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Kinney AR, Yan XD, Schneider AL, Rickles E, King SE, O'Donnell F, Forster JE, Brenner LA. Unmet Need for Outpatient Occupational Therapy Services Among Veterans With Mild Traumatic Brain Injury in the Veterans Health Administration: The Role of Facility Characteristics. Arch Phys Med Rehabil 2023; 104:1802-1811. [PMID: 37116557 DOI: 10.1016/j.apmr.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To investigate whether participation restrictions, an indicator of need for occupational therapy (OT), was associated with outpatient OT utilization in the Veterans Health Administration (VHA) among Veterans with mild traumatic brain injury (mTBI), and whether this relation differs by facility characteristics. DESIGN In a secondary analysis of national VHA data, we used modified Poisson regression to model OT utilization (yes/no) as a function of participation restrictions (Mayo-Portland Adaptability Inventory Participation Index [M2PI]), facility characteristics, and covariates. Facility characteristics included complexity, geographic region, and self-reported access to specialty care. Covariates included prior OT utilization, sociodemographic factors, injury characteristics, and spatial access (eg, drive time). Interactions estimated whether the relation between participation restrictions and OT utilization differed across facility characteristics. SETTING Outpatient setting in the VHA. PARTICIPANTS 8684 Veterans with a clinician-confirmed mTBI who received outpatient VHA care between 2012 and 2020 (N=8684). INTERVENTIONS None. MAIN OUTCOME MEASURE(S) OT utilization was measured within a year of M2PI administration using VHA administrative data. RESULTS Many Veterans who did not receive OT reported participation limitations, indicating unmet need for OT (eg, 67% with leisure restrictions). Participation restrictions were associated with increased likelihood of receiving OT (risk ratio [RR]=1.01; 95% confidence interval [CI]=1.006-1.019), suggesting a tendency for Veterans' OT-related needs to be satisfied. However, interactions indicated that this was not the case among Veterans receiving care in lower complexity facilities, and those in the South. Veterans with longer drive times were less likely to receive OT (RR=0.82; 95% CI=0.744-0.904). CONCLUSIONS Participation restrictions were associated with OT utilization, yet many Veterans with mTBI who may have benefited did not receive such care. Specific barriers to accessing OT (eg, OT practitioner supply) should be investigated. Novel care models can ensure access to OT services among Veterans seeking care at less-resourced and/or geographically distant VHA facilities.
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Affiliation(s)
- Adam R Kinney
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO; University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO.
| | - Xiang-Dong Yan
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
| | - Alexandra L Schneider
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
| | - Emma Rickles
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO
| | - Samuel E King
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO
| | - Frederica O'Donnell
- Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, DC
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO; University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, CO
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Aurora, CO; University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Aurora, CO
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Ataman R, Thomas A, Roberge-Dao J, McKerral M, Auger C, Wittich W, Kengne Talla P, Boychuck Z, Ahmed S. Measurement Properties of the Mayo-Portland Adaptability Inventory (MPAI-4) and Related Measures: A Systematic Review. Arch Phys Med Rehabil 2023; 104:1300-1313. [PMID: 36708857 DOI: 10.1016/j.apmr.2022.12.196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the Mayo-Portland Adaptability Inventory-version 4 (MPAI-4) and related measures' measurement properties and the quality of evidence supporting these results; and identify the interpretability and feasibility of the MPAI-4 and related measures. DATA SOURCES We conducted a systematic review according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. We searched 9 electronic databases and registries, and hand searched reference lists of included articles. STUDY SELECTION Two independent reviewers screened and selected all articles. From 605 retrieved articles, 48 were included. DATA EXTRACTION Two independent reviewers appraised the evidence quality and rated the extracted classical test theory and Rasch results from each study. DATA SYNTHESIS We used meta-analysis and COSMIN's approach to synthesize measurement properties evidence (insufficient, sufficient), and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to synthesize evidence quality (very low, low, moderate, high) by diagnosis (traumatic brain injury [TBI], stroke), and setting (inpatient, outpatient). The MPAI-4 and its subscales are sufficiently comprehensible (GRADE: very low), but there is currently no other content validity evidence (relevance, comprehensiveness). The MPAI-4 and its participation index (M2PI) have sufficient interrater reliability for stroke and TBI outpatients (GRADE: moderate), whereas interrater reliability between TBI inpatients and clinicians is currently insufficient (GRADE: moderate). There is no evidence for measurement error. For stroke and TBI outpatients, the MPAI-4 and M2PI have sufficient construct validity (GRADE: high) and responsiveness (GRADE: moderate-high). For TBI inpatients, the MPAI-4 and M2PI have mixed indeterminant/sufficient construct validity and responsiveness evidence (GRADE: moderate-high). There is 1 study with mixed insufficient/sufficient evidence for each MPAI-4 adaptation (21- and 22-item MPAI, 9-item M2PI) (GRADE: low-high). CONCLUSION Users can be most confident in using the MPAI-4 and M2PI in TBI and stroke outpatient settings. Future research is needed on reliability, measurement error, predictive validity, and content validity of the MPAI-4 and its related measures across populations and settings.
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Affiliation(s)
- Rebecca Ataman
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada; Institute of Health Sciences Education, McGill University, Montréal, Canada
| | - Jacqueline Roberge-Dao
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal, Montréal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, Canada
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, Montréal, Canada; School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Walter Wittich
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada; School of Optometry, Université de Montreal, Montréal, Canada
| | - Pascaline Kengne Talla
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Canada
| | - Zachary Boychuck
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada; McGill University Health Center, Clinical Epidemiology, Montréal, Canada.
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Merritt VC, Chanfreau-Coffinier C, Sakamoto MS, Jak AJ, Delano-Wood L. Characterizing Sex Differences in Clinical and Functional Outcomes Among Military Veterans with a Comprehensive Traumatic Brain Injury Evaluation (CTBIE): A Million Veteran Program (MVP) Study. Clin Psychol Sci 2022; 2022:10.1177/21677026221100230. [PMID: 36714216 PMCID: PMC9881235 DOI: 10.1177/21677026221100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using a diverse sample of military Veterans enrolled in the VA's Million Veteran Program (N=14,378; n=1,361 females [9.5%]; all previously deployed), we examined sex differences on the Comprehensive Traumatic Brain Injury Evaluation (CTBIE), a structured traumatic brain injury (TBI) interview routinely administered within the VA. Confirmed TBI diagnoses were more frequent among males than females (65% vs. 58%). Additionally, when compared to females, a greater proportion of males with CTBIE-confirmed TBI histories experienced blast-related injuries and were employed. In contrast, a greater proportion of females reported experiencing falls, sustaining a TBI since deployment, and having more severe neurobehavioral symptoms (particularly affective-related symptoms). Results indicate that males and females experience differential clinical and functional outcomes in the aftermath of military TBI. Findings underscore the need to increase female representation in TBI research to increase understanding of sex-specific experiences with TBI and to improve the clinical care targeted to this vulnerable population.
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Affiliation(s)
- Victoria C. Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States,Address correspondence to: Victoria C. Merritt, Ph.D., VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA 92161, Phone: (858) 552-8585 (x2670),
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - McKenna S. Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Amy J. Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States,Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
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Kinney AR, Yan XD, Schneider AL, King S, Forster JE, Bahraini N, Brenner LA. Post-concussive symptoms mediate the relationship between sleep problems and participation restrictions among veterans with mild traumatic brain injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:964420. [PMID: 36311204 PMCID: PMC9597091 DOI: 10.3389/fresc.2022.964420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Adam R. Kinney
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Correspondence: Adam R. Kinney
| | - Xiang-Dong Yan
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States
| | - Alexandra L. Schneider
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States
| | - Samuel King
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States
| | - Jeri E. Forster
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States,Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nazanin Bahraini
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States,Departments of Physical Medicine and Rehabilitation and Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa A. Brenner
- Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Aurora, CO, United States,Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Kinney AR, Stephenson RO, Cogan AM, Forster JE, Gerber HR, Brenner LA. Participation Mediates the Relationship Between Postconcussive Symptoms and Suicidal Ideation Among Veterans. Am J Occup Ther 2022; 76:23273. [PMID: 35486717 DOI: 10.5014/ajot.2022.048561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Veterans with mild traumatic brain injury (mTBI) and associated symptoms are at risk for suicide. Postconcussive symptoms (PCS) may heighten risk for suicidal thoughts by limiting veterans' participation. OBJECTIVE To investigate whether participation mediates the relationship between PCS and suicidal ideation. DESIGN Cross-sectional, exploratory design. Structural equation models were used to investigate whether participation mediated the relationship between PCS and suicidal ideation. SETTING Community. PARTICIPANTS Veterans with mTBI (N = 145). OUTCOMES AND MEASURES The Ohio State University TBI Identification Method was used to establish mTBI diagnosis. We identified latent variables for PCS and participation using the Neurobehavioral Symptom Inventory and select domains of the Medical Outcomes Study Short Form-36, respectively. We used the Beck Scale for Suicide Ideation to measure the presence of suicidal ideation. RESULTS Participation mediated the relationship between PCS and the presence of suicidal ideation (odds ratio [OR] = 1.09, p = .011). More severe PCS were associated with lesser participation (β = -.86, p < .001); greater participation was associated with lower odds of suicidal ideation (OR = 0.92, p = .007). CONCLUSIONS AND RELEVANCE PCS may heighten risk for suicidal thoughts among veterans by limiting successful participation, a primary target of occupational therapy intervention. Thus, the results suggest that occupational therapy practitioners can play a substantial role in suicide prevention services for veterans with mTBI. Preventive services could mitigate suicide risk among veterans with mTBI by enabling sustained engagement in meaningful and health-promoting activity (e.g., reasons for living) and targeting PCS. What This Article Adds: Researchers have proposed that occupational therapy practitioners can help prevent veteran suicide by supporting their engagement in meaningful, health-promoting activity and by targeting suicide risk factors within their scope of practice. To the best of our knowledge, this is the first study to offer empirical support for such proposed suicide prevention efforts. Although additional research is needed, these results are promising and highlight a distinct role for occupational therapy in suicide prevention.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - Ryan O Stephenson
- Ryan O. Stephenson, DO, is Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, and Medical Director of Polytrauma and Traumatic Brain Injury, Eastern Colorado Health Care System, Denver VA Medical Center, Denver, CO
| | - Alison M Cogan
- Alison M. Cogan, PhD, OTR/L, is Health Science Specialist at the Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jeri E Forster
- Jeri E. Forster, PhD, is Director of the Data and Statistical Core, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - Holly R Gerber
- Holly R. Gerber, MS, is Research Coordinator, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Doctoral Candidate, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA
| | - Lisa A Brenner
- Lisa A. Brenner, PhD, is Director, VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Aurora, CO, and Professor, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora
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Troyanskaya M, Pastorek NJ, Walder A, Wilde EA, Kennedy JE, Levin HS, Scheibel RS. Role of deployment-related mTBI and resilience in perceived participation limitations among Veterans. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maya Troyanskaya
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Nicholas J. Pastorek
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Annette Walder
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Elisabeth A. Wilde
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jan E. Kennedy
- DefenseTX And Veterans Brain Injury Center, Brooke Army Medical Center Ft Sam Houston, San Antonio, Texas, USA
- General Dynamics Information Technology Falls Church, Falls Church, Virginia, USA
| | - Harvey S. Levin
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurology, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine Houston, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine Houston, Houston, Texas, USA
| | - Randall S. Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center Houston, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Houston, Houston, Texas, USA
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Psychometric properties and sex differences on the Mayo-Portland Adaptability Inventory Participation subscale (M2PI) in Veterans with TBI. Arch Phys Med Rehabil 2021; 102:2193-2200.e3. [PMID: 34175272 DOI: 10.1016/j.apmr.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
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 1st 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.
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