Executive functioning in schizophrenia using a novel virtual reality-simulated workplace: validity, test-retest reliability, and links to competitive employment

Virtual reality offers a promising avenue for the assessment of executive functioning in complex workplace environments. However, its use in schizophrenia remains limited. For that reason, we investigated the validity and test-retest reliability of the Jansari assessment of Executive Functions (JEF©) in individuals with schizophrenia and its associations with competitive employment. A total of 69 participants with schizophrenia and 67 healthy controls completed JEF© and standard tests. A subsample of 58 patients was retested after an 8-week interval. Individuals with schizophrenia performed more poorly than controls on JEF© (p < 0.001) and standard tests (p < 0.05). JEF© scores correlated with standard measures (p < 0.05), except inhibition tests, and with clinician-report of everyday problems (p < 0.001). Total score showed a good test-retest reliability and the practice adjusted RCI indicated 87.9% of patients remained stable over 8 weeks. In logistic regression, higher JEF© total score significantly predicted competitive employment after adjusting for age (p = 0.004) and remained significant when years of education were added (p = 0.014). This comprehensive evaluation indicates that JEF© is a valid and reliable tool assessing executive functions required in office work and offers an ecologically relevant complement to standard measures in schizophrenia.