Validation of the virtual reality functional capacity assessment tool (VRFCAT) in a Spanish sample of individuals with psychosis and healthy controls

Abstract

Background The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a performance-based measure developed to assess functional capacity through simulations of daily activities. This study examined its psychometric properties in a Spanish sample, including individuals with first-episode psychosis (FEP), schizophrenia, and healthy controls.

Methods A total of 370 participants (99 FEP, 116 schizophrenia, and 155 controls) completed the VRFCAT in a multicenter study. Internal consistency (McDonald’s omega), discriminative validity (group comparisons and ROC curves), and convergent validity via correlations with cognitive performance and clinical symptoms were examined. Reference percentiles were calculated from the healthy control sample using quantile regression, stratified by age and education.

Results Item-level VRFCAT completion times showed acceptable to good internal consistency overall and in controls and schizophrenia samples, but poor in FEP. Differences in VRFCAT performance emerged (χ2 = 108.88, p < .001), with controls performing best, schizophrenia worst, and FEP in between. ROC analyses indicated good discriminative accuracy in distinguishing patients from controls (area under the curve [AUC] = 0.779, sensitivity = 80.0%, specificity = 64.2%); but limited discrimination between schizophrenia and FEP. Age and education, but not sex, significantly affected performance. VRFCAT showed small-to-moderate correlations with cognitive performance, and no significant associations with symptom severity.

Conclusions The VRFCAT is a reliable and valid tool for assessing functional capacity in Spanish-speaking individuals with psychotic disorders. Its ecological validity, objectivity, psychometric properties, brief administration time, and ease of use support its potential use in clinical and research settings for evaluating functional recovery and treatment outcomes.

This study was supported by the Instituto de Salud Carlos III (ISCIII) through project PI20/00066, co-funded by the European Union. Ana González-Pinto acknowledges the support of the Spanish Ministry of Science, Innovation and Universities, integrated into the National R&D&I Plan and co-funded by the ISCIII–Subdirección General de Evaluación and the European Regional Development Fund (FEDER; grants PI18/01055 and PI21/00713), as well as the CIBERSAM, the Basque Government (grant 2022111054), and the University of the Basque Country (grant IT1631–22). Roberto Rodriguez-Jimenez is partially supported by the Madrid Regional Government (R&D activities in Biomedicine S2022/BMD–7216 (AGES 3–CM)), and CIBERSAM-ISCIII. Ángel Yorca-Ruiz is funded by a predoctoral contract (PFIS FI/00162) from the Carlos III Health Institute. Rosa Ayesa-Arriola was funded by a Miguel Servet contract from the Carlos III Health Institute (CP18/00003) and a Consolidator Grant from the Spanish Ministry of Science and Innovation (CNS2022–136110).