Mayo-Portland Adaptability Inventory

Acquired Brain Injury: ( Malec and Lezac, 2003; manual)

• T-scores provided are based on data sets from two populations of individuals with ABI. They have not been referenced to non-ABI samples.
• When compared to the reference populations with ABI:
• total T-scores less than 30: good outcome
• 30 – 40: mild limitations
• 40 – 50: mild to moderate limitations
• 50 – 60: moderate to severe difficulties
• above 60: severe limitations

Children and Adolescents with Acquired Brain Injury : (Oddson et al, 2006; n=335 (for test retest: n=early outpatient recovery n=230, late follow up recovery n=45); median age=9 years 8 months (5 years); gender=215 males, 120 females; assessment was from 5 months to 6 years post injury)

• Test-retest reliability has been reported to be adequate-excellent in children with ABI (Spearman rho =.45–.93); all correlations significant , p<.001

Acquired Brain Injury : (Bohac et al, 1997; n=189; mean age=39.0 (16.08) years; years post injury=7.96 (8.5))

• Inter-item correlations were <0.30 for items Audition, Law Violations, Alcohol Use and Illegal Drug Use
• Law violations, alcohol use and illegal drug use were significantly correlated only to each other

Traumatic Brain Injury, Stroke, Tumor, Other Neurological disorder : (Malec et al, 2000; evaluation sample n=305; treatment sample n=52; mean age of evaluation sample=36.7 (13.3); mean age of treatment sample=34 (12.7); Evaluation sample: TBI=76%; Stroke=14%; Tumor=4%; Other=6%; Treatment sample: TBI=83%, Stroke=17%; Time since injury evaluation sample=4.5 (6.8); Time since injury treatment sample=5.6 (7.7))

• On Rasch analysis:
• 30-item MPAI: person separation =1.90 and person reliability = 0.78 and item separation = 9.54 and item reliability = 0.99
• 22-item MPAI: person separation = 2.12 and person reliability = 0.82, item separation = 9.33 and item reliability = 0.99

Acquired Brain Injury (Traumatic Brain Injury, Stroke, Other): (Malec et al, 2003; n=386; Time since injury=6.9 (7.5)

• Cronbach alpha for overall measure=0.89
• Cronbach alpha for 3 subscales=.76-.83

Interscale and subscale-full scale correlations of recoded MPAI-4 subscales

• Subscales correlated moderately (Pearson r=.49–.65) with each other and strongly with the overall scale (Pearson r=.82–.86).

Acquired Brain Injury (Traumatic Brain Injury, Stroke, Tumor, Encephalitis, Others): (Malec, 2004; n=134; Time since injury=5.3 years (8.4)

**Person Reliability over .80 and Item Reliability over .90 is desirable

**Separation of at least 2 is desired (Malec, 2003)

Traumatic Brain Injury: (Kean et al, 2011; n=603; mean age=40.2 (14.8))

• Analysis of crucial Rasch measurement properties revealed a person reliability score of .90 and a person separation score of 3.03, which exceeded the critical threshold of 2.0 and allows the identification of four performance strata
• Item separation in this initial calibration was 14.50, and item reliability approached 1.0. The analysis of item fit in this first calibration indicated three items with infit statistical values that were outside the relatively strict criterion of – .3: audition, productive activity, and dizziness
• Items with outfit statistic values outside acceptable cutoffs were: audition, productive activity, transportation, dizziness, pain, use of hands, and anger

Predictive validity:

Traumatic Brain Injury, Stroke, Tumor, Other Neurological disorder : (Malec et al, 2000; evaluation sample n=305; treatment sample n=52; mean age of evaluation sample=36.7 (13.3); mean age of treatment sample=34 (12.7); Evaluation sample: TBI=76%; Stroke=14%; Tumor=4%; Other=6%; Treatment sample: TBI=83%, Stroke=17%; Time since injury evaluation sample=4.5 (6.8); Time since injury treatment sample=5.6 (7.7))

• The Rasch analysis derived 22-item MPAI does as well as the raw score-sum 30-item version in predicting MPAI scores, goal-attainment scores, and independent living outcomes at discharge.
• The 22-item version does less well predicting vocational outcome at discharge but equally well predicting vocational outcome after one year.
• Both the raw score-sum 30-item and Rasch analysis derived 22-item versions predict longer term vocational outcomes better than progress achieved by discharge from the outpatient rehabilitation program.
• The correlation between measures of vocational outcome at discharge and one year later is .49 in this sample (n=52)

Acquired Brain Injury (TBI, CVA, Tumor, Other) : (Malec et al, 2000; Evaluation sample n=305, treatment sample n=52; 1 year follow up n=42; mean age evaluation sample n=36.7 (13.3); mean age treatment sample n=34.0 (12.7))

• Pre-treatment MPAI-30 score: predictive of outcome post-treatment as assessed by the MPAI-30 (0.52), MPAI-22 (0.51), Goal Attainment Scaling (-0.49), the Independent Living Status (-0.32) and the Vocational Independence Scale (-0.26)
• Pre-treatment MPAI-22: was similarly predictive of outcome, although the association with VIS scores was weak (-0.17)
• At one year follow-up: pre-treatment MPAI-30 and MPAI-22 scores were predictive of ILS and VIS scores (-0.25 & -0.34 vs. –0.26 & -0.32, for the 30 item and 22 item version, respectively)

Acquired Brain Injury (TBI, CVA, Other-e.g. anoxia): (Malec, 2001; program graduates n=96; mean age=34.2 (12.2))

• Admission MPAI-22 score predicted independent living scale scores (concordance = 70.2%, p<0.01) and vocational independence scale scores (concordance = 66.9%, p<0.05) at 1 year follow-up following comprehensive day treatment

Acquired Brain Injury: (Malec et al, 2002; n=114; mean age=37.4 (11.8) years)

• At one year follow up: staff MPAI-22 ratings contributed significantly to the prediction of community-based employment (p<0.01)

Acquired Brain Injury (Traumatic Brain Injury, Stroke, Other) : (Malec et al, 2000; n=114; mean age=37.4 years (11.8); time since injury=65.5 months (111.3)

• The measure has been found to predict employment status
• Time since injury and staff rated MPAI-22 were identified as significant predictors of Vocational Independence scale scores at job placement in the medical/vocational case coordination system (p<0.01), staff-rated MPAI-22 was also predictive of time to placement (p<0.001)

Acquired Brain Injury (Traumatic Brain Injury, Stroke, Other) : (Malec, 2001; n=96; mean age=34.2 (12.2); Time since injury=4.6 years (6.6))

• The MPAI predicts long-term health outcomes of a day treatment program for patients with brain injury.
• Pre-admission MPAI-22 score predicted independent living scale scores (concordance = 70.2%, p<0.01) and vocational independence scale scores (concordance = 66.9%, p<0.05) at 1 year follow-up following comprehensive day treatment (Malec, 2001)

Traumatic Brain Injury: (Testa et al, 2005; n=82 orthopedic injured patients; n=195 TBI)

• The MPAI was moderately predictive of level of functioning, return to employment, and independent living status 1 to 2 years post-injury.

Concurrent Validity:

Acquired Brain Injury TBI, cerebral hemorrhage, anoxia) : ( Malec and Thompson, 1994; n=50; gender=16 female, 34 male; median age=33.2 (range 18-59 years); assessment period=20 days to over 32 years post injury (median time since onset=1.5 years)

• Original MPAI consensus ratings correlated with:
• Disability Rating Scale (DRS) scores (r=0.81)
• Rivermead Behavioral Memory Test (r=-0.47)
• Various neuropsychometric/cognitive measures (correlations ranged from 0.04 with Woodcock-Johnson Reading Cluster (WJ Read) to 0.56 with Stroop Color-Word test

Acquired Brain Injury : (Bohac et al, 1997; n=189; mean age=39.0 (16.08) years; years post injury=7.96 (8.5))

• Principal components analysis of MPAI after Varimax rotation revealed 8 orthogonal factors; factors interpreted as representing Activities of Daily Living, Social Initiation, Cognition, Impaired Self-Awareness/Distress, Social skills/Support, Independence, Visuoperceptual, Psychiatric – several items loaded significantly on more than one factor

Traumatic Brain Injury, Stroke, Tumor, Other Neurological disorder : (Malec et al, 2000; evaluation sample n=305; treatment sample n=52; mean age of evaluation sample=36.7 (13.3); mean age of treatment sample=34 (12.7); Evaluation sample: TBI=76%; Stroke=14%; Tumor=4%; Other=6%; Treatment sample: TBI=83%, Stroke=17%; Time since injury evaluation sample=4.5 (6.8); Time since injury treatment sample=5.6 (7.7))

• Principal component analysis of 22-item MPAI revealed five factors
• One 8-item set was identified with acceptable levels of person separation and reliability
• Correlation between MPAI-30 item and MPAI – 22 item = 0.98

Acquired Brain Injury (Traumatic Brain Injury, Stroke, Other): (Malec et al, 2003; n=386; Time since injury=6.9 (7.5)

• Item cluster analysis: 3-cluster solution that was substantially similar to the item groupings derived rationally by the scale authors
• Cluster analysis solution was not statistically superior to the rational item groupings
• Factor analysis revealed 7 factors with Eigenvalues > 1 though each factor contained few items
• Moderate correlations between subscales (0.49 to 0.65) suggested that subscales/dimensions may be assessing different aspects of a single underlying construct

Children and Adolescents with Acquired Brain Injury : (Oddson et al, 2006; n=335; median age=9 years 8 months (5 years); gender=215 males, 120 females; assessment was from 5 months to 6 years post injury)

• MPAI total scores taken during in-patient admission correlated negatively with GCS (r=-0.36, n=72), indicating low GCS was associated with high subsequent disability
• MPAI total scores correlated positively with days of PTA (r=0.44, n=57)
• MPAI total scores correlated negatively on GCS scores during first outpatient admission (r=-0.33; n=195)
• MPAI total scores did not correlate with days of PTA (r=-0.08, n=216); days of ventilation correlated with total MPAI total score (r=0.22; n=320)
• Correlations between MPAI and outcomes at first follow up assessment (n=335) see table below:

Known Groups

Traumatic Brain Injury: (Murrey et al, 2005; n=43 with TBI and frontal lobe damage and n=69 with TBI and no frontal lobe damage; mean age=34 for TBI with frontal lobe damage and mean age=34.4 for TBI without frontal lobe damage; mean time since injury=5.2 years for TBI with frontal lobe damage; 4.8 years for TBI without frontal lobe damage)

• The MPAI has been found to discriminate between persons with severe TBI and frontal lobe damage and persons with mild TBI and no frontal lobe damage
• Significant differences (p<0.001) in MPAI scores were identified in groups differentiated by Rancho Levels of Cognitive Functioning Scale (Malec & Thompson, 1994);

Acquired Brain Injury: Malec et al, 2002; n=114; mean age=37.4 (11.8) years)

• Staff-completed MPAI-22 ratings: distinguished between patients receiving specialized vocational services (SVS), those receiving community reintegration services + SVS and those receiving comprehensive day treatment + SVS (p=0.0001)

Acquired Brain Injury (TBI, CVA/vascular injury, tumor, encephalitis/infection, anoxia/multiple sclerosis, toxicity) : (Malec, 2004; n=134; mean age=38.8 (13.5); time since injury=5.3 years (8.4))

• No substantial floor or ceiling effects reported – very high scores and very low scores were not common (<5% and <7% respectively)

• MPAI provides a broader assessment at lower levels of disability than DRS (Malec & Thompson, 1994)
• Significant change in MPAI-22 score from pre-admission to end of comprehensive day treatment program (paired t= 8.35, p<0.0001) (Malec, 2001)