Measurement Properties of the Mayo-Portland Adaptability Inventory (MPAI-4) and related measures: A Systematic Review

Published:January 25, 2023DOI:



      To assess the MPAI-4 and related measures’ measurement properties and the quality of evidence supporting these results; and identify the interpretability and feasibility of the MPAI-4 and related measures.

      Data Sources

      We conducted a systematic review according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. We searched nine electronic databases and registries, and hand searched reference lists of included articles.

      Study Selection

      Two independent reviewers screened and selected all articles. From 605 retrieved articles, 48 were included.

      Data Extraction

      Two independent reviewers appraised the evidence quality and rated the extracted Classical Test Theory and Rasch results from each study.

      Data Synthesis

      We used meta-analysis and COSMIN's approach to synthesize measurement properties evidence (insufficient, sufficient), and the modified GRADE approach to synthesize evidence quality (very-low, low, moderate, high) by diagnosis (traumatic brain injury (TBI), stroke) and setting (inpatient, outpatient). The MPAI-4 and its subscales are sufficiently comprehensible (GRADE: very-low), but there is currently no other content validity evidence (relevance, comprehensiveness). The MPAI-4 and its participation index (M2PI) have sufficient interrater reliability for stroke and TBI outpatients (GRADE: moderate), whereas interrater reliability between TBI inpatients and clinicians is currently insufficient (GRADE: moderate). There is no evidence for measurement error. For stroke and TBI outpatients the MPAI-4 and M2PI have sufficient construct validity (GRADE: high) and responsiveness (GRADE: moderate-high). For TBI inpatients the MPAI-4 and M2PI have mixed indeterminant/sufficient construct validity and responsiveness evidence (GRADE: moderate-high). There is one study with mixed insufficient/sufficient evidence for each MPAI-4 adaptation (21- and 22-item MPAI, 9-item M2PI) (GRADE: low-high).


      Users can be most confident in using the MPAI-4 and M2PI in TBI and stroke outpatient settings. Future research is needed on reliability, measurement error, predictive validity and content validity of the MPAI-4 and its related measures across populations and settings.


      List of abbreviations:

      CTT (Classical test theory), COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments), MPAI-4 (Mayo-Portland Adaptability Inventory - version 4), M2PI (Mayo-Portland Adaptability Inventory - version 4 Participation Index)
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