Abstract
Abstract
Background
Performance-based functional capacity measures as treatment outcomes have evolved into the use of virtual reality (VR) assessments. These strategies assess functional skills with objectives that include realistic performance of everyday tasks. One such task, the Virtual Reality Functional Capacity Assessment Task (VRFCAT), has a series of objectives focused on meal preparation, travel and transit, shopping, and financial skills. There are 12 different objectives in the task, of which 5 are performed while home alone and the other 7 are performed outside of the participant’s virtual residence. The 5 at home tasks are solitary and the other 7 tasks have actual or implied social interactions. In this study, we examined the differential correlates of these solitary vs. socially relevant tasks. In so doing, we examined whether patients with more severe reduced emotional experience had differential challenges with the solitary vs. socially relevant tasks. We also examined whether performance on these two tasks was differentially associated with real-world functioning in domains of work, everyday activities, and social outcomes.
Methods
158 patients with schizophrenia performed the VRFCAT, were tested with the MATRICS consensus cognitive battery (MCCB), were rated with the PANSS, and received informant ratings of everyday functioning. Negative symptom domains of reduced emotional experience and reduced expression were derived from PANSS scores using previously determined criteria. Analyses examined the correlations between VRFCAT subdomains, the two domains of negative symptoms, MCCB performance and everyday functioning.
Results
Reduced emotional experience, but not reduced expression, was correlated with socially relevant VRFCAT tasks and with informant ratings of real-world social functioning. Further, performance on the VRFCAT socially relevant tasks, but not the VRFCAT solitary tasks, shared variance with informant ratings of work outcomes. Finally, MCCB performance was associated with both sets of VRFCAT demands, but the socially relevant tasks shared considerably more variance with MCCB scores than the solitary tasks.
Discussion
Patients with higher scores on reduced emotional experience were able to validly engage in socially relevant VR simulations, as evidenced by systematic correlations with outcome measures. However, these patients had poorer performance on these tasks than solitary functional tasks. The differential validity of solitary vs. socially relevant VR simulations was supported by differences in the correlates of these two VR subdomains, suggesting that short forms of an assessment could also be constructed with a special focus on the ability to perform simulated tasks away from home in the community.
