Table 5 - uploaded by Jacob Kean
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The precise measurement of patient outcomes depends upon clearly articulated constructs and refined clinical assessment instruments that work equally well for all subgroups within a population. This is a challenging task in those with acquired brain injury (ABI) because of the marked heterogeneity of the disorder and subsequent outcomes. Although e...
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Background:
Acquired Brain injury (ABI) is a very critical event in a family, as it is a highly distressing and traumatic experience, imposing a very deep reorganization of the whole family.
Objective:
This study aims to evaluate the possible correlation between the family aspects and the patients' functional outcomes after rehabilitation.
Meth...
Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the c...
Citations
... 2. The Disability Rating Scale (DRS) uses eight clinicianrated items to chart an individual's recovery and has good internal consistency (a ¼ .83-.84) and inter-rater reliability (r ¼ .91-.98) (Malec et al., 2012). 3. The Mayo-Portland Adaptability Inventory (MPAI) (Malec et al., 2007) assesses barriers to community integration through thirty-five questions exploring ability, adjustment, participation, and behaviors following a brain injury and is rated on a 5-point Likert scale, and is shown to have adequate validity and reliability (Kean et al., 2011). 4. The Community Integration Questionnaire (CIQ) (Willer et al., 1993) is a 15-item measure that aims to assess an individual's functioning in three domains; home, social, and productivity. ...
Objectives:
Deficits in executive functioning are a common consequence of Traumatic Brain Injury (TBI) and the severity of TBI is known to predict functional outcomes. In this review, the authors examine the ability of three commonly used tests of executive functioning [The Trail Making Test (TMT-B), The Wisconsin Card Sorting Test (WCST), and Verbal Fluency (VF)] to predict domains of function.
Methods:
Seven hundred and twenty articles were identified and twenty-four met inclusion criteria (original articles published in English examining an adult TBI population). Data were subject to a study quality analysis and then meta-analyzed to assess whether tests of executive functioning (TMT-B, WCST, and VF) can predict functional, employment, and driving outcomes following a TBI.
Results:
The TMT-B (r = 0.29; 95% CI 0.17-0.41) and the WCST (r = 0.20; 95% CI 0.02-0.37) were significantly associated with functional outcomes. The TMT-B was also associated with a person's ability to return to driving (r = 0.3890; 95% CI 0.2678-0.5103). No test of executive functioning was associated with employment outcomes following a TBI.
Conclusion:
These findings are important to guide rehabilitation strategies and future planning. This review has also highlighted the scarcity of research on specific outcomes.
... The MCID is 5 T-score points for total MPAI-4 [28]. The MPAI-4 is a widely used and well-validated instrument for the evaluation of psychosocial functioning in both TBI and stroke samples [27,29] and displays adequate psychometric properties both for the use of the total score and the three major domains [27,30]. Individual items within the scale are also considered valid for analysis [27]. ...
Objectives:
This study aimed to evaluate the mediational role of change in psychosocial abilities, adjustment and participation on change in motor and cognitive function from admission to discharge from a staged community-based brain injury rehabilitation (SCBIR) service in Western Australia, 2011-2020.
Methods:
A retrospective cohort study of n = 324 adults with ABI enrolled in SCBIR using routinely collected rehabilitation outcome measures data. Motor and cognitive function were assessed with the UK Functional Independence and Assessment Measure and psychosocial function with the Mayo-Portland Adaptability Inventory-4. Six multilevel mediation regression analyses were conducted to determine whether change in psychosocial function (abilities, adjustment and participation) mediated change in motor and cognitive function from admission to discharge.
Results:
Participants demonstrated clinically significant improvements in both motor (+ 11.8, p < 0.001) and cognitive (+ 9.5, p < 0.001) functioning from admission to discharge. Statistically significant improvements in psychosocial abilities (- 4.8, p < 0.001), adjustment (- 2.9, p = 0.001) and participation (- 2.5, p < 0.001) were also seen but were not clinically significant. Mediation analyses showed that participation accounted for 81% of improvements in motor function at discharge and 71% of cognitive function improvements. Adjustment accounted for 26% and 32% of change in motor and cognitive function, respectively. Abilities accounted for 60% of change in cognitive function but did not significantly influence change in motor function. Changes in psychosocial participation fully mediated change in motor function during neurorehabilitation.
Conclusions:
Psychosocial function, particularly participation, is an important driver of motor and cognitive recovery throughout neurorehabilitation. Functional rehabilitation programs should target psychosocial improvement as an important mechanism of change.
... Participants rate the following activities on a 5-point scale from 0 (i.e., no participation restriction) to 4 (i.e., severe participation restriction): initiation of activities; social contact; leisure and recreational activities; self-care; residence management (e.g., meal preparation); transportation; employment/other employment; and, financial management. The full Mayo-Portland Adaptability Inventory-4 is valid and reliable among community-based individuals living with TBI, and its subscales (i.e., the M2PI) can be used as standalone assessments (34)(35)(36). The M2PI has exhibited adequate psychometric properties when administered to post-9/11 Veterans with TBI (37). ...
Background
Sleep problems are common among Veterans with mild traumatic brain injury (mTBI) and may contribute to participation restrictions. However, explanatory mechanisms underlying this relationship are poorly understood. Sleep problems are associated with post-concussive symptoms (e.g., headaches). In turn, post-concussive symptoms contribute to participation restrictions. We hypothesized that post-concussive symptom severity mediates the purported relationship between sleep problems and participation restrictions among Veterans with mTBI.
Materials and Methods
This study was a retrospective analysis of clinical data among 8,733 Veterans with mTBI receiving Veterans Health Administration outpatient care. Sleep problems (yes/no) were identified using the sleep-related item from the Neurobehavioral Symptom Inventory (NSI). Post-concussive symptoms were measured using remaining NSI items. Participation restrictions were measured using the Mayo-Portland Adaptability Inventory Participation Index. We specified a latent variable path model to estimate relationships between: (1) sleep problems and three latent indicators of post-concussive symptoms [vestibular-sensory (e.g., headache)]; mood-behavioral [e.g., anxiety]; cognitive [e.g., forgetfulness]); and, (2) the three latent indicators of post-concussive symptoms and two latent indicators of participation restrictions (social and community participation [e.g., leisure activities]; productivity [e.g., financial management]). We examined the indirect effects of sleep problems upon participation restrictions, as mediated by post-concussive symptoms. Estimates were adjusted for sociodemographic factors (e.g., age), injury characteristics (e.g., blast), and co-morbid conditions (e.g., depression).
Results
87% of Veterans reported sleep problems. Sleep problems were associated with greater social and community participation restrictions, as mediated by mood-behavioral ( β = 0.41, p < 0 .001) and cognitive symptoms ( β = 0.13, p < 0 .001). There was no evidence that vestibular-sensory symptoms mediated this relationship ( β = -0.01, p = 0 .48). Sleep problems were associated with greater productivity restrictions, as mediated by vestibular-sensory ( β = 0.16, p < 0 .001) and cognitive symptoms ( β = 0.14, p < 0 .001). There was no evidence that mood-behavioral symptoms mediated this relationship ( β = 0.02, p = 0 .37).
Discussion
Findings suggest that evidence-based sleep treatment should occupy a prominent role in the rehabilitation of Veterans with mTBI. Indirect effects of sleep problems differed when considering impact on social and community participation vs. productivity, informing individualized rehabilitative care for Veterans with mTBI.
... The subscales can be used separately or combined in a total MPAI-4 score, reflecting the general level of adaptation and SP. The psychometric properties of the MPAI-4 have been supported in several studies [17][18][19][20][21][22][23][24][25][26][27][28][29] and the questionnaire is now used worldwide in inpatient, outpatient and vocational rehabilitation settings to measure TBI patients' progress and outcome. [30][31][32][33][34] The MPAI-4 is available in many languages, and recently the French-Canadian version of the MPAI-4 underwent cultural adaptation and validation. ...
Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care, and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (N = 372) were adults admitted to an inpatient-outpatient rehabilitation pathway or an outpatient rehabilitation pathway after sustaining a TBI between 2016 and 2020, and for whom Mayo-Portland Adaptability Intentory-4 (MPAI-4) outcomes were prospectively obtained at the start and end of rehabilitation. Additional data was collected from medical files. For both rehabilitation pathways, predicted SP outcome was MPAI-4 Participation score at discharge from outpatient rehabilitation. Multiple regression models investigated the predictive value of each variable for SP outcome, separately for each care pathway. Main findings show that for the inpatient-outpatient sample, three variables (education years, MPAI-4 Ability and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 49% of the variance. For the outpatient sample, five variables (premorbid hypertension and mental health diagnosis, total indirect rehabilitation hours received, MPAI-4 Abilities and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 47% of the variance. In conclusion, different premorbid and post-injury variables are involved in predicting SP, depending on the rehabilitation path followed. The predictive value of those variables could help clinicians identify patients more likely of showing poorer SP at discharge and who may require additional or different interventions.
... These include initiation, social contact, leisure and recreation, self-care, residence, employment, transportation, and managing money and finances. The items are rated on a scale of 0-4, with higher scores indicating lower participation [76,77]. Scores are converted into T-scores representing different participation limitation levels: scores beneath 30 indicate relatively high participation; scores between 30 and 40 indicate mild limitations; scores between 40 and 50 indicate mild to moderate limitations; scores above 60 indicate severe limitations [77]. ...
... It has been well established that the MPAI-4 provides satisfactory internal consistency (Cronbach's α = 0.85-0.90) [78] and high construct, concurrent, and predictive validity for the full questionnaire and its subscales [76,79]. Furthermore, the MPAI-4 shows sensitivity to clinical change after rehabilitation [80,81]. ...
Abstract: This exploratory study aimed to examine multiple aspects of the participation of adults
in the chronic phase following acquired brain injury (ABI), considering different disability levels.
Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without
severe cognitive decline. Primary measures included the Canadian Occupational Performance
Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation
Index (objective participation). The results indicated subjective participation problems in all of the
International Classification of Functioning, Disability and Health participation domains. In addition,
objective participation was reported as most limited in the areas of leisure and recreational activities,
residence, and employment. Both subjective and objective participation profiles varied according
to the disability level except for the social and leisure areas, which were found to be similar across
all subgroups. However, only partial compatibility was found between the subjective and objective
participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety
of subjective and objective participation concerns that varied according to their disability levels.
Moreover, the incongruity between the participation aspects suggests that the level of limitation
may not necessarily correspond to the importance of a particular participation area. This highlights
the need for comprehensive assessments to determine unique individual participation profiles in
order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling
ABI survivors.
... These include initiation, social contact, leisure and recreation, self-care, residence, employment, transportation, and managing money and finances. The items are rated on a scale of 0-4, with higher scores indicating lower participation [76,77]. Scores are converted into T-scores representing different participation limitation levels: scores beneath 30 indicate relatively high participation; scores between 30 and 40 indicate mild limitations; scores between 40 and 50 indicate mild to moderate limitations; scores above 60 indicate severe limitations [77]. ...
... It has been well established that the MPAI-4 provides satisfactory internal consistency (Cronbach's α = 0.85-0.90) [78] and high construct, concurrent, and predictive validity for the full questionnaire and its subscales [76,79]. Furthermore, the MPAI-4 shows sensitivity to clinical change after rehabilitation [80,81]. ...
... El Inventario de Adaptabilidad Mayo-Portland (MPAI-4 por sus siglas en inglés) consta de 30 ítems diseñados para evaluar las limitaciones comunes luego de sufrir un daño cerebral, ha sido implementado en Estados Unidos y otras partes del mundo para evaluar a participantes de programas de rehabilitación posoperatoria, a partir de la medición del índice de capacidad, ajuste y participación (Kean, Malec, Altman, y Swick, 2011). Se realizó un análisis estadístico del estado de salud de pacientes vinculados a una institución de rehabilitación que implementa la RBC, al aplicar el inventario los investigadores evidenciaron que las personas cuentan con una excelente cobertura respecto al rango de habilidades y actividades al participar en un programa de rehabilitación ambulatorio; en este sentido, destacan la importancia de adaptar un modelo logístico para identificar las secuelas y limitaciones clínicas que tienen pacientes con lesiones graves y, por consiguiente, proveer mejoras en los tratamientos realizados en centros de atención hospitalaria y en casa (Kean, Malec, Altman, y Swick, 2011). ...
... El Inventario de Adaptabilidad Mayo-Portland (MPAI-4 por sus siglas en inglés) consta de 30 ítems diseñados para evaluar las limitaciones comunes luego de sufrir un daño cerebral, ha sido implementado en Estados Unidos y otras partes del mundo para evaluar a participantes de programas de rehabilitación posoperatoria, a partir de la medición del índice de capacidad, ajuste y participación (Kean, Malec, Altman, y Swick, 2011). Se realizó un análisis estadístico del estado de salud de pacientes vinculados a una institución de rehabilitación que implementa la RBC, al aplicar el inventario los investigadores evidenciaron que las personas cuentan con una excelente cobertura respecto al rango de habilidades y actividades al participar en un programa de rehabilitación ambulatorio; en este sentido, destacan la importancia de adaptar un modelo logístico para identificar las secuelas y limitaciones clínicas que tienen pacientes con lesiones graves y, por consiguiente, proveer mejoras en los tratamientos realizados en centros de atención hospitalaria y en casa (Kean, Malec, Altman, y Swick, 2011). Es imprescindible la aplicación de diseños estadísticos que permitan evaluar la evolución de los sujetos participantes en la RBC, la variación de índices es un punto de partida para establecer mejoras y optimizar la intervención del equipo interdisciplinario. ...
771 | Resumen El propósito del artículo consiste en identificar estrategias de rehabilitación im-plementadas en pacientes con amputación o lesiones asociadas a sucesos trau-máticos, en el marco de conflictos armados y modelos innovadores de rehabili-tación con enfoque comunitario. Se realizó un análisis bibliométrico mediante un software de vigilancia tecnológica, para luego proceder a una revisión siste-mática de literatura científica. Los resultados señalan las tendencias del periodo 2000-2017, a partir de estudios de caso en diferentes contextos de guerra; por lo cual, se analizaron modelos de rehabilitación relacionados con aprendizaje pedagógico, tratamientos especializados en realidad virtual y funcionamiento en comunidad. Palabras Clave: Víctimas; minas antipersonales; rehabilitación; revisión siste-mática, conflicto armado. Abstract The purpose of the article is to identify rehabilitation strategies implemented in patients with amputation or injuries associated with traumatic events, in the framework of armed conflicts and innovative models of rehabilitation with community approach. A bibliometric analysis was carried out by means of a technological surveillance software, and, then, a systematic review of scientific literature was conducted. The results show the trends of the 2000-2017 period, based on case studies in different war contexts. Therefore, rehabilitation models related to pedagogical learning, specialized treatments in virtual reality, and community functioning were analyzed.
... Since TBI may affect many areas of functioning as well as community integration and emotional adjustment, it would be of value to measure outcome with more detailed outcome scales. The Mayo-Portland Adaptability Index (MPAI-4 [11]) has been developed specifically to measure these aspects of outcome after brain injury and has been demonstrated to be a valid and reliable instrument [12,13]. To our knowledge, no studies have been published relating BNIS to more detailed measures of long-term outcome after sTBI. ...
The objective was to investigate the relationship between early global cognitive functioning using the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and cognitive flexibility (Trail Making Test (TMT), TMT B-A), with long-term outcome assessed by the Mayo-Portland Adaptability Index (MPAI-4) in severe traumatic brain injury (sTBI) controlling for the influence of cognitive reserve, age, and injury severity. Of 114 patients aged 18–65 with acute Glasgow Coma Scale 3–8, 41 patients were able to complete (BNIS) at 3 months after injury and MPAI-4 5–8 years after injury. Of these, 33 patients also completed TMT at 3 months. Global cognition and cognitive flexibility correlated significantly with long-term outcome measured with MPAI-4 total score (rBNIS = 0.315; rTMT = 0.355). Global cognition correlated significantly with the participation subscale (r = 0.388), while cognitive flexibility correlated with the adjustment (r = 0.364) and ability (r = 0.364) subscales. Adjusting for cognitive reserve and acute injury severity did not alter these relationships. The effect size for education on BNIS and TMT scores was large (d ≈ 0.85). Early screenings with BNIS and TMT are related to long-term outcome after sTBI and seem to measure complementary aspects of outcome. As early as 3 months after sTBI, educational level influences the scores on neuropsychological screening instruments.
... The items are rated on a scale of 0-4, with higher scores indicating more problems and limitations. The total score reflects overall disability [51,52]. The scores are converted into standardized Tscores that represent different levels of participation: below 30 = relatively good participation; 30-40 = mild limitations; 40-50 = mild to moderate limitations; 50-60 = moderate to severe limitations; above 60 = severe limitations [52]. ...
... The MPAI-4 is widely used by rehabilitation professionals to evaluate individuals after ABI, and there is substantial evidence that it provides satisfactory internal consistency (Cronbach's α = 0.85-0.90) [53], as well as high construct, concurrent, and predictive validity for the full questionnaire and its subscales [51,54,55]. Further, the MPAI-4 shows sensitivity to clinical change after rehabilitation [56,57]. ...
This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability.
... Items are rated on a five-point scale (0-4) with higher scores indicating greater functional impairment. The index shows acceptable reliability (Kean et al., 2011). ...
Acquired brain injury (ABI) is often associated with personality changes. Pre- as well as post-injury personality traits are related to rehabilitation outcomes. However, it largely remains unclear whether post-injury personality shows any associations with rehabilitation outcomes over and above pre-injury personality. Using a case–control design, this study investigated (1) personality changes after ABI from patients' and significant others’ perspective, and (2) relations of pre- and post-ABI personality traits to rehabilitation outcomes in the short- and long-term. 40 patients with ABI (85% stroke, 15% traumatic brain injury), 46 healthy controls and their significant others participated. Personality was assessed with NEO-FFI, rehabilitation outcomes (activities, participation, depression) were measured at two and ten months after ABI. Patient-ratings indicated decreases in extraversion and a trend towards reduced conscientiousness. Significant others reported increases in patients’ neuroticism. Pre- as well as post-injury personality traits were associated with depression and activities at both short- and long-term timepoints after ABI. The association was strongest for long-term depressive symptoms where personality trait variables accounted for 49% of variance (Radjusted2). Our results confirm that ABI patients and significant others perceive personality changes, albeit in different dimensions. Pre- and post-ABI personality traits showed associations with rehabilitation outcomes, especially with emotional adjustment after the injury.
