Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lau E(1), Lee PY(1), Lo MT(1)
Affiliation :
(1) Occupational Therapy Department, Castle Peak Hospital
Introduction :
Executive function (EF) encompasses a set of higher-order cognitive processes that enable individuals to self-regulate and engage in goal-directed behaviors, being crucial for coping with the ever-changing demands of the world. Unfortunately, EF impairments are prevalent in various mental disorders. Traditional "bottom-up" cognitive rehabilitation approach may not effectively impact these higher cognitive processes to yield the necessary improvements for real-world functioning. This project aims to develop an evidence-based "top-down" MCEF program for EF and functional improvements.
Objectives :
To develop the MCEF Program and to evaluate its preliminary efficacy through a pilot study.
Methodology :
Following a three-phase stage model (conceptualization, standardization, and evaluation), we conducted a literature review to consolidate evidence on the concept of EF and effective intervention strategies. Subsequently, we established a theoretical framework to guide the standardization of the program's content.
The 10-session program included drills and strategies learning to enhance metacognitive and EF skills. In-class activities were designed to promote participants' metacognitive awareness and self-regulation of their EF performance. Participants were encouraged to apply these skills in various real-life contexts through scenario discussions and take-home assignments. Computer-assisted cognitive training was also used for drill and practice.
Two pilot groups were conducted at the outpatient clinic of Castle Peak Hospital from March to November 2023. Ten subjects with mental disorders were recruited. Baseline and post-intervention assessments were conducted using performance-based EF measures and self-rated EF functioning in everyday environment including Stroop Color and Word Test (SCWT), Color Trial Test (CTT), Tower of London (TOL), and Behavior Rating Inventory of Executive Function for Adults (BRIEF-A).
Result & Outcome :
All the ten subjects completed the program and attained an average score of 5.2 in a 6-point Likert scale on the satisfaction level, supporting the feasibility and acceptability of the intervention. Significant improvements were observed in measures of inhibition, working memory, and planning (Cohen's d ranged from .74 to .97, p < .05), reaching medium to large effect sizes. Improvements in planning and task monitoring (Cohen's d = .73 to 1.05, p < .05) in everyday environment were also reported based on self-rating of the BRIEF-A. These preliminary findings support the potential benefit of this new “top-down” approach. Further randomized controlled trials are necessary to confirm its treatment effects.
