The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory.
James F Malec, Jacob Kean, Patrick O Monahan
PMID 28489702WHAT IT FOUND
A 5-point rise on the MPAI-4 total score may mark the smallest meaningful improvement, and a 9-point rise a moderate improvement, in adults during post-inpatient brain injury rehabilitation.
Key findings
01Both hypothesised change values separated groups with significant change from intensive rehabilitation from groups with stable function in supported living, and the 5T value gave the clearest separation.
02Expert clinicians rated 99% of cases with a 9T change as at least a little better, and 87% of cases with a 5T change less than 1 year post-injury and 81% of cases with a 5T change more than 1 year post-injury as at least a little better.
03Groups that did not reach the minimal change threshold, reached it but not the more robust threshold, or reached the more robust threshold differed significantly in change on the Supervision Rating Scale.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study did not include patient-reported outcomes, so the thresholds reflect provider and supervision-based anchors rather than what people with brain injury said mattered to them. Detailed diagnostic information was not available for most cases, although the measure is intended for acquired brain injury function rather than diagnosis. The Supervision Rating Scale anchoring showed only modest correct classification, partly because the MPAI-4 and Supervision Rating Scale measure different constructs. The expert rating step used only nine cases with a 5T change and nine cases with a 9T change. The values were developed for post-inpatient rehabilitation and supported living settings, so they may not apply to inpatient rehabilitation or other settings.
Declared interests
The OutcomeInfo database was developed through an NIH Small Business Technology Transfer grant, and providers paid a subscription fee for data management and reporting.
The easy way to misread this
Do not read a 5-point or 9-point MPAI-4 improvement as proof that rehabilitation caused meaningful benefit. The study did not test treatment effects, and the thresholds were not anchored to patient-reported outcomes.