OBJECTIVES To determine whether the measurement properties of the Mayo-Portland Adaptability Inventory-Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted as two outcome measures in the Veterans Health Administration (VHA) National Polytrauma Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain injury (mTBI). DESIGN Cross Sectional SETTING: Outpatient rehabilitation PARTICIPANTS: 177 post-deployment veterans diagnosed with blast-related mild traumatic brain injury. INTERVENTION Not applicable. MAIN MEASURES Mayo-Portland Adaptability Inventory-Version 4 (MPAI-4) and Community Integration Questionnaire (CIQ) RESULTS: The unidimensional factor structure of the MPAI-4 total and three index scores (abilities, adjustment and participation) were confirmed. Eight of the 30 items were removed for violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale was collapsed from five to three ratings due to structure issues. The remaining 22 MPAI-4 items demonstrated excellent item/person reliability (0.98/0.91) and separated person ability into four strata. Two of the MPAI-4 index scores (abilities and adjustment) had good measurement properties. The third index, M2PI, only retained three items that had adequate person reliability (0.75) but only separated person ability into two strata. A significant but fair association with the CIQ was demonstrated with the modified MPAI-4. CONCLUSIONS The MPAI-4 has been validated in moderate to severe TBI but required modification when used in active military personnel with mTBI. We also identified the need for modification of the MPAI-4 to support adequate psychometrics when measuring outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans and active military personnel with mTBI, to determine whether the M2PI should continue to be used as an outcome measure in the VHA Polytrauma rehabilitation systems.

中文翻译：

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MPAI-4 在 mTBI 退伍军人中的测量特性

目的 确定 Mayo-Portland Adaptability Inventory-Version 4 (MPAI-4) 的测量特性及其参与指数 (M2PI) 是否已被退伍军人健康管理局 (VHA) 国家多发伤康复系统作为两个结果指标采用的护理，对于轻度创伤性脑损伤 (mTBI) 的退伍军人来说是足够的。设计横断面设置：门诊康复参与者：177 名被诊断患有爆炸相关轻度创伤性脑损伤的部署后退伍军人。干预 不适用。主要衡量指标 Mayo-Portland Adaptability Inventory-Version 4 (MPAI-4) 和社区融合问卷 (CIQ) 结果：确认了 MPAI-4 总分和三个指标分数（能力、调整和参与）的单维因素结构。30 项中的 8 项因违反单调性（6 项）和超过 Rasch infit（2 项）而被删除。由于结构问题，评级量表从 5 级降至 3 级。其余 22 个 MPAI-4 项目表现出出色的项目/人可靠性（0.98/0.91）并将人的能力分为四个层次。MPAI-4 指标得分中的两个（能力和调整）具有良好的测量特性。第三个指标M2PI只保留了三​​个具有足够人信度（0.75）的项目，但只将人的能力分为两个层次。修改后的 MPAI-4 证明了与 CIQ 的显着但公平的关联。结论 MPAI-4 已在中度至重度 TBI 中得到验证，但当用于患有 mTBI 的现役军人时需要修改。我们还确定需要修改 MPAI-4，以在测量 mTBI 退伍军人的结果时支持足够的心理测量学。对于患有 mTBI 的退伍军人和现役军人，需要对 M2PI 进行额外验证，以确定 M2PI 是否应继续用作 VHA 多创康复系统中的结果测量。