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ruff_figural_fluency_test [2019/07/22 09:31] – trynkeruff_figural_fluency_test [2025/02/05 13:49] (current) – external edit 127.0.0.1
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 ====== Ruff Figural Fluency Test ====== ====== Ruff Figural Fluency Test ======
-The RFFT is a measure of nonverbal fluency, a parameter of executive cognitive functioning. The RFFT consists of five parts, each presenting a different stimulus pattern of dots, in which the task is to draw as many unique designs as possible within a set time period. +The Ruff Figural Fluency Test (RFFT) ([[sections|section]]: [[mental health]]) was measured in all [[start|Lifelines]] participants aged 18 years and older during: 
 +  * [[1A Visit 1]] (n = ~91.000) 
 +  * [[3A Visit 1]]
  
-The RFFT was measured on paper in approximately 50% of adult and elderly participants that underwent [[1A Visit 1]], as the RFFT and [[Pulmonary function test|Spirometry]] were measured in alternate weeks.\\  +===== Background =====
-The RFFT will be measured digitally during [[3A Visit 1]]+
  
-===== Protocol RFFT on Paper =====+The RFFT is a measure of nonverbal fluency, a parameter of executive cognitive functioning ([[sections|section]]: [[mental health]]). The RFFT consists of five parts, each presenting a different stimulus pattern of dots, in which the task is to draw as many unique designs as possible within a set time period.  
 + 
 +The RFFT was measured on paper in adult and elderly [[start|Lifelines]] participants during [[1A Visit 1]]. Participants underwent either the RFFT or [[Pulmonary function test|Spirometry]], as these tests were performed in alternate weeks.\\  
 +In assessment [[2A Visit 1|2A]], executive cognitive functioning was measured with [[CogState]] instead of the RFFT.\\  
 +In assessment [[3A Visit 1|3A]], both the RFFT and CogState are measured with tablet and PC. 
 + 
 +==== Protocol RFFT on Paper ====
 During [[1A visit 1]], the RFFT was performed on paper using a red marker.\\ During [[1A visit 1]], the RFFT was performed on paper using a red marker.\\
 The RFFT contains five parts, each presented on a separate stimulus sheet containing 35 identical replications of a unique stimulus item (see figure).  The RFFT contains five parts, each presented on a separate stimulus sheet containing 35 identical replications of a unique stimulus item (see figure). 
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 As an index of planning efficiency, the error ratio can be calculated. The error ratio can be calculated by summing the number of unique designs and the number of perseverative errors across the five different parts, and then dividing the total number of perseverative errors by the total number of unique designs. The error ratio assesses the degree to which the respondent is able to minimize repetition while maximizing unique productions ((Ruff, R.M. (1996). Ruff Figural Fluency Test: Professional Manual. Lutz (United States): Psychological Assessment Resources, Inc.)). As an index of planning efficiency, the error ratio can be calculated. The error ratio can be calculated by summing the number of unique designs and the number of perseverative errors across the five different parts, and then dividing the total number of perseverative errors by the total number of unique designs. The error ratio assesses the degree to which the respondent is able to minimize repetition while maximizing unique productions ((Ruff, R.M. (1996). Ruff Figural Fluency Test: Professional Manual. Lutz (United States): Psychological Assessment Resources, Inc.)).
  
-===== Exclusion criteria =====+==== Exclusion criteria ====
 Exclusion criteria for performing the RFFT in Lifelines are: Exclusion criteria for performing the RFFT in Lifelines are:
   * The participant is not sufficiently able to hold a pencil.   * The participant is not sufficiently able to hold a pencil.
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   * The participant has participated in the PREVEND study less than a month prior to his/her visit to the LifeLines facility.   * The participant has participated in the PREVEND study less than a month prior to his/her visit to the LifeLines facility.
  
-===== Validity of the RFFT =====+==== Validity of the RFFT ====
 The RFFT is a measure of nonverbal fluency, an example of executive functioning, which is the ability to utilize one or more strategies that maximize production of responses and avoid response repetition. The RFFT was developed with the aim of providing clinical information regarding nonverbal capacity for fluid and divergent thinking, ability to flexibly shift cognitive set, planning strategies, and executive ability to coordinate this process. The RFFT is a measure of nonverbal fluency, an example of executive functioning, which is the ability to utilize one or more strategies that maximize production of responses and avoid response repetition. The RFFT was developed with the aim of providing clinical information regarding nonverbal capacity for fluid and divergent thinking, ability to flexibly shift cognitive set, planning strategies, and executive ability to coordinate this process.
  
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 The number of unique designs on the RFFT also correlated (r = 0.25) with a measure of general intelligence, and the RFFT error ratio correlated (r = 0.46) with a measure of nonverbal working memory. These results suggest that general intelligence and working memory may influence the performance on the RFFT. However, these RFFT indices did not correlate with any other (mostly verbal) measure of intelligence, working memory, or verbal learning, which supports convergent validity. The number of unique designs on the RFFT also correlated (r = 0.25) with a measure of general intelligence, and the RFFT error ratio correlated (r = 0.46) with a measure of nonverbal working memory. These results suggest that general intelligence and working memory may influence the performance on the RFFT. However, these RFFT indices did not correlate with any other (mostly verbal) measure of intelligence, working memory, or verbal learning, which supports convergent validity.
  
-===== Reliabiliy of the RFFT =====+==== Reliabiliy of the RFFT ====
 The study described in the previous section also examined inter-rater reliability of the RFFT ((Ross, T.P. (2014). The reliability and convergent and divergent validity of the Ruff Figural Fluency Test in healthy young adults. Archives of Clinical Neuropsychology, 29: 806-817)). The RFFT protocols of all participants (N = 102, as described earlier) were scored by six raters. The raters were undergraduate psychology majors, who had all received prior training in the administration and scoring of several neuropsychological tests. The study described in the previous section also examined inter-rater reliability of the RFFT ((Ross, T.P. (2014). The reliability and convergent and divergent validity of the Ruff Figural Fluency Test in healthy young adults. Archives of Clinical Neuropsychology, 29: 806-817)). The RFFT protocols of all participants (N = 102, as described earlier) were scored by six raters. The raters were undergraduate psychology majors, who had all received prior training in the administration and scoring of several neuropsychological tests.
 Intra-class correlation coefficients (ICC’s) were .98 for the number of unique designs, .94 for the number of perseverations, and .84 for the error ratio. These ICC values are generally considered excellent ((Cicchetti, D.V., Sparrow, S.S. (1981). Developing criteria for establishing the interrater reliability of specific items in a given inventory: applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86: 127-137)). Intra-class correlation coefficients (ICC’s) were .98 for the number of unique designs, .94 for the number of perseverations, and .84 for the error ratio. These ICC values are generally considered excellent ((Cicchetti, D.V., Sparrow, S.S. (1981). Developing criteria for establishing the interrater reliability of specific items in a given inventory: applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86: 127-137)).
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 The longitudinal performance on the RFFT was tested in a study in which 2515 participants (47% women; mean age = 53 yrs, +/- 10 yrs) from a longitudinal study in the Netherlands participated ((Van Eersel, M.E.A., Joosten, H., Koerts, J., Gansevoort, R.T., Slaets, J.P.J., Izaks, G.J. (2015). Longitudinal study of performance on the Ruff Figural Fluency Test in persons aged 35 years or older. PloS One, 10: e0121411)). Participants were recruited from the general population, and selection was based on their urinary albumin excretion. All participants completed the RFFT at three moments: the mean follow-up time between the first and second measurement was 2.8 (+/- 0.5) years; the mean follow-up time between the second and third measurement was 2.7 (+/- 0.5) years. The longitudinal performance on the RFFT was tested in a study in which 2515 participants (47% women; mean age = 53 yrs, +/- 10 yrs) from a longitudinal study in the Netherlands participated ((Van Eersel, M.E.A., Joosten, H., Koerts, J., Gansevoort, R.T., Slaets, J.P.J., Izaks, G.J. (2015). Longitudinal study of performance on the Ruff Figural Fluency Test in persons aged 35 years or older. PloS One, 10: e0121411)). Participants were recruited from the general population, and selection was based on their urinary albumin excretion. All participants completed the RFFT at three moments: the mean follow-up time between the first and second measurement was 2.8 (+/- 0.5) years; the mean follow-up time between the second and third measurement was 2.7 (+/- 0.5) years.
 Results of the study show that the mean number of unique designs increased significantly from 73 (+/-26) at baseline to 79 (+/- 27) at first follow-up, and 83 (+/- 26) at second follow-up overall (p < 0.001). Results of the study show that the mean number of unique designs increased significantly from 73 (+/-26) at baseline to 79 (+/- 27) at first follow-up, and 83 (+/- 26) at second follow-up overall (p < 0.001).
 +
 +==== RFFT in Lifelines ====
 +
 +The RFFT may be analyzed by humans or by computer software, yielding similar results ((Elderson, M.F., Pham, S., Eersel, M.E.A. van, Study, L.C., Wolffenbuttel, B.H.R., Kok, J., Gansevoort, R.T., Tucha, O., Klauw, M.M. van der, Slaets, J.P.J., et al. (2016). Agreement between Computerized and Human Assessment of Performance on the Ruff Figural Fluency Test. PLOS ONE 11, e0163286)).
 +
 +Lifelines uses both RFFT and [[CogState]] to assess executive cognitive functions. In how far do these two instruments measure the same thing? In a subset of 509 participants (mean age (SD): 53 years (14.6); range 18–87 years), correlations between the scores of the RFFT and the CogState were statistically significant (except for the correlation between the RFFT error ratio and the CogState One Back Task), hoewever they were weak to moderate (ranging from -0.39 to 0.28). Stratifying the analyses for age, education, and gender did not substantially affect our conclusions. Sensitivity analyses showed no substantial influence of level of computer experience or (physical) impairments ((Kuiper, J.S., Oude Voshaar, R.C., Verhoeven, F.E.A., Zuidema, S.U., and Smidt, N. (2017). Comparison of cognitive functioning as measured by the Ruff Figural Fluency Test and the CogState computerized battery within the LifeLines Cohort Study. BMC Psychol. 5, 15)).
  
 ==== Variables ==== ==== Variables ====
  
 +| **English**                      | **Code**                       | **Variable**              | **Assessment**                       | **Age**  |
 +| unique designs (part 1-5)        | rfft_unique_adu_m_1_01-05      | RFFT_UNIQUE (1-5)         | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 18+      |
 +| perseverative errors (part 1-5)  | rfft_errors_adu_m_1_01-05      | RFFT_PERSEVERATIVE (1-5)  | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 18+      |
 +| violations (part 1-5)            | rfft_violations_adu_m_1_01-05  | RFFT_VIOLATION (1-5)      | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 18+      |
 +| empty (part 1-5)                 | rfft_empty_adu_m_1_01-05       | RFFT_EMPTY (1-5)          | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 18+      |
  
  
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