Malec James F, Logan Daniel M, McGrath Claire, Parrott Devan, Walters G Joseph
Author Affiliations: Foundation to Advance Brain Rehabilitation (FABR), and Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (Drs Malec and Parrott); Mayo Clinic, Rochester, Minnesota (Dr Malec); On With Life, Ankeny, Iowa (Messrs Logan and Walters); and Bancroft NeuroRehab, Cherry Hill, New Jersey (Dr McGrath).
J Head Trauma Rehabil. 2025;40(1):8-16. doi: 10.1097/HTR.0000000000000935. Epub 2024 Feb 27.
Reexamine the item structure and reliability of the Mayo-Portland Adaptability Inventory (4th ed; MPAI-4) through Rasch analysis of admission and discharge scores for a large sample of adults with acquired brain injury (ABI) who participated in various types of posthospital brain injury rehabilitation (PHBIR) programs; (2) compare differential item functioning (DIF) for traumatic brain injury (TBI), stroke and other ABI; and (3) explore the viability of more specific subscales in addition to the established indices.
Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community, Day Treatment, and Outpatient rehabilitation programs serving individuals with ABI.
A total of 2154 individuals with TBI, stroke, or other ABI.
Retrospective analysis of de-identified admission and discharge data from the Foundation to Advance Brain Rehabilitation (FABR) consortium database.
MPAI-4.
After adjusting 4 misfitting items and eliminating 20 misfitting persons, the MPAI-4 demonstrated real person reliability/separation = 0.93/3.52 and real item reliability/separation = 1.00/24.02. Independent Rasch analyses by diagnostic category found similar reliabilities and separations. Residual item correlations and principal component analysis of residuals (PCAR) indicated areas of local dependence arranged hierarchically reflecting the full-scale item hierarchy and providing the basis for 3 new subscales of Physical Abilities, Cognitive Abilities, and Autonomy. DIF across diagnostic categories revealed differences in item elevations characteristic of typical patients in each category. Measure means and SDs were very similar across categories.
MPAI-4 items demonstrate very good person and item reliabilities for individuals with TBI, stroke, and other ABI at a level that supports individual evaluation. Variations in item calibrations across diagnostic categories reflect the differential characteristics of typical patients within categories. The entire measure provides an overall assessment of common sequalae of ABI, and standard indices used in combination with newly derived subscales provide more specific assessments of rehabilitation needs for treatment planning.
通过对大量获得性脑损伤（ABI）成年患者的入院和出院分数进行拉施分析，重新审视梅奥 - 波特兰适应性量表（第4版；MPAI - 4）的项目结构和信度，这些患者参与了各种类型的院后脑损伤康复（PHBIR）项目；（2）比较创伤性脑损伤（TBI）、中风和其他ABI的项目功能差异（DIF）；（3）除既定指标外，探索更具体子量表的可行性。
来自为ABI患者提供服务的住院神经行为、住院神经康复、家庭和社区、日间治疗以及门诊康复项目的数据。
总共2154名患有TBI、中风或其他ABI的个体。
对来自促进脑康复基金会（FABR）联盟数据库的匿名入院和出院数据进行回顾性分析。
MPAI - 4。
在调整4个不拟合项目并排除20名不拟合个体后，MPAI - 4显示出真实个体信度/区分度 = 0.93/3.52以及真实项目信度/区分度 = 1.00/24.02。按诊断类别进行的独立拉施分析发现了相似的信度和区分度。残差项目相关性和残差主成分分析（PCAR）表明存在局部依赖区域，这些区域按层次排列，反映了全量表项目层次结构，并为身体能力、认知能力和自主性这3个新的子量表提供了基础。不同诊断类别间的DIF揭示了各类典型患者项目高度的差异。不同类别间的测量均值和标准差非常相似。
MPAI - 4项目对于患有TBI、中风和其他ABI的个体显示出非常好的个体和项目信度，达到了支持个体评估的水平。不同诊断类别间项目校准的差异反映了各类典型患者的不同特征。整个量表提供了对ABI常见后遗症的总体评估，标准指标与新得出的子量表结合使用可为治疗计划中的康复需求提供更具体的评估。
