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J Head Trauma Rehabil. 2015 Jan-Feb;30(1):38-46. doi: 10.1097/HTR.0000000000000041.

Clinician versus Veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.

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Traumatic Brain Injury Center of Excellence (Ms McCulloch and Drs Pastorek, Miller, and Troyanskaya) and Rehabilitation and Extended Care Line (Dr Pastorek), Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Psychology, University of Houston, Houston, Texas (Ms McCulloch); Department of Physical Medicine and Rehabilitation (Drs Pastorek, Troyanskaya, and Maestas) and Menninger Department of Psychiatry and Behavioral Sciences (Dr Miller), Baylor College of Medicine, Houston, Texas; Department of Mental Health, George E. Wahlen VA Medical Center, Salt Lake City, Utah (Dr Romesser); Department of Mental and Behavioral Health, Oklahoma City VA Medical Center, Oklahoma City (Dr Linck); Department of Physical Medicine and Rehabilitation, Minneapolis VA Medical Center, Minneapolis, Minnesota (Dr Sim); and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Maestas).



The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI).


To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings.


A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation.


Interrater reliability study.


M2PI; Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS).


Veterans reported greater perceived restrictions than clinicians across all M2PI items and total score. Interrater correlations ranged from rs = 0.27 (residence) to rs = 0.58 (money management) across items, with a total score correlation of rs = 0.60. When response bias was indicated, both Veterans and clinicians reported greater participation restrictions than those reported by Veterans without evidenced response bias.


Low interrater correlation is consistent with previous findings. As ratings of clinicians and Veterans should not be interpreted as equivalent, documenting the rater's identity is important for interpretation. Using objective indicators of functional outcome may assist clinician raters, particularly when self-report may be biased.

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