Trail Making Test: Comparison of paper-and-pencil and electronic versions.

The Trail Making Test (TMT) was adapted for the iPad by Parker-O'Brien, which uses the 2004 Tombaugh norms. This study investigated the equivalency of this electronic test by (a) examining the test-retest reliability of the iPad-TMT, and (b) calculating the concurrent validity between the two versions. The sample included 77 healthy adults. Reliability was assessed by Pearson product-moment correlation and intraclass correlation coefficient, while validity was assessed by MANOVA. Results indicate that Part A of the iPad-TMT did not demonstrate adequate test-retest reliability over 1 week (r = 0.15-0.70); Part B demonstrated adequate test-retest reliability in the majority of groups (r = 0.33-0.80). Conversely, Part A of the electronic TMT demonstrated adequate concurrent validity, whereas Part B did not; however, validity in Part A has minimal significance without adequate reliability. Handedness had a significant effect on performance, with left-handers performing slower on the electronic TMT Part A (p < .05) and the traditional TMT Part B (p < .05). Clinicians should use caution when using electronic versions of traditional tests, as they may assess different constructs. New norms should be developed. The role of handedness on TMT performance should be further assessed.