Anna L. Kratz, Stacey L. Schepens, Susan L. Murphy; Effects of Cognitive Task Demands on Subsequent Symptoms and Activity in Adults With Symptomatic Osteoarthritis. Am J Occup Ther 2013;67(6):683–691. https://doi.org/10.5014/ajot.2013.008540
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© 2019 American Occupational Therapy Association
OBJECTIVE. Adults with osteoarthritis (OA) experience fatigue in daily life that is negatively related to physical activity; however, it is unclear how task demands affect fatigue and occupational performance. We examined effects of a cognitive task on subsequent symptoms and activity.
METHOD. Adults with knee or hip OA completed a standardized cognitive task during a lab visit. Objective physical activity and symptoms were tracked during two home-monitoring periods (i.e., 4-day period before and 5-day period after the lab visit). Multilevel modeling was used to compare pretask with posttask fatigue, pain, and activity levels.
RESULTS. Fatigue increased and pain decreased for 2 days after performing the lab task. The authors found no pretask to posttask changes in activity levels. At posttask, daily fatigue and activity patterns changed relative to baseline.
CONCLUSION. For adults with symptomatic OA, cognitive task demands may be an important contributor to fatigue and pain.
Are fatigue and pain higher and activity lower in a 5-day period after the cognitive task (i.e., are there carryover effects)?
Are there changes in daily patterns of fatigue, pain, and activity after the cognitive task?
Does the association between perceived fatigue and objective activity level (i.e., fatigability) change from baseline after the cognitive task?
Berg’s Card Sorting Test (Berg, 1948): Participants sorted cards with various shapes and colors into piles according to an unknown, ever-changing rule.
Digit span: Participants were presented with a series of digits and were instructed to recall the list by typing the numbers into a keyboard.
Four Choice Response Time (Wilkinson & Houghton, 1975): Participants were required to strike a key depending on the quadrant of the screen in which a visual stimulus appeared.
Implicit Association Test (Greenwald, McGhee, & Schwartz, 1998): Participants reported whether an image depicted something manufactured (e.g., airplane) or natural (e.g., flower).
Lexical Decision (Meyer & Schvaneveldt, 1971): Participants indicated whether text presented was a word or nonword.
PEBL Perceptual Vigilance Task (Wilkinson & Houghton, 1982): Participants pressed the space bar as quickly as possible in response to a series of visual stimuli, separated by a time delay of 2–12 s.
Spatial Cueing (Posner, 1976): Participants responded to an intermittent stimulus as fast as possible, indicating where they thought the next stimulus would appear given a probabilistic cue.
Stroop Task (Stroop, 1935): Participants responded to either the color or name of a stimulus word by pressing a key; the task alternated between series of color and name stimuli.
Tower of London (Shallice, 1982): Participants reproduced a pattern of colored disks by rearranging a prestacked pile in as few moves as possible.
Simple response time: Participants were asked to press a key as fast as they could on the appearance of an X for 5 min.
Cognitive task demands may play an important role in the physical activity patterns and experience of fatigue and pain in older adults with hip or knee OA.
A cognitively demanding task may result in sustained changes in daily activity patterns and reports of symptoms.
Occupational therapists should expand their focus beyond physical activity and consider incorporating measures of cognitive activity and cognitive fatigue into clinical assessment and treatment planning for clients for whom fatigue is problematic because cognitive effort and fatigue may be affecting their occupational performance and experience of symptoms.
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