title: Ecologically relevant outcome measure for post-inpatient rehabilitation.
abstract: BACKGROUND
  Transfer of skills learned within the clinic environment to patients' home or community is important in post-inpatient brain injury rehabilitation (PBIR). Outcome measures used in PBIR assess level of independence during functional tasks; however, available functional instruments do not quantitate the environment in which the behaviors occur.
  
  
  OBJECTIVE
  To examine the reliability and validity of an instrument used to assess patients' functional abilities while quantifying the amount of structure and distractions in the environment.
  
  
  METHODS
  2501 patients who sustained a traumatic brain injury (TBI) or cerebrovascular accident (CVA) and participated in a multidisciplinary PBIR program between 2006 and 2014 were identified retrospectively for this study. The PERPOS and MPAI-4 were used to assess functional abilities at admission and at discharge. Construct validity was assessed using a bivariate Spearman rho analysis A subsample of 56 consecutive admissions during 2014 were examined to determine inter-rater reliability. Intra-class correlation coefficient (ICC) and Kappa coefficients assessed inter-rater agreement of the total PERPOS and PERPOS subscales respectively.
  
  
  RESULTS
  The PERPOS and MPAI-4 demonstrated a strong negative association among both TBI and CVA patients. Kappa scores for the three PERPOS scales each demonstrated good to excellent inter-rater agreement. The ICC for overall PERPOS scores fell in the good agreement range.
  
  
  CONCLUSIONS
  The PERPOS can be used reliably in PBIR to quantify patients' functional abilities within the context of environmental demands.
authors.affiliation: Pate Rehabilitation Medical Center, Dallas, TX, USA.|University of Texas Southwestern Medical Center, Dallas TX, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Marquez de la Plata
authors.affiliation: Pate Rehabilitation Medical Center, Dallas, TX, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Qualls
authors.affiliation: Pate Rehabilitation Medical Center, Dallas, TX, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Plenger
authors.affiliation: Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, IN, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.affiliation: Pate Rehabilitation Medical Center, Dallas, TX, USA.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Hayden
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D055669:Ecological and Environmental Phenomena; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge / Q000592:standards* / Q000639:trends; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000592:standards* / Q000639:trends; D055815:Young Adult
keywords: Brain Injury; CVA; TBI; environment; outcome measure; rehabilitation