title: Utility of the Mayo-Portland adaptability inventory-4 for self-reported outcomes in a military sample with traumatic brain injury.
abstract: OBJECTIVE
  To investigate the psychometric properties of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) obtained by self-report in a large sample of active duty military personnel with traumatic brain injury (TBI).
  
  
  METHODS
  Consecutive cohort who completed the MPAI-4 as a part of a larger battery of clinical outcome measures at the time of intake to an outpatient brain injury clinic.
  
  
  METHODS
  Medical center.
  
  
  METHODS
  Consecutively referred sample of active duty military personnel (N=404) who suffered predominantly mild (n=355), but also moderate (n=37) and severe (n=12), TBI.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  MPAI-4 RESULTS: Initial factor analysis suggested 2 salient dimensions. In subsequent analysis, the ratio of the first and second eigenvalues (6.84:1) and parallel analysis indicated sufficient unidimensionality in 26 retained items. Iterative Rasch analysis resulted in the rescaling of the measure and the removal of 5 additional items for poor fit. The items of the final 21-item Mayo-Portland Adaptability Inventory-military were locally independent, demonstrated monotonically increasing responses, adequately fit the item response model, and permitted the identification of nearly 5 statistically distinct levels of disability in the study population. Slight mistargeting of the population resulted in the global outcome, as measured by the Mayo-Portland Adaptability Inventory-military, tending to be less reflective of very mild levels of disability.
  
  
  CONCLUSIONS
  These data collected in a relatively large sample of active duty service members with TBI provide insight into the ability of patients to self-report functional impairment and the distinct effects of military deployment on outcome, providing important guidance for the meaningful measurement of outcome in this population.
authors: VA Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Health Services Research Center, Regenstrief Institute, Indianapolis, IN; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN. Electronic address: jacob.kean@gmail.com.
authors: Jacob
authors: J
authors: Kean
authors: Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
authors: James F
authors: JF
authors: Malec
authors: Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors: Douglas B
authors: DB
authors: Cooper
authors: Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors: Amy O
authors: AO
authors: Bowles
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D025341:Principal Component Analysis; D011594:Psychometrics; D015203:Reproducibility of Results; D057566:Self Report
keywords: Brain injuries; MPAI-4; MPAI-m; MRFA; MTBI; Mayo-Portland Adaptability Inventory-4; Mayo-Portland Adaptability Inventory-military; Military personnel; Outcome and process assessment (health care); Outcome assessment (health care); Psychometrics; Rehabilitation; TBI; VHS; mild traumatic brain injury; minimum rank factor analysis; traumatic brain injury; veteran health care systems