Using the Mayo-Portland Adaptability Index (MPAI-4) to evaluate multidisciplinary acquired brain injury rehabilitation services.
Rachael Mumme1, Miffy Durham1, Rose Blight1 1State Head Injury Unit, Nedlands, Western Australia, Australia
Abstract
Background and Objectives: The State Head Injury Unit (SHIU) is a multi-disciplinary service providing rehabilitation to clients post-acquired brain injury (ABI). Client outcomes are measured by Case Coordinators at client admission to, and discharge from, the service using the MPAI-4. The MPAI-4 aids the clinical evaluation of people with ABI during the post-acute period, and the evaluation of rehabilitation programs. This investigation sought to use existing MPAI-4 data to explore service level changes in client functioning during SHIU admission.
Method: Archival MPAI-4 data from 1987 – 2020 was analysed using examination of change statistics between MPAI-4 scores at admission and at discharge. This was completed across the three MPAI-4 sub-scales of ability, adjustment, and participation. Additionally, mean change scores were compared to established MPAI-4 clinical significance thresholds (i.e., a 5-point difference in T scores represents minimal clinically important difference whilst a 9-point difference in T scores is thought to represent robust clinically importance differences).
Results: The MPAI-4 scores of approximately 2500 clients were analysed. There were no additional inclusion criteria imposed beyond that of service eligibility. Examination of mean T-scores revealed lower scores at discharge across all three subscales indicating improved client function. Non-parametric t-tests revealed these differences were statistically significant across ability (z = 28.722, 1484, p < .001), adjustment (z = 34.945, 1586, p < .001), and participation (z = 35.353, 2214, p < .001). Mean change scores met criteria for robust clinically important differences with a 9-point reduction in ability, 11-point reduction in adjustment, and an 11-point reduction in participation.
Conclusions: Clients with an ABI showed a statistically and clinically significant improvement in functioning while engaged with the SHIU multi-disciplinary rehabilitation program.
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