Advertisement
ORIGINAL RESEARCH| Volume 102, ISSUE 11, P2193-2200.e3, November 2021

Psychometric Properties and Sex Differences on the Mayo-Portland Adaptability Inventory Participation Subscale (M2PI) in Veterans With Traumatic Brain Injury

      Abstract

      Objective

      To evaluate the structural validity of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in a sample of veterans and to assess whether the tool functioned similarly for male and female veterans.

      Design

      Rasch analysis of M2PI records from the National Veterans Traumatic Brain Injury Health Registry database from 2012-2018.

      Setting

      National VA Polytrauma System of Care outpatient settings.

      Participants

      Veterans with a clinically confirmed history of traumatic brain injury (TBI) (N=6065; 94% male).

      Interventions

      Not applicable.

      Main Outcome Measures

      M2PI, a 5-point Likert-type scale with 8 items. For this analysis, the 2 employment items were treated individually for a total of 9 items.

      Results

      The employment items misfit the Rasch Measurement model (paid employment mean square [MnSq]=1.40; other employment MnSq=1.34) and were removed from subsequent iterations. The final model had eigenvalue 1.87 on the first contrast, suggesting unidimensionality of the remaining 7 items. Item order from least to most participation restriction was transportation, self-care, residence management, financial management, initiation, leisure, and social contact. Wright's person separation reliability for nonnormal distributions was 0.93, indicating appropriateness of M2PI for making individual-level treatment decisions. Mean person measure was −0.92±1.34 logits, suggesting that participants did not report restrictions on most items (item mean=0 logits). A total of 3.8% of the sample had the minimum score (no impairment on all items), and 0.2% had the maximum score. Four items had different item calibrations (≥0.25 logits) for female compared with male veterans, but the hierarchy of items was unchanged when the female sample was examined separately.

      Conclusions

      These findings suggest that, although employment is a poor indicator of participation restrictions among veterans with TBI, the M2PI is unidimensional. Because of subtle differences in scale function between male and female participants, M2PI should be part of a more thorough clinical interview about participation strengths and restrictions.

      Keywords

      List of abbreviations:

      DIF (differential item functioning), M2PI (Mayo-Portland Adaptability Inventory Participation Index), MnSq (mean square), MPAI4 (Mayo-Portland Adaptability Inventory 4), PSR (person separation reliability), TBI (traumatic brain injury), VHA (Veterans Health Administration)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Available at: https://apps.who.int/iris/bitstream/handle/10665/42407/9241545429_tha+eng.pdf. Accessed April 9, 2020.

      2. Malec JF, Lezak MD. Manual for the Mayo-Portland Adaptability Inventory (MPAI-4) for adults, children and adolescents. Available at: http://www.tbims.org/combi/mpai/manual.pdf. Accessed April 16, 2020.

        • Kean J
        • Malec JF
        • Altman IM
        • Swick S.
        Rasch measurement analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a community-based rehabilitation sample.
        J Neurotrauma. 2011; 28: 745-753
        • Malec JF.
        The Mayo-Portland Participation Index: a brief and psychometrically sound measure of brain injury outcome.
        Arch Phys Med Rehabil. 2004; 85: 1989-1996
        • Malec JF.
        Comparability of Mayo-Portland Adaptability Inventory ratings by staff, significant others and people with acquired brain injury.
        Brain Inj. 2004; 18: 563-575
        • McCulloch K
        • Pastorek NJ
        • Miller BI
        • et al.
        Clinician versus veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.
        J Head Trauma Rehabil. 2015; 30: 38-46
        • Kean J
        • Malec JF
        • Cooper DB
        • Bowles AO.
        Utility of the Mayo-Portland Adaptability Inventory-4 for self-reported outcomes in a military sample with traumatic brain injury.
        Arch Phys Med Rehabil. 2013; 94: 2417-2424
        • O'Rourke J
        • Critchfield E
        • Soble J
        • Bain K
        • Fullen C
        • Eapen B.
        The utility of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in US military veterans with a history of mild traumatic brain injury.
        J Head Trauma Rehabil. 2019; 34: 30-35
        • Waid-Ebbs JK
        • Wen PS
        • Graham DP
        • Leroux AJ
        • O'Connor MK
        • Helmer DA
        Measurement properties of the MPAI-4 in veterans with mTBI.
        Arch Phys Med Rehabil. 2020; 101: 789-796
        • Hawkins BL
        • Crowe BM.
        Contextual facilitators and barriers of community reintegration among injured female military veterans: a qualitative study.
        Arch Phys Med Rehabil. 2018; 99: S65-S71
        • Cogan AM
        • Smith B
        • Bender Pape T
        • Mallinson T
        • Eapen BC
        • Scholten J.
        Self-reported participation restrictions among veterans with traumatic brain injury in VA outpatient polytrauma programs.
        Arch Phys Med Rehabil. 2020; 101: 2071-2079
        • Bond TG
        • Yan Z
        • Heene M.
        Applying the Rasch model.
        4th ed. Routledge, New York2021
        • Baghaei P.
        The Rasch model as a construct validation tool.
        Rasch Meas Trans. 2008; 11: 1145-1146
        • Messick S.
        Foundations of validity: meaning and consequences in psychological assessment.
        Educational Testing Service, Princeton1993
        • Wright BD
        • Linacre JM.
        Reasonable mean-square fit values.
        Rasch Meas Trans. 1994; 8: 370
        • Smith RM
        • Schumacker RE
        • Bush MJ.
        Using item mean squares to evaluate fit to the Rasch model.
        J Outcome Meas. 1998; 2: 66-78
      3. Linacre JM. Simulated file specifications. Available at: https://www.winsteps.com/winman/simulated.htm. Accessed November 15, 2020.

      4. Linacre JM. Help for WINSTEPS Rasch measurement and Rasch analysis software. Available at: https://www.winsteps.com/winman/principalcomponents.htm. Accessed September 23, 2020.

        • Raîche G.
        Critical eigenvalue sizes (variances) in standardized residual principal components analysis (PCA).
        Rasch Meas Trans. 2005; 19: 1012
        • Wright BD.
        Reliability and separation.
        Rasch Meas Trans. 1996; 9: 472
        • Wright BD.
        Separation, reliability and skewed distributions: Statistically different levels of performance.
        Rasch Meas Trans. 2001; 14: 786
      5. Linacre JM. A User's Guide to WINSTEPS & MINISTEP Rasch-model computer programs. Available at: https://www.winsteps.com/winman/. Accessed September 23, 2020.

        • Horne RM
        • Johnson MD
        • Galambos NL
        • Krahn HJ.
        Time, money, or gender? Predictors of the division of household labour across life stages.
        Sex Roles. 2018; 78: 731-743
        • Starmer AJ
        • Frintner MP
        • Matos K
        • Somberg C
        • Freed G
        • Byrne BJ.
        Gender discrepancies related to pediatrician work-life balance and household responsibilities.
        Pediatrics. 2019; 144e20182926
        • Codina N
        • Pestana JV.
        Time matters differently in leisure experience for men and women: leisure dedication and time perspective.
        Int J Environ Res Public Health. 2019; 16: 2513
        • Mallinson T
        • Hammel J.
        Measurement of participation: intersecting person, task, and environment.
        Arch Phys Med Rehabil. 2010; 91: S29-S33
      6. Departments of Veterans Affairs and Defense. VA/DoD clinical practice guideline for the management of concussion-mild traumatic brain injury (MTBI). Departments of Veterans Affairs and Defense. Available at: https://www.healthquality.va.gov/guidelines/Rehab/mtbi/mTBICPGFullCPG50821816.pdf. Accessed August 5, 2019.

        • Cogan AM
        • Carlson M.
        Deciphering participation: an interpretive synthesis of its meaning and application in rehabilitation.
        Disabil Rehabil. 2018; 40: 2692-2703