Mayo-Portland Adaptability Inventory

The Mayo-Portland Adaptability Inventory (MPAI-4) is based on an earlier scale, the Portland Adaptability Inventory (Lezak 1987). Specifically designed for the evaluation of individuals during the post-acute period following ABI, the scale was developed to provide a representation of the sequelae of ABI through the use key indicators of abilities, activities and social participation (Malec 2004b). Assessment with the MPAI is intended to yield information applicable to the development and ongoing evaluation of rehabilitation services within this population (Malec 2003). 

The original version of the MPAI consisted of six subscales: physical/medical, cognition, emotion, everyday activities, social behaviours and behaviours (Bohac et al. 1997). Items were rated to reflect distinctions between impairment, disability and handicap as defined by the World Health Organization’s International Classification of Impairments, Disabilities and Handicaps (Malec & Lezak 2003; Malec et al. 2000). The MPAI has undergone successive revisions based on ongoing Rasch and multivariate analyses. The most current version is the MPAI-4, which evaluates the general dimension of sequelae of ABI in 3 sub-dimensions: ability, adjustment and participation (Malec 2004b).

The MPAI-4 consists of 29 items in 3 subscales (the Ability Index, the Adjustment Index and the Participation Index) plus an additional 6 items that are not included in the MPAI-4 score. The first 29 scale items are intended to reflect the current status of the individual with brain injury without attempting to determine whether their status might be influenced by factors other than ABI. The additional six, unscored items are intended to identify the presence of other factors that may be contributing to the individual’s current status (Malec & Lezak 2003).

In general, items are rated on a 5-point scale from 0 to 4 where 0 represents the most favourable outcome, no problem or independence, and 4 represents the presence of severe problems. A worksheet is provided that guides the user through the scoring and re-scoring of items. Following any necessary re-scoring, item scores are summed for each subscale to provide a raw score for that index. After making adjustment for items appearing in more than one index, subscale raw scores are summed to provide an overall adaptability index score. Raw scores for the indices and total scale may be converted to T-scores with a mean of 50 and a standard deviation of 10 using the tables provided in the manual (Malec & Lezak 2003). T-scores provided are based on data sets from two populations of individuals with ABI. They have not been referenced to non-ABI samples. In general, when compared to the reference populations with ABI, total T-scores less than 30 are indicative of good outcome, 30-40 of mild limitations, 40-50 of mild to moderate limitations, 50-60 of moderate to severe difficulties, and >60 of severe limitations (Malec & Lezak 2003).

The MPAI-4 was designed to be completed by professional staff, individuals who have experienced brain injury and/or their significant others. Ratings provided by any two or more of these groups can be combined to provide a more comprehensive composite score (Malec & Lezak 2003). When administered by professional staff, the ratings should be completed by team consensus. The MPAI-4 is free of charge. The manual and rating forms may be downloaded from the COMBI website (http://tbims.org/combi/mpai). A French translation of the rating form is also available from the website. 

Table: Characteristics of the Mayo-Portland Adaptability Inventory

Advantages. The MPAI is a readily available assessment of the post-acute sequelae of ABI. The Participation Index may be administered independently to provide a quick evaluation of participation outcomes. Differences in ratings between staff member consensus and individuals with ABI or between significant others and individuals with ABI may provide a measure of impaired self-awareness (Malec 2004a; Malec & Degiorgio 2002).

Limitations. The authors do not recommend the MPAI-4 for use in the assessment of individuals with very severe ABI (Malec & Lezak 2003). 

The authors reported that the placement of items in the 3 scale indices is based on a rational process in keeping with clinical observation and the results of ongoing analyses (Malec & Lezak 2003). However, the placement of some items appears odd. Self-care, for instance, is part of the participation index. In an earlier analysis, it was stated that it was more conceptually sound to place the self-care items with other basic skills such as use of hands, mobility and speech (Bohac et al. 1997). These basic items are currently part of the MPAI-4 abilities index. Other items, such as initiation, social contact and leisure skills/recreation were assigned to more than one index suggesting significant overlap between the subscales of adjustment and participation.

There are no published validation or reliability studies of the Mayo-Portland Adaptability that did not originate from the group responsible for the development of the scale. 

 

Summary-Mayo-Portland Adaptability Inventory

Interpretability: Tables are provided and raw scores are converted to standardized T-scores based on a national sample (n=386) or regional sample (n=134). No truly normative data is available for the purpose of comparison. 

Acceptability: May be completed by patients and significant others with trained professionals available to provide assistance. 

Feasibility: The MPAI-4 is free to download and copy. Administration, scoring and interpretation should be undertaken by trained professionals. The manual also contains a recommendation that a person capable in advanced psychometrics should be available. To maintain high levels of reliability, assessment should be completed by team consensus. 

 

Table: Mayo-Portland Adaptability Inventory Evaluation Summary

Reliability

Validity

Responsiveness

Rigor

Results

Rigor

Results

Rigor

Results

Floor/ceiling

+

+++ (IC)

+

++

+

+ (p-value only)

N/A

NOTE: +++=Excellent; ++=Adequate; +=Poor; N/A=insufficient information; TR=Test re-test; IC=Internal Consistency; IO=Interobserver; Varied (re. floor/ceiling effects; mixed results).