title: Methodological considerations of measuring disability in bipolar disorder: validity of the Multidimensional Scale of Independent Functioning.
abstract: OBJECTIVE
  Recent studies have highlighted the prevalence, severity and persistence of the disability associated with bipolar disorder (BPD). Reliable instruments are needed to support research into the factors associated with disability and treatment response. Contextual factors (e.g., availability of supported employment programs) can affect functionality, posing a challenge to such investigations. We present preliminary findings regarding the validity of the Multidimensional Scale of Independent Functioning (MSIF) in BPD. The MSIF provides discrete ratings of support separate from both role responsibility and performance quality in work, residential and educational environments. These distinctions allow the 'correction' for variability explained by contextual factors that allows the comparison of studies conducted in different environments and time.
  
  
  METHODS
  Participants with BPD were administered the MSIF, the Social Adjustment Scale II (SAS-II) and an interview recording objective data regarding work, school and residential activities as part of an ongoing longitudinal study of BPD disability.
  
  
  RESULTS
  Construct validity estimated using standardized Cronbach's alpha coefficient was 0.76 (n = 58). MSIF global ratings were significantly lower (reflecting higher functionality) for subjects engaged in productive activity compared with participants who were not active (t = -3.6, p = 0.001) demonstrating external validity. Inter-rater reliability estimates ranged from 0.86 to 0.99 (n = 49). Significant, high correlations were demonstrated between comparable MSIF and SAS-II global ratings (criterion validity = 0.70-0.79) and low correlations were found between non-comparable ratings (discriminant validity = -0.07 to -0.35) (n = 14).
  
  
  CONCLUSIONS
  We conclude that the MSIF is a valid and reliable instrument optimally designed for studying determinants of disability and treatment response in BPD.
authors: The Center for Neuropsychiatric Outcome and Rehabilitation Research, The Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY 11004, USA. berns@lij.edu
authors: Stefanie
authors: S
authors: Berns
authors: Sarah
authors: S
authors: Uzelac
authors: Cristina
authors: C
authors: Gonzalez
authors: Judith
authors: J
authors: Jaeger
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D016832:Employment, Supported; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D012917:Social Adjustment; D011795:Surveys and Questionnaires