Clinimetric properties of the CoCo-P: can we really distinguish cognitive functions?

Abstract

Background: The Cognitive Complaints – Participation (CoCo-P) identifies cognitive complaints, specifically memory, attention, and executive functioning, as well as fatigue during participation. The CoCo-P seemed appropriate for evaluation of occupational therapy in individuals with Post COVID-19 Condition (PCC), because it measures complaints experienced by individuals with PCC. For proper application and interpretation of the CoCo-P, it is necessary to know its clinimetric properties, and to explore whether cognitive complaints are associated to characteristics of individuals with PCC. Aim: To determine responsiveness and dimensionality of the CoCo-P in individuals with PCC. Secondary, to explore whether characteristics of individuals with PCC who received occupational therapy are associated to severity and change of cognitive complaints measured with the CoCo-P. Methods: This clinimetric study included individuals with PCC (20-73 years), who received occupational therapy in primary care in the Netherlands, and completed the CoCo-P before and after therapy. Paired samples t-tests were performed to assess changes before and after occupational therapy on the CoCo-P constructs. To determine construct responsiveness, six hypotheses were formulated in the protocol, and during the study Pearson correlation coefficients were computed to examine correlations between constructs of the CoCo-P and similar constructs of other outcome measures. Dimensionality was examined by performance of a Principal Component Analysis (PCA). To explore associations, univariate linear regression analyses were performed. P-values 0.05 were considered statistically significant. Results: 239 individuals with PCC were included. Significant improvements with small to moderate effect sizes were found after occupational therapy on the CoCo-P constructs. 83% of the hypotheses about responsiveness were confirmed. Nine factors were identified in the PCA. Fatigue measured before occupational therapy was significantly associated to severity of cognitive complaints. No significant associations were found between characteristics and change of cognitive complaints. Conclusion: This study demonstrates the CoCo-P is a responsive outcome measure in individuals with PCC. In contrast with the assumed cognitive functions, no underlying dimensions of the CoCo-P were found. As fatigue and cognition are associated, fatigue should be considered when observing cognitive functioning. Recommendations: Occupational therapists can use the CoCo-P for individuals with PCC to identify and evaluate cognitive complaints in daily life.