Abstract
Objectives
To determine whether the measurement properties of the Mayo-Portland Adaptability
Inventory Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted
as 2 outcome measures in the Veterans Health Administration (VHA) National Polytrauma
Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain
injury (mTBI).
Design
Cross-sectional.
Setting
Outpatient rehabilitation.
Participants
Postdeployment veterans with blast-related mTBI (N=177).
Intervention
Not applicable.
Main Outcome Measures
Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and Community Integration
Questionnaire (CIQ).
Results
The unidimensional factor structure of the MPAI-4 total and 3 index scores (abilities,
adjustment, participation) were confirmed. Eight of the 30 items were removed for
violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale
was collapsed from 5 to 3 ratings because of structure issues. The remaining 22 MPAI-4
items demonstrated excellent item/person reliability (0.98/0.91) and separated person
ability into 4 strata. Two of the MPAI-4 index scores (abilities and adjustment) had
good measurement properties. The third index, M2PI, retained only 3 items that had
adequate person reliability (0.75) but separated person ability into only 2 strata.
A significant but fair association with the CIQ was demonstrated with the modified
MPAI-4.
Conclusions
The MPAI-4 has been validated in moderate to severe traumatic brain injury but required
modification when used in active military personnel with mTBI. We also identified
the need for modification of the MPAI-4 to support adequate psychometrics when measuring
outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans
and active military personnel with mTBI, to determine whether the M2PI should continue
to be used as an outcome measure in the VHA polytrauma rehabilitation systems.
List of abbreviations:
CIQ (Community Integration Questionnaire), MP (military personnel), MPAI-4 (Mayo-Portland Adaptability Inventory Version 4), M2PI (Mayo-Portland Adaptability Inventory Participation Index), mTBI (mild traumatic brain injury), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), VHA (Veterans Health Administration)Keywords
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Article Info
Publication History
Published online: December 07, 2019
Footnotes
Disclosures: none.
Supported by the Neurons to Networks TBI Center of Excellence (award no. #B6812C) from the United States Department of Veterans Affairs Rehabilitation Research and Development Service .
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
