Measurement Properties of the MPAI-4 in Veterans With mTBI

J Kay Waid-Ebbs; Pey-Shan Wen; David P Graham; Audrey Josee Leroux; Maureen K O'Connor; Drew A Helmer

doi:10.1016/j.apmr.2019.10.191

Measurement Properties of the MPAI-4 in Veterans With mTBI

Arch Phys Med Rehabil. 2020 May;101(5):789-796. doi: 10.1016/j.apmr.2019.10.191. Epub 2019 Dec 7.

Authors

J Kay Waid-Ebbs¹, Pey-Shan Wen², David P Graham³, Audrey Josee Leroux⁴, Maureen K O'Connor⁵, Drew A Helmer⁶

Affiliations

¹ Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida. Electronic address: julia.waid-ebbs@va.gov.
² Occupational Therapy Department, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia.
³ Neurorehabilitation: Neurons to Network, Traumatic Brain Injury Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Menninger Departments of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Houston, Texas.
⁴ Department of Educational Policy Studies, Georgia State University, Atlanta, Georgia.
⁵ Bedford Veterans Administration Hospital, Psychology Department, Bedford, Massachusetts.
⁶ War Related Illness and Injury Study Center VA-New Jersey Health Care System, East Orange, New Jersey; Rutgers University-New Jersey Medical School, Newark, New Jersey.

PMID: 31821800
DOI: 10.1016/j.apmr.2019.10.191

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.

Keywords: Brain injuries; Psychometrics; Rehabilitation; Veterans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Validation Study

MeSH terms

Adaptation, Psychological*
Adult
Blast Injuries / complications
Brain Concussion / complications*
Brain Concussion / etiology
Brain Concussion / psychology
Cross-Sectional Studies
Depression / complications
Disability Evaluation*
Factor Analysis, Statistical
Female
Humans
Male
Psychometrics
Reproducibility of Results
Self Report
Social Participation
United States
Veterans*