2. Before Starting a QbTest
The objective of this chapter is to make you, as a test leader, feel comfortable in preparing for QbTest administration by knowing:
- How to prepare before the patient enters the test room
- How to adjust the equipment to the patient
- How to standardize the test instructions
2.1 Set up and preparations
In this chapter you will learn how to prepare to administer a QbTest before the patient arrives.
Before inviting the patient to the test room.
We recommend that you prepare as much as possible before you invite the patient into the test room. We suggest that you carry out the following 4 steps:
- Start the QbTest software and choose the appropriate test version
- Enter patient-related data into the software
- Choose and prepare the appropriate seating arrangement
- Ensure that the test room environment is optimal for testing
Step 1: Start software and choose test version
Choose the appropriate test version depending on your patient’s age – either ‘QbTest 6-12’ or ‘QbTest 12-60’ by clicking on the corresponding icon under the ‘Start Test’ tab.
For children aged 12 you may choose either version as there is an age and sex matched norm group for both test versions. Generally, we advise testing 12-year-old children on the QbTest (12-60) version, as most are capable of understanding and completing the slightly more cognitively loaded task of QbTest (12-60) This way, if you opt to retest as they get older, their tests can be compared as they would have completed the same version of the test.
However, this is a clinical decision so if your information indicates that the patient does not understand the task or cannot execute it appropriately, you may want to revert to the QbTest 6-12 version. Do not, under any circumstance, administer a QbTest if the patient does not understand what is expected of him.
Step 2: Enter patient related data into the software
The next step is to enter any relevant patient information in a series of easy to follow dialogue boxes. Basic demographics such as age and biological sex are the most important data to enter since this will allow the QbTest Database to make an accurate comparison with the age and sex matched norm group.
If the patient is being tested on medication, we recommend that you stop at this screen and enter the rest of the information once the patient has joined you. It is essential that you confirm the exact medication, dose and timing of administration with the patient or parent, before continuing as inaccuracies in this information could lead to a misleading interpretation of the report.
At any time during this process, you may be prompted for your individual username and password that was given to you by your Clinical Advisor at the installation training or set up for you at another time. You will enter that here when prompted. Please remember your username begins with your clinic ID followed by your first name and then initially the random password given to you but you can change that going forward to be something more memorable. It is important not to share your username or password with other staff at your clinic.
Only staff who have completed a Qbtech approved training course can administer a QbTest, and they will all have been set up with their own account. Patient tests are linked to the user ID used during test administration as a quality control measure.
Please view the video below to ensure you understand entering data into the software.
Step 3: Choose appropriate seating arrangement
Next you need to choose the appropriate seating arrangement depending on which test version you are administering. This is very important for the standardization of the test situation.
Patients performing QbTest (6-12) should be seated on a hard stool without a backrest or armrests.
Patients performing (QbTest 12-60) should be seated on a sturdy, firm chair with a backrest but no armrests.
Step 4: Optimize the testing environment
Finally, ensure that any windows in the room have blinds or curtains drawn, completely blocking out sunlight, to eliminate possible reflections. Also make sure that the area around the QbTest computer is free from distractions. There should be no posters, paintings, mirrors or clocks on the wall and no clutter, toys, etc. within the patient’s view.
Given you will be remaining in the room to observe the child during QbTest, you will need to ensure that you have a copy of the “Behavioral Observation” form to help you record your observations. You will also need a stopwatch or phone (on silent/flight mode) to keep accurate track of time.
*Insert pictures of crossed out posters, paintings, mirrors, clocks, toys.
*Insert picture of new behavioral observation sheet.
You are now ready to welcome the patient into the test room!
- Preparation before the patient enters can be done in four steps:
Choose the appropriate test version depending on your patient’s age
- Enter patient and diagnostic related data into the QbTest Software
- Choose the appropriate seating arrangement
- Optimize the test room environment according to QbTest standards
2.2 Adjust the equipment to the patient
In this chapter you will learn how to correctly adjust the QbTest equipment to your patient.
After you have set up and prepared the room for testing, invite the patient into the test room.
Please ensure that:
- The patient’s mobile phone is switched off or left with parents outside the room. If the administrator is using his/her phone for time keeping, it is particularly important that it is on silent, with no vibrating or ringing options as this can be distracting to the patient during testing.
- The patient removes any coats/jackets/reflective clothing/jewelry
- The patient has had something to drink/has used the restroom before starting (this may be especially important for younger children since it is not possible to take a break during the QbTest)
- The patient understands he cannot eat/drink/leave during the test
- The patient is not chewing gum
- The patient does not have any toys, fidget gadgets etc with him in the QbTest room.
Ask the patient to take a seat in front of the screen.
Presence of guardians/parents
Parents and guardians are not allowed in the room during QbTest. It is advised to warn parents and patients of this well in advance, prior to their appointment (i.e. in the appointment letter/email/phone call) so they are aware ahead of time that they cannot be present in the room.
Collect patient consent
In order to start a QbTest administration you need to collect patient consent to store the test results on the Qbtech server. Our recommendation is that you have discussed this with the patient, or the patient’s parent or guardian, before you start preparing the patient for the QbTest. Consent forms are usually sent out in advance and so the presence of the parent and patient at the QbTest appointment, indicates informed consent. In order to start the test the ‘I have understood and approve’ box needs to be checked.
Inform the patient of the purpose of the test
Inform the patient about the nature and purpose of QbTest so that he or she understands what is expected. Try to refer to the test as a computer task rather than a computer/video game in order to set the correct expectations. To introduce the QbTest you could say something like:
“This is a computer-based task that is used to measure your activity level ability and your ability to pay attention over time. The test will continue for 20 (15) minutes. Throughout this task, you will be wearing a headband with a marker. The camera is designed to trace the marker but will not film you at any point during the task. Do you have any questions?”
Adjust the seating arrangement
*Insert original picture of patient sitting from QbUser with him leaning on table crossed out and a new one showing distance from desk
Make sure that the patient is sitting comfortably in front of the computer where he can see the screen, but is not close to the table or the keyboard. Please do NOT instruct the patient that he should try to sit as still as possible during the testing. Likewise, do not instruct the patient to sit up straighter or slouch down in order to facilitate getting the reflector marker into the camera tracking area. Adjust the camera to the patient, not the patient to the camera.
The stool or chair should be placed so that the patient is not restricted in his or her movement by surrounding walls or the table. The patient should not be sitting so close to the table that he or she can lean on the table or rest their hands on the table. If the patient’s feet cannot touch the floor, provide a stable foot rest. This may be the case especially for younger children who might otherwise dangle their feet which may cause an overestimation of their activity scores.
Adjust headband with marker and the camera
Advise the patient that you are going to put the headband around his head with the marker in the middle of his forehead. If needed, help/allow the patient to adjust it afterward to ensure it feels comfortable and secure and is not blocking his vision. Make sure that the reflector marker on the patient’s head is 1 meter (3.28 feet) away from the camera, using the green measuring tape attached to the camera.
Then adjust the camera height using the levers so that the marker is clearly visible just above the cross in the center of the square visible on the computer screen. If the marker is sitting too low on the screen, adjust the camera by moving the camera lower. If the marker is too high on the screen, raise the camera higher. Again, do not allow/instruct the patient to reposition themselves in an attempt to achieve this. As you adjust the height you will also need to re-check the distance from the patient’s head to the camera, and make sure you maintain the correct 1-meter distance. This is important as the activity will be over-reported if the test taker is too close to the camera, and under-reported if they are too far away.
The camera should have a digital number ‘1’ showing below its lens, indicating that it is picking up the reflective marker and no other reflections. If the camera shows a ‘0’ it is not picking up the reflective marker, and if the number is higher than 1, there are additional reflections.
Then show the patient how to hold the response button. It should be held in whichever hand is most comfortable (usually their dominant hand) so they can press the button with their thumb. During testing, you may want to note if the patient switches hands or presses the responder button in any way different than with their dominant hand and thumb. Ask the patient to click the button to ensure that it has a connection to the USB-port.
If everything is set up correctly you should have 3 green dots on the screen indicating that the camera and response button are working properly and that the camera is only picking up the reflective marker and no other sources of reflections. You are now ready to give more detailed instructions to the patient.
Please see the video below to ensure you have set the patient up correctly.
- First ask the patient to:
- take off jacket or coat
- turn off mobile phone
- remove or cover reflecting jewelry or clothing
- Check if the patient needs the bathroom – once started it will not be possible to take a break
- Seat patient according to correct standardized seating arrangement
- Introduce test to patient
- Ensure the consent form box is checked
- Make sure the patient’s feet are firmly resting on the floor; if not, provide a footrest
- Put the headband on the patient’s head and allow him to adjust if needed
- Adjust the camera so the marker is clearly visible, slightly above the center of the cross on the screen
- Show the patient how to hold response button and ask him to demonstrate pressing it
- Check that three green dots are showing in the software indicating that camera and response button are working correctly and that only 1 reflection from the marker is picked up by the camera.
2.3 Instructions to the patient
In this chapter you will learn how to instruct your patient prior to a QbTest.
To ensure the validity and reliability of the test results, it is important that you follow these standardized instructions even if the patient has been tested before.
The instructions you will give to the patient basically consist of 4 steps:
Step 1: Show the instruction video
When the patient is seated comfortably in front of the QbTest computer with the software up and running, it is time to show the instruction video and give a more detailed introduction to the test. Start the video.
Please see the two instructional videos below;
*Insert the two videos (6-12) and (12-60) in here
Step 2: Stimulus cards
*Insert the two sides of the stimulus card here
When the video has finished ask the patient to explain his understanding of the test using the “stimulus card”. If the patient makes any errors, explain the task again using the same card.
Em¬phasize that he should try to respond as quickly and accurately as possible, but he is not expected to respond before the target disappears. This is especially important when testing younger children who might believe this is required if not instructed otherwise. A mistake occasionally made by patients performing the QbTest (12-60) is that they only identify identical pairs rather than responding to all consecutive targets, so it is important to emphasize that they should continue to press for every consecutive repeat, and to watch out for this error in the Ability Test.
Step 3: Start the Ability Test
Once you believe the patient has understood the task, let him know that he will have a chance to practice and demonstrate his understanding. Start the short practice test by clicking on the button ‘Ability Test’ in the QbTest software.
Feedback during the Ability Test
When administering the QbTest (6-12), especially with younger children, you might want to give them positive feedback during the ability test for the initial correct responses. However, avoid commenting on the performance for patients performing QbTest (12-60), since any remarks during the Ability Test are generally perceived as distracting. Wait until after the Ability Test to comment.
If the patient seems unsure of the instructions during or after the Ability Test, provide further instructions by using the video or the stimulus card again, or allowing consecutive practices on the Ability Test. If you deviate from standardized test instructions in an attempt to ensure the patient understands what is required, be sure to note this on your behavior observation form.
The Ability Test result can indicate reflections
When the Ability Test is finished you can see the results on the screen. The camera registration of the reflective marker is shown as either green tracks, (i.e. correct registrations) and /or red tracks that indicates that there are other sources of reflections present. Make sure that you have removed or covered any of these reflective sources before starting the actual test.
The Ability Test result can indicate if the patient has understood the instructions
The Ability Test also gives you a percentage of how many errors the patient has made. The two types of errors shown are:
- Commission errors - that is, incorrect button presses made by the patient
- Omission errors - when the patient has not pressed the responder button when he should have
If the patient has an Error Rate (Number of Omission and/or Commission Errors) of 30% or more, the test administrator must ensure that this is not due to the test taker not understanding and/or can't follow the test rules. To ensure that the test taker understands and follows the test rules, the test administrator should present the Stimulus card and go through the test rules, ask the test taker to repeat the test rules and then let the test taker perform the Ability Test once again.
If the test taker has difficulties understanding the test rules, the test taker can repeat the Ability Test up to 3 times. If the test taker still doesn't understand the test rules after 3 Ability Tests, or is physically incapable of performing the test, the test taker may be unable to perform the QbTest.
If the test administrator has ensured that the test taker understands and can follow the test rules, but the test taker has an Error Rate (Number of Omission and/or Commission Errors) of 30% or more, the QbTest can still be performed. However, It is imperative that Ability Test scores and observations are communicated to the clinician so interpretation of QbTest results take these into consideration.
Step 4: Start the test
When you are confident that the patient has clearly understood the instructions, you may continue with the actual test. Proceed by saying to the patient:
“Well done! You are now ready to start the actual test. The task will last for 15/20 minutes. Please try to respond as quickly and as accurately as possible but remember that you are not expected to press the button before the figure disappears. Also, I cannot speak to you during the test. Do you have any questions before we start?”
Start the test.
Observations in the test environment
This is an excellent opportunity to make clinical observations. Position yourself seated diagonally behind the patient and outside his field of vision, but in a place where you can see his side profile.
You must always have your behavior observation form to fill out with detailed notes and a stopwatch/phone to record times that behaviors/incidents are occurring.
- Show instruction video
- Ask patient to explain his understanding of the test instructions by using the stimulus card
- Administer the Ability Test
- Start the test if the patient has clearly understood the instructions and passed the Ability Test