is to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in persons who have survived stroke.MATERIAL AND METHODS: Systematic database searches of PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be conducted. COSMIN Risk of Bias checklist will be used to evaluate methodological quality of the included articles. Measurement properties of the included studies will be rated against criteria for good measurement properties. The overall evidence of each measurement property per instrument is graded using a modified GRADE approach.RESULTS: Results will be presented in text and tables.CONCLUSIONS: Conclusion will be drawn up-on the overall evidence to give recommendations on the most suitable instrument.SIGNIFICANCE: It is expected that findings of the review will provide evidence to guide professionals in the selection of a performance-based instruments to measure mental function in practice and research.TRIAL REGISTRATION NUMBER: PROSPERO CRD42018086744.

BACKGROUND: Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice.OBJECTIVES: To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke.MATERIAL AND METHODS: We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach.RESULTS: Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test.CONCLUSIONS: Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose.SIGNIFICANCE: Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke.TRIAL REGISTRATION NUMBER: PROSPERO CRD42018086744.