Mayo-Portland Adaptability Inventory Research Articles

Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship

ObjectivesTo (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. DesignRetrospective analysis of program evaluation data for treatment completers and noncompleters. SettingHCBR conducted in 7 geographically distinct U.S. cities. ParticipantsIndividuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. InterventionHCBR delivered by certified professional staff on an individualized basis. Main Outcome MeasuresMayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. ResultsWith the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P<.001) with a moderate effect size (partial η2=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P<.001; partial η2=.08), Adjustment (F=99.67, P<.001; partial η2=.10), and Participation (F=69.15, P<.001; partial η2=.07). ConclusionsIndividuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.

Managing executive dysfunction following acquired brain injury and stroke using an ecologically valid rehabilitation approach: a study protocol for a randomized, controlled trial

BackgroundWe have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke.Methods/designWe will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function – Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile.DiscussionThis study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke.Trial registrationclinicaltrials.gov, Trial Identification Number: NCT01414348

Disability Rating Scale

T DISABILITY RATING SCALE (DRS) is an 8-item outcome measure that is one of the more frequently used measures in traumatic brain injury (TBI) research.1 The scale is sometimes referred to as the Rappaport DRS to discriminate the Disability Rating Scale from the Dementia Rating Scale (also abbreviated DRS). The popularity of the DRS is derived from its brief administration time, its usefulness in a large variety of settings or levels of care, its widespread acceptance and use in research, and its free availability in the public domain. The DRS was designed to measure changes in recovery in adults with TBI, where total scores are meant to reflect a level of disability.2 It has been recommended as a useful outcome measure for clinical trials involving individuals with brain injury and is currently classified as a Supplemental Measure within the National Institute of Neurological Disorders and Stroke Common Data Elements Project (www.commondataelements.ninds.nih. gov). The DRS has also been used to validate other brain injury outcome scales, including the Coma Recovery Scale, Mayo Portland Adaptability Inventory, Supervision Rating Scale, and the Community Integration Questionnaire.3 Because of the brief administration time, one important benefit of the DRS is the efficiency at which it can be administered and the ability for researchers to complete it over the phone. The DRS is also unusual in that it has the ability to describe disability for individuals in a wide variety of settings, from acute care hospitals

The Arabic version of the Mayo-Portland Adaptability Inventory 4

The Mayo-Portland Adaptability Inventory 4 (MPAI-4) is a valid and reliable assessment tool to detect clinical impairments in patients with acquired brain injury. The tool is widely used by rehabilitation therapists worldwide, given its good psychometric properties and its availability in several languages. The purpose of this study was to translate the tool into Arabic and to examine its validity and reliability with multiple sclerosis and stroke patients. A total of 128 participants were enrolled in this study: 49 with multiple sclerosis, 17 with stroke, and 62 healthy adults. The psychometric properties of discriminative and convergent construct validity as well as test-retest reliability were tested. The translated tool, the Arabic-MPAI-4 (A-MPAI-4), significantly discriminated among the three subgroups (F=50.93, P<0.001), correlated moderately but significantly with the Arabic version of the Performance Assessment of Self-Care Skills Self-Report as a measure of functional independence in daily activities (r=-0.35, P<0.001), and showed good stability over time (r=0.73, P<0.001). The A-MPAI-4 is a valid and reliable tool for clinical use with multiple sclerosis and stroke patients who speak Arabic.

Unique Contribution of Fatigue to Disability in Community-Dwelling Adults With Traumatic Brain Injury

ObjectiveTo examine the unique contribution of fatigue to self-reported disability in community-dwelling adults with traumatic brain injury (TBI). DesignA cross-sectional cohort design. SettingCommunity dwellings. ParticipantsAdults (N=50) with a history of mild to severe TBI were assessed. InterventionNot applicable. Main Outcome MeasuresThis study assessed the contribution of fatigue (Modified Fatigue Impact Scale) to disability (Mayo-Portland Adaptability Inventory), controlling for executive functions (Frontal Systems Behavior Scale), depression status (major depression in partial remission/current major depression/depressive symptoms or no history of depression), and initial injury severity (uncomplicated mild, complicated mild, moderate, or severe). ResultsFatigue was found to contribute uniquely to the variance in self-reported disability (β=.47, P<.001) after controlling for injury severity, executive functions, and depression status. The overall model was significant (F4,45=17.32, P<.001) and explained 61% of the variance in self-reported disability, with fatigue alone accounting for 12% of the variance in self-reported disability (F1,45=13.97, P<.001). ConclusionsFatigue contributes uniquely to disability status among community-dwelling adults with chronic TBI, independent of injury severity, executive functions, and depression. Addressing fatigue through targeted interventions may help to improve self-perceived disability in this population.

Executive Functioning and Adaptive Living Skills after Acquired Brain Injury

Executive dysfunction is common following brain injury, with impairments involving attention, social pragmatics, higher-order thinking, judgment, and reasoning. Executive function impairments may have a direct impact on an individual's ability to return to instrumental activities of daily living (IADL), including employment, money management, driving, and maintaining a residence. Research has shown that neuropsychological executive function measures may be able to predict daily-living skills. There is limited research evaluating the relationship between executive functions and IADLs in adults with acquired brain injuries (ABI), with none investigating levels of proficiency as related to specific test scores. We hypothesize that neuropsychological executive function measures will have significant and moderate-to-strong correlations with participant-rated proficiency on functional tasks as measured by the Mayo-Portland Adaptability Inventory. Results support that IQ and some of the executive function measures (Processing Speed, Working Memory, and Trail-Making Test-Part B) correlated significantly and strongly and explained unique variance in all IADLs in this study. Data suggest that individuals with ABI who performed in the higher end of the low-average range or higher on measures of executive functioning tend to require little or no assistance to be independent with transportation, money management, living without support, and employment. Results also suggest that individuals with less executive dysfunction are likely to have greater overall community participation.

Psychometric Properties of the Arab Heritage Activity Card Sort

The Activity Card Sort is a valid and reliable assessment tool that was created to assess Participation. It has been translated to several languages and adapted to different international cultures. The most recent version of this tool is the Arabic Heritage Activity Card Sort (A-ACS). The purpose of this study was to establish the psychometric properties of the new Arabic version in Jordanian adults. Forty three Jordanian patients with multiple sclerosis (MS) and 62 healthy adults were recruited to test the psychometric properties of the tool. The A-ACS correlated moderately with the participation index of the Mayo-Portland Adaptability Inventory (r = -0.458, p < 0.00) (concurrent validity), was able to discriminate between patients and healthy participants on the current and retained levels of participation (F = 5.09, p < 0.03; F = 6.01, p < 0.02, respectively) (discriminative validity), and correlated moderately with the total scores of the Mayo-Portland Adaptability Inventory (r = -0.458, p < 0.00) and the total score on the Arabic version of the self-report Performance Assessment of Self-care Skills (r = 0.581, p < 0.00) (convergent validity). The tool also showed good test-retest reliability (r = 0.80, p < 0.00) and excellent internal consistency (α = 0.90). The Arabic Heritage of the Activity Card Sort is a valid and reliable tool for Arabic-speaking occupational therapists to use when assessing participation in Jordanian patients with MS or healthy adults. Limitations of this study include using only one diagnostic group from Jordan and examining only the Recovery and Community Versions of the tool. Future studies are needed to examine further psychometric properties for patients with different diagnoses and from different countries in the Arabic region for all three versions of the A-ACS.

Mayo-Portland Adaptability Inventory: Comparing Psychometrics in Cerebrovascular Accident to Traumatic Brain Injury

Malec JF, Kean J, Altman IM, Swick S. Mayo-Portland Adaptability Inventory: comparing psychometrics in cerebrovascular accident to traumatic brain injury. Objectives(1) To evaluate the measurement reliability and construct validity of the Mayo-Portland Adaptability Inventory, 4th revision (MPAI-4) in a sample consisting exclusively of patients with cerebrovascular accident (CVA) using single parameter (Rasch) item-response methods; (2) to examine the differential item functioning (DIF) by sex within the CVA population; and (3) to examine DIF and differential test functioning (DTF) across traumatic brain injury (TBI) and CVA samples. DesignRetrospective psychometric analysis of rating scale data. SettingHome- and community-based brain injury rehabilitation program. ParticipantsIndividuals post-CVA (n=861) and individuals with TBI (n=603). InterventionsNot applicable. Main Outcome MeasureMPAI-4. ResultsItem data on admission to community-based rehabilitation were submitted to Rasch, DIF, and DTF analyses. The final calibration in the CVA sample revealed satisfactory reliability/separation for persons (.91/3.16) and items (1.00/23.64). DIF showed that items for pain, anger, audition, and memory were associated with higher levels of disability for CVA than TBI patients; whereas, self-care, mobility, and use of hands indicated greater overall disability for TBI patients. DTF analyses showed a high degree of association between the 2 sets of items (R=.92; R2=.85) and, at most, a 3.7 point difference in raw scores. ConclusionsThe MPAI-4 demonstrates satisfactory psychometric properties for use with individuals with CVA applying for interdisciplinary posthospital rehabilitation. DIF reveals clinically meaningful differences between CVA and TBI groups that should be considered in results at the item and subscale level.

Anosognosia and Multiple Sclerosis (P02.037)

Objective: To determine the prevalence of anosognosia in a MS population. Background Anosognosia can be defined as an impaired ability to recognize the presence of disease. Is frequently observed in other neurological processes but is sparse studied in MS patients. Design/Methods: 39 (27 females and 12 males) with diagnosis of definite MS, ( Poser and Mc Donalds) were studied. The mean age was 34.6 years(SD 5.9) and the clinical picture was RR in 24 cases, and SP in the remaining 14 patients. The mean time of evolution was 4.7 years and the mean EDSS was 3.0 (SD 2.0). The education period was 8.4 years .All the patients were evaluated utilizing clinical and neuropsychological assesment. The specific scales in order to evaluate anosognosia were the Visual-Analogue Test assesing anosognosia for motor impairment (VATA-m) and the Mayo-Portland Adaptability Inventory (MPAI). The severity and stages of this disorder were measured utilizing the Bisiach Scale. Particular emphasis was directed in the observation of coincidences between caregivers and patients related to the IADL .Correlation between MRI number,size, severity and localization of lesions was stablished. Results: We observed a highly prevalence of anosognosia (59%), with remarkable dissociation between the perception of this symptoms when scales were administered to patients and caregivers. The grade was mainly 1 or 2 and the awareness of impairment was mainly linked to deficits in neurocognitive tasks and fine motility skills. Our findings correlated possitively with EDSS, evolution time and the presence of a large number of lesions located in the right temporo-parietal subcortical areas. No relationship with other variables were observed. Conclusions: Anosognosia is a highly prevalent disorder in MS patients, suggesting a dysfunction in the mechanisms of self awareness, with implications in the ADL and with predictive value on poor functional outcome. Neuroimaging studies revealed more often localization of lesions in right parieto temporal hemispheric localization. Disclosure: Dr. Reich has nothing to disclose. Dr. Arias has nothing to disclose. Dr. Kerszberg has nothing to disclose.

Factors associated with the occurrence of sentinel events during transition from hospital to home for individuals with traumatic brain injury

To describe the timing and factors associated with the occurrence of sentinel events (financial strain, difficulty accessing therapy, return to work, accommodation change and independent transport use) during transition to the community for individuals with traumatic brain injury. Longitudinal cohort design with data collected pre discharge and at 1, 3 and 6-month follow-ups. Individuals with moderate to severe traumatic brain injury (n = 127), discharged home from acute care and inpatient rehabilitation. Data were collected using self-report questionnaires (sentinel events questionnaire, Mayo Portland Adaptability Inventory-4, Sydney Psychosocial Reintegration Scale, Depression Anxiety Stress Scale). Logistic regression was used to identify factors associated with sentinel events. The most commonly reported events were independent transport use and return to work, reported on 104 and 90 occasions, respectively. A longer hospital stay and poorer community integration were related to negative events (e.g. reduced therapy). The inverse relationship was seen for positive events. Links existed between sentinel events (e.g. previous financial strain increased the likelihood of this event in transition). This paper highlights the interplay between personal and environmental factors and life events in shaping transition experiences. Individualised service planning and monitoring of sentinel events is important to promote successful community transition.

Mapping the Mayo-Portland Adaptability Inventory to the International Classification of Functioning, Disability and Health

To examine the contents of the Mayo-Portland Adaptability Inventory (MPAI-4) by mapping it to the International Classification of Functioning, Disability and Health (ICF). Each of the 30 scoreable items in the MPAI-4 was mapped to the most precise ICF categories. All 30 items could be mapped to components and categories in the ICF. A total of 88 meaningful concepts were identified. There were, on average, 2.9 meaningful concepts per item, and 65% of all concepts could be mapped. Items in the Ability and Adjustment subscales mapped to categories in both the Body Functions and Activity/Participation components of the ICF, whereas all except 1 in the Participation subscale were to categories in the Activity/Participation component. The items could also be mapped to 34 (13%) of the 258 Environmental Factors in the ICF. This mapping provides better definition through more concrete examples (as listed in the ICF) of the types of body functions, activities, and participation indicators that are represented by the 30 scoreable MPAI-4 items. This may assist users throughout the world in understanding the intent of each item, and support further development and the possibility to report results in the form of an ICF categorical profile, making it universally interpretable.

Association between cognitive performance and functional outcome following traumatic brain injury: A longitudinal multilevel examination.

Individuals' cognitive abilities predict functional outcomes following traumatic brain injury (TBI). However, it is not known to what extent concurrent cognitive abilities affect the magnitude or the rate of functional recovery. The current study modeled the progression of functional outcome as it related to background, injury severity, and cognitive variables over the first year postinjury. This study comprised 111 individuals with moderate-to-severe TBI assessed on average at 3, 6, and 13 months postinjury. In addition, 79 healthy controls were assessed at a single time point. Each assessment consisted of an administration of a neuropsychological battery--comprising measures of memory, information processing speed, and executive functions--as well as an administration of the Mayo-Portland Adaptability Inventory to examine functional outcomes. Older age, lower levels of education, and greater days of posttraumatic amnesia were associated with poorer functional outcomes. The addition of cognitive variables resulted in better models than simply considering background and injury severity variables. However, the results showed that the model comprising executive functions best characterized the progression of functional outcomes. The findings indicate that consideration of cognitive ability, rather than reliance on demographic and injury severity variables, provide a more accurate representation of functional outcome over the first year postinjury. In addition, the results suggest that specific cognitive domains, particularly executive functions, are likely to have the strongest effect on functional outcomes.

Progress Assessed With the Mayo-Portland Adaptability Inventory in 604 Participants in 4 Types of Post–Inpatient Rehabilitation Brain Injury Programs

Eicher V, Murphy MP, Murphy TF, Malec JF. Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post–inpatient rehabilitation brain injury programs. Objective To compare progress in 4 types of post–inpatient rehabilitation brain injury programs. Design Quasiexperimental observational cohort study. Setting Community and residential. Participants Individuals (N=604) with acquired brain injury. Interventions Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments. Main Outcome Measure Mayo-Portland Adaptability Inventory (MPAI-4). Results Program types differed in participant age (F=10.69, P<.001), sex (χ 2=22.38, P<.001), time from first to second assessment (F=20.71, P<.001), initial MPAI-4 score (F=6.89, P<.001), and chronicity (F=13.43, P<.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores. Conclusions Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs.

Post-injury personality in the prediction of outcome following severe acquired brain injury

Primary objective: The aim of the study was to examine the utility of five measures of non-cognitive neurobehavioural (NCNB) changes that often occur following acquired brain injury, in predicting outcome (measured in terms of participation and social adaptation) at 1-year follow-up.Research design: The study employed a longitudinal, correlational design.Methods and procedures: Multiple regression was employed to investigate the value of five new NCNB measures of social perception, emotional regulation, motivation, impulsivity and disinhibition in the prediction of outcome as measured by the Mayo-Portland Adaptability Inventory (MPAI).Main outcomes and results: Two NCNB measures (motivation and emotional regulation) were found to significantly predict outcome at 1-year follow-up, accounting for 53% of the variance in MPAI total scores.Conclusions: These measures provide a method of quantifying the extent of NCNB changes following brain injury. The predictive value of the measures indicates that they may represent a useful tool which could aid clinicians in identifying early-on those whose symptoms are likely to persist and who may require ongoing intervention. This could facilitate the planning of rehabilitation programmes.

Are Vision-Specific Quality of Life Questionnaires Important in Assessing Rehabilitation for Patients With Hemianopia Post Stroke?

Objective: To explore the relationship between disability and functional measures with vision-specific quality of life (QoL) measures for people with hemianopia and stroke. Method: The Behavioral Inattention Test (BIT) and the Mayo-Portland Adaptability Inventory (MPAI) were compared with scores on 2 vision-specific QoL measures, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Veteran Low Vision Visual Function Questionnaire (VA LV VFQ-48). Setting: Rehabilitation hospitals in Adelaide, South Australia. Participants: Stroke patients (n = 24) with homonymous hemianopia. Results: Most of the BIT and MPAI scores were significantly associated with the NEI VFQ-25 and VA LV VFQ-48 scores. Behavioral test scores of the BIT and the MPAI total score correlated with more aspects of the QoL measures than the other components of the BIT and the MPAI. Conclusion: BIT and MPAI measure constructs associated with QoL for people with hemianopia following stroke. Vision-specific QoL questionnaires can complement the functional instruments by identifying the domains of difficulty, based on the instrument’s subscale, that can guide rehabilitation therapists to address the person’s deficit.

Rasch measurement analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a community-based rehabilitation sample.

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 essential, the iterative process of instrument refinement is often neglected. This present study was undertaken to examine validity, reliability, dimensionality and item estimate invariance of the Mayo-Portland Adaptability Inventory - 4 (MPAI-4), an outcome measure for persons with ABI. The sampled population included 603 persons with traumatic ABI participating in a home- and community-based rehabilitation program. Results indicated that the MPAI-4 is a valid, reliable measure of outcome following traumatic ABI, which measures a broad but unitary core construct of outcome after ABI. Further, the MPAI-4 is composed of items that are unbiased toward selected subgroups except where differences could be expected [e.g., more chronic traumatic brain injury (TBI) patients are better able to negotiate demands of transportation than more acute TBI patients]. We address the trade-offs between strict unidimensionality and clinical applicability in measuring outcome, and illustrate the advantages and disadvantages of applying single-parameter measurement models to broad constructs.

Sense of coherence and disability and the relationship with life satisfaction 6–15 years after traumatic brain injury in northern Sweden

The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18–65 years) who were 6–15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.

Ecological validity of the screening module and the Daily Living tests of the Neuropsychological Assessment Battery using the Mayo-Portland Adaptability Inventory-4 in postacute brain injury rehabilitation.

The assessment of ecological validity of neuropsychological measures is an area of growing interest, particularly in the postacute brain injury rehabilitation (PABIR) setting, as there is an increasing demand for clinicians to address functional and real-world outcomes. In the current study, we assessed the predictive value of the Screening module and the Daily Living tests of the Neuropsychological Assessment Battery (NAB) using clinician ratings from the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in patients with moderate to severe traumatic brain injury. Forty-seven individuals were each administered the NAB Screening module (NAB-SM) and the NAB Daily Living (NAB-DL) tests following admission to a residential PABIR program. MPAI-4 ratings were also obtained at admission. Linear regression analysis was used to examine the association between these functional and neuropsychological assessment measures. We replicated prior work (Temple at al., 2009) and expanded evidence for the ecological validity of the NAB-SM. Furthermore, our findings support the ecological validity of the NAB-DL Bill Payment, Judgment, and Map Reading tests with regards to functional skills and real-world activities. The current study supports prior work from our lab assessing the predictive value of the NAB-SM, as well as provides evidence for the ecological validity for select NAB-DL tests in patients with moderate to severe traumatic brain injury admitted to a residential PABIR program.

Development of Depressive Symptoms During Early Community Reintegration After Traumatic Brain Injury

The early onset of depression following traumatic brain injury (TBI) is associated with poorer psychosocial outcomes; however, the direction of this relationship is unclear. This study investigated the relationship between progress in resuming preinjury lifestyle (transition events), change in perceived functioning and level of depressive symptoms at discharge and 3-months postdischarge. As part of a prospective longitudinal study of brain injury outcomes, 96 consecutively discharged patients with TBI completed measures of transition events (Sentinel Events Questionnaire) and perceived functioning (Mayo-Portland Adaptability Inventory-4 Ability and Adjustment indices) at discharge and 3-months follow-up. Level of depressive symptoms was assessed at discharge and 3-months follow-up using the Depression Anxiety Stress Scale 21. After controlling for age and discharge depressive symptoms, change in perceived functioning was found to mediate the relationship between total transition events and depressive symptoms at 3-months postdischarge (β reduced from .21 to .14), with a significant indirect effect observed. The present findings indicate that lack of progress in resuming preinjury lifestyle contributes to postdischarge depressive symptoms through an influence on perceived functioning, thus providing an improved conceptualization of reactive depression in the context of brain injury.

Effectiveness of Community-Based Rehabilitation After Traumatic Brain Injury for 489 Program Completers Compared With Those Precipitously Discharged

Altman IM, Swick S, Parrot D, Malec JF. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged. Objective To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR). Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities. Participants Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group). Intervention PABIR delivered in home and community settings by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact. Results Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up. Conclusions Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up.