Form Structure: Mayo-Portland Adaptability Inventory-4 (MPAI-4)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Mayo-Portland Adaptability Inventory-4 (MPAI-4)
Short Name:
MPAI4
Description:
The Mayo-Portland Adaptability Inventory (MPAI) was primarily designed:
- to assist in the clinical evaluation of people during the postacute (posthospital) period following acquired brain injury (ABI), and - to assist in the evaluation of rehabilitation programs designed to serve these people.
Refer to :
Malec, J. (2005). The Mayo Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury.
Jacob Kean et al, Rasch Measurement Analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a Community-Based Rehabilitation Sample, J Neurotrauma. 2011 May; 28(5): 745Â753. doi: 10.1089/neu.2010.1573, PMCID: PMC3088961
Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-03-30
Version:
1.2
Date Created:
2014-05-28
Owner:
Number of Data Elements:
71
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
Abilities (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Mayo-Portland Adaptability Inventory (MPAI-4) -mobility scale | Mobility: Problems walking or moving; balance problems that interfere with moving about | MPAI4MobilityScale | Optional | CDE |
| 2 | Mayo-Portland Adaptability Inventory (MPAI-4) - use hand scale | Use of hands: Impaired strength or coordination in one or both hands, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4UseHandScale | Optional | CDE |
| 3 | Mayo-Portland Adaptability Inventory (MPAI-4) - vision scale | Description of level at which the patient/subject experiences vision problems including problems seeing, double vision, eye, brain or nerve injuries that interfere with seeing, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4VisScale | Optional | CDE |
| 4 | Mayo-Portland Adaptability Inventory (MPAI-4) - audition scale | Description of level at which the patient/subject experiences audition problems including problems hearing; ringing in the ears, as [art pf the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4AudScale | Optional | CDE |
| 5 | Mayo-Portland Adaptability Inventory (MPAI-4) - dizziness scale | Description of level at which the patient/subject experiences dizziness problems including feeling unsteady, dizzy, light-headed, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4DizScale | Optional | CDE |
| 6 | Mayo-Portland Adaptability Inventory (MPAI-4) - motor speech scale | Description of level at which the patient/subject experiences motor speech problems including abnormal clearness or rate of speech; stuttering, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4MotSpeechScale | Optional | CDE |
| 7 | Mayo-Portland Adaptability Inventory (MPAI-4) - verbal communication scale | Description of level at which the patient/subject experiences verbal communication problems including problems expressing or understanding language, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4VerbCommunScale | Optional | CDE |
| 8 | Mayo-Portland Adaptability Inventory (MPAI-4) - nonverbal communication scale | Description of level at which the patient/subject experiences nonverbal communication problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4NonverbCommunScale | Optional | CDE |
| 9 | Mayo-Portland Adaptability Inventory (MPAI-4) - attention concentration scale | Description of level at which the patient/subject experiences attention/concentration problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4AttenConcenScale | Optional | CDE |
| 10 | Mayo-Portland Adaptability Inventory (MPAI-4) - memory scale | Description of level at which the patient/subject experiences memory problems including problems learning and recalling new information, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4MemryScale | Optional | CDE |
| 11 | Mayo-Portland Adaptability Inventory (MPAI-4) - information fund scale | Description of level at which the patient/subject experiences fund of information problems including problems remembering information learned in school or on the job; as part of the Mayo-Portland Adaptability Inventory (MPAI-4). | MPAI4InfoFundScale | Optional | CDE |
| 12 | Mayo-Portland Adaptability Inventory (MPAI-4) - novel problem solve scale | Description of level at which the patient/subject experiences novel problem solving problems including problems thinking up solutions or picking the best solution to new problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4NovProbSlvScale | Optional | CDE |
| 13 | Mayo-Portland Adaptability Inventory (MPAI-4) - visuospatial ability scale | Description of level at which the patient/subject experiences visuospatial ability problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4). | MPAI4VisspatAblScale | Optional | CDE |
Adjustment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Mayo-Portland Adaptability Inventory (MPAI-4) - anxiety scale | Description of level at which the patient/subject experiences anxiety problems including being tense nervous, fearful or having phobias, nightmares, flashbacks of stressful events as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4AnxtylScale | Optional | CDE |
| 2 | Mayo-Portland Adaptability Inventory (MPAI-4) - depression scale | Description of level at which the patient/subject experiences depression problems including being sad, blue, hopeless, having poor appetite, poor sleep, worry, self-criticism as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4DeprsnScale | Optional | CDE |
| 3 | Mayo-Portland Adaptability Inventory (MPAI-4) - irritability anger aggression scale | Description of level at which the patient/subject experiences irritability, anger, aggression problems including verbal or physical expressions of anger, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4IrritAngAgrsnScale | Optional | CDE |
| 4 | Mayo-Portland Adaptability Inventory (MPAI-4) - pain headache scale | Description of level at which the patient/subject experiences pain and headache problems including verbal and nonverbal expressions of pain; activities limited by pain, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PainHeadachScale | Optional | CDE |
| 5 | Mayo-Portland Adaptability Inventory (MPAI-4) - fatigue scale | Description of level at which the patient/subject experiences fatigue problems including feeling tired; lack of energy; tiring easily as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4FatgeScale | Optional | CDE |
| 6 | Mayo-Portland Adaptability Inventory (MPAI-4) - mild symptom sensitivity scale | Description of level at which the patient/subject experiences sensitivity to mild symptoms problems including focusing on thinking, physical or emotional problems attributed to brain injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4MldSymptmSensScale | Optional | CDE |
| 7 | Mayo-Portland Adaptability Inventory (MPAI-4) - inappropriate social scale | Description of level at which the patient/subject experiences inappropriate social interaction problems including acting childish, silly, rude, behavior not fitting for time and place, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4InApprSocInterScale | Optional | CDE |
| 8 | Mayo-Portland Adaptability Inventory (MPAI-4) - impaired self awareness scale | Description of level at which the patient/subject experiences impaired self-awareness problems, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4ImprdSelfawrnesScale | Optional | CDE |
| 9 | Mayo-Portland Adaptability Inventory (MPAI-4) - family relationship scale | Description of the stress level at which the patient/subject experiences family/significant relationship issues including interactions with close others, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4FmlyRelateScale | Optional | CDE |
Participation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Mayo-Portland Adaptability Inventory (MPAI-4) - initiation scale | Description of level at which the participant/subject experiences problems with initiation including problems getting started on activities without prompting, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4InitScale | Optional | CDE |
| 2 | Mayo-Portland Adaptability Inventory (MPAI-4) - social contact scale | Description of level at which the participant/subject experiences problems with social contact with friends, work associates, and people who are not family, significant others or professionals, as part of the Mayo-Portland Adaptability Inventory (MPAI-4). | MPAI4SoclContScale | Optional | CDE |
| 3 | Mayo-Portland Adaptability Inventory (MPAI-4) - leisure scale | Description of level at which the participant/subject experiences problems with leisure and recreational activities, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4LeisScale | Optional | CDE |
| 4 | Mayo-Portland Adaptability Inventory (MPAI-4) - self care scale | Description of level at which the participant/subject experiences problems with self-care including eating, dressing, bathing, hygiene, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4SelfcareScale | Optional | CDE |
| 5 | Mayo-Portland Adaptability Inventory (MPAI-4) - residence scale | Description of level at which the participant/subject experiences problems with residence including responsibilities of independent living and homemaking as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4ResdnceScale | Optional | CDE |
| 6 | Mayo-Portland Adaptability Inventory (MPAI-4) - transportation scale | Description of level at which the participant/subject experiences problems with transportation, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4TrsptScale | Optional | CDE |
| 7 | Mayo-Portland Adaptability Inventory (MPAI-4) - paid employment scale | Description of level at which the participant/subject experiences problems with paid employment, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PaidEmplmtScale | Optional | CDE |
| 8 | Mayo-Portland Adaptability Inventory (MPAI-4) - other employment scale | Description of level at which the participant/subject experiences problems with other employment for example involved in constructive, role-appropriate activity other than paid employment, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4OthrEmplmtScale | Optional | CDE |
| 9 | Mayo-Portland Adaptability Inventory (MPAI-4) - primary social role name | Primary desired social role for other employment of participant/subject, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PrimrySoclRoleName | Optional | CDE |
| 10 | Mayo-Portland Adaptability Inventory (MPAI-4) - manage money scale | Description of level at which the participant/subject experiences problems with managing money and finances, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4MngMnyScale | Optional | CDE |
Pre-existing and Associated Conditions (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre alcohol use scale | Use of alcoholic beverages by the participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PreAlcUseScale | Optional | CDE |
| 2 | Mayo-Portland Adaptability Inventory (MPAI-4) - post alcohol use scale | Use of alcoholic beverages by the participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PostAlcUseScale | Optional | CDE |
| 3 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre drug use scale | Use of illegal drugs or abuse of prescription drugs by the participant/subject pre-injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PreDrugUseScale | Optional | CDE |
| 4 | Mayo-Portland Adaptability Inventory (MPAI-4) - post drug use scale | Use of illegal drugs or abuse of prescription drugs by the participant/subject post-injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PostDrugUseScale | Optional | CDE |
| 5 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre psychotic symptom scale | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PrePyschSymptmScale | Optional | CDE |
| 6 | Mayo-Portland Adaptability Inventory (MPAI-4) - post psychotic symptom scale | Hallucinations, delusions, other persistent severely distorted perceptions of reality experienced by the participant/subject after the injury as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PstPyschSymptmScale | Optional | CDE |
| 7 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre law violation scale | History of law violations of participant/subject before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PreLawViolScale | Optional | CDE |
| 8 | Mayo-Portland Adaptability Inventory (MPAI-4) - post law violation scale | History of law violations of participant/subject after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PstLawViolScale | Optional | CDE |
| 9 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre other physical impairment scale | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury before the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PreOthrPhysImpairScale | Optional | CDE |
| 10 | Mayo-Portland Adaptability Inventory (MPAI-4) - post other physical impairment scale | Description of other condition causing physical impairment for participant/subject including physical disability due to medical conditions other than brain injury after the injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PstOthrPhysImpairScale | Optional | CDE |
| 11 | Mayo-Portland Adaptability Inventory (MPAI-4) - pre other cognitive impairment scale | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions other than brain injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PreOthrCogImpair | Optional | CDE |
| 12 | Mayo-Portland Adaptability Inventory (MPAI-4) - post other cognitive impairment scale | Description of other condition causing cognitive impairment for participant/subject including cognitive disability due to nonpsychiatric medical conditions other than brain injury, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PstOthrCogImpair | Optional | CDE |
Scores (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Mayo-Portland Adaptability Inventory (MPAI-4) - Adjustment raw score | MPAI-4 Adjustment raw score | MPAI4AdjSubscaleRawScore | Recommended | CDE |
| 2 | Mayo-Portland Adaptability Inventory (MPAI-4) - Adjustment standard score | MPAI-4 Adjustment Standard score, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4AdjSubscaleScore | Optional | CDE |
| 3 | Mayo-Portland Adaptability Inventory (MPAI-4) - Adjustment T-score | MPAI-4 Adjustment T-score | MPAI4AdjSubscaleTScore | Recommended | CDE |
| 4 | Mayo-Portland Adaptability Inventory (MPAI-4) - Ability raw score | MPAI-4 Ability raw score | MPAI4AblSubscaleRawScore | Recommended | CDE |
| 5 | Mayo-Portland Adaptability Inventory (MPAI-4) - Ability standard score | MPAI-4 Ability Standard score, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4AblSubscaleScore | Optional | CDE |
| 6 | Mayo-Portland Adaptability Inventory (MPAI-4) - Ability T-score | MPAI-4 Ability T-score | MPAI4AblSubscaleTScore | Recommended | CDE |
| 7 | Mayo-Portland Adaptability Inventory (MPAI-4) - Participation raw score | MPAI-4 Participation raw score | MPAI4PrtpSubscaleRawScore | Recommended | CDE |
| 8 | Mayo-Portland Adaptability Inventory (MPAI-4) - Participation standard score | MPAI-4 Participation Standard score, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4PrtpSubscaleScore | Optional | CDE |
| 9 | Mayo-Portland Adaptability Inventory (MPAI-4) - Participation T-score | MPAI-4 Participation T-score | MPAI4PrtpSubscaleTScore | Recommended | CDE |
| 10 | Mayo-Portland Adaptability Inventory (MPAI-4) - Total raw score | MPAI-4 Total raw score, as part of the Mayo-Portland Adaptability Inventory (MPAI-4) | MPAI4TotlRawScore | Optional | CDE |
| 11 | Mayo-Portland Adaptability Inventory (MPAI-4) - Total standard score | MPAI-4 Total standard score | MPAI4TotlStandardScore | Recommended | CDE |
| 12 | Mayo-Portland Adaptability Inventory (MPAI-4) - Total T-score | MPAI-4 Total T-score | MPAI4TotTScore | Recommended | CDE |
Keywords
