More than meets the eye: how examiner training affects the reliability of the MacNeill-Lichtenberg decision tree in geriatric rehabilitation patients.

OBJECTIVE To examine the effect of examiner training on the test-retest reliability of the MacNeill-Lichtenberg Decision Tree (MLDT), a tool for guiding clinicians' decision making for referrals for mental health problems. DESIGN Correlational analyses and chi-squares were used to examine the influence of demographic variables on MLDT performance and the test-retest reliability of its cognitive and affective components. SETTING Rehabilitation unit of a large, freestanding, urban hospital. PARTICIPANTS In study 1, 39 older, medical rehabilitation patients consecutively referred to the neuropsychology service. In study 2, 57 older, consecutively admitted medical rehabilitation patients. INTERVENTIONS In study 1, patients underwent testing with the MLDT by a novice examiner. In study 2, patients were tested by trained examiners. Both sets of results were compared with those obtained by experienced examiners. MAIN OUTCOME MEASURES The temporal stability of participants' performance on the cognitive and affective components of the MLDT was compared between the 2 studies. RESULTS Training was associated with high test-retest reliability on both the cognitive and affective components. A lack of training was associated with reduced reliability in depression screening. CONCLUSION These findings support the use of the MLDT as a mental health triage tool for older adults in inpatient medical settings. Its use is dependent on training and accurate administration.

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