Citation

Cogan AM, Weaver JA, Scholten J, Pape TB, Mallinson T. Arch. Phys. Med. Rehabil. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.apmr.2021.06.003

PMID

unavailable

Abstract

OBJECTIVE: To evaluate the structural validity of the Mayo-Portland Adaptability Inventory - Participation subscale (M2PI) in a sample of Veterans and to assess whether the tool functioned similarly for male and female Veterans DESIGN: Rasch analysis of M2PI records from the National Veterans TBI Health Registry database from 2012-2018. SETTING: National VA Polytrauma System of Care outpatient settings. PARTICIPANTS: Veterans with a clinically confirmed history of TBI (N = 6,065; 94% male). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): M2PI, a five-point Likert-type scale with eight items. For this analysis, the two employment items were treated individually for a total of nine items.

RESULTS: The employment items misfit the Rasch Measurement model (paid employment MnSq=1.40; other employment MnSq=1.34) and were removed from subsequent iterations. The final model had eigenvalue 1.87 on the 1(st) contrast, suggesting unidimensionality of the remaining 7 items. Item order from least to most participation restriction was transportation, self-care, residence management, financial management, initiation, leisure, and social contact. Wright's person separation reliability for non-normal distributions was 0.93 indicating appropriateness of M2PI for making individual-level treatment decisions. Mean person measure was -0.92 logits (SD 1.34) suggesting that participants did not report restrictions on most items (item mean = 0 logits). 3.8% of the sample had the minimum score (no impairment on all items) and 0.2% had the maximum score. Four items had different item calibrations (≥0.25 logits) for females compared to males but the hierarchy of items was unchanged when the female sample was examined separately.

CONCLUSION(S): These findings suggest that, although employment is a poor indicator of participation restrictions among Veterans with TBI, the M2PI is unidimensional. Because of subtle differences in scale function between male and female Veterans, M2PI should be part of a more thorough clinical interview about participation strengths and restrictions.

Language: en

Keywords

Traumatic brain injury; Veterans; Community participation; outcome assessment; psychometrics