Research article summary (published 29 Apr 2008):

The Moss Attention Rating Scale for traumatic brain injury: further explorations of reliability and sensitivity to change.

Full Abstract

OBJECTIVE: To examine the interrater agreement and responsiveness to change of the Moss Attention Rating Scale (MARS), 22-item version, during acute inpatient rehabilitation after traumatic brain injury (TBI). DESIGN: Observational study of clinician ratings (physical therapy [PT], occupational therapy [OT], speech-language pathology [SLP], nursing) of each patient's attentional function at 2 points in time, near the time of admission and near the time of discharge from inpatient rehabilitation. SETTING: Dedicated acute inpatient brain injury rehabilitation program. PARTICIPANTS: Inpatients (N=149) with moderate to severe TBI (58% enrolled in the National Institute on Disability Rehabilitation Research-funded Traumatic Brain Injury Model System); age 16 years or older; receiving OT, PT, SLP, and nursing care on the inpatient TBI rehabilitation unit; and having Rancho Los Amigos Levels of Cognitive Functioning Scale scores of IV (confused/agitated) or higher at enrollment. Patients were excluded if they had premorbid history of attention-deficit hyperactivity disorder, major psychiatric disorder (eg, bipolar), or neurologic impairment (eg, stroke). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Scores on the MARS (22-item version) and its 3 factor scores. RESULTS: Intraclass correlations among ratings from PT, OT, and SLP ranged from .69 to .78 at the initial assessment and .67 to .72 at the follow-up assessment. Agreement between nursing and the other disciplines was somewhat lower (at initial assessment, .59-.68; at follow-up, .48-.59), although still substantial. Agreement for 2 of the factor scores (restlessness and/or distractibility, initiation) was similar but agreement for the third factor (consistent and/or sustained attention) was lower (.25-.27). The total MARS scores were highly significantly improved (P<.001) at follow-up compared with initial assessment (mean, 27.6d between ratings; median, 21d; range, 4-125d) for each of the rating disciplines, with change scores ranging from 7.8 points (OT) to 13.1 points (nursing). Factor scores also improved significantly during the same interval. When different occupational therapists provided the initial and follow-up OT ratings, these follow-up ratings were significantly lower, but this pattern was not seen among other rating disciplines. CONCLUSIONS: The 22-item MARS showed good interrater agreement among PT, OT, and SLP and lower but still acceptable agreement between nursing and the other disciplines. Two of the 3 factor scores also showed good agreement. The 22-item total score and all 3 factor scores were highly sensitive to change occurring during inpatient rehabilitation. These results show that the 22-item MARS is a reliable instrument for the observational rating of attentiveness in an acute TBI rehabilitation sample. Lower agreement between nursing and the other disciplines suggests that the less structured environment of the nursing unit compared with therapy sessions reduces interrater agreement. The utility of the factor scores, particularly the least reliable sustained and/or consistent attention factor, requires additional investigation. Further research on construct validity and impact of the use of the MARS on clinical practice are warranted.

Author information

Author/s: Whyte, John (J); Hart, Tessa (T); Ellis, Colin A (CA); Chervoneva, Inna (I);

Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA 19027, USA. jwhyte(-atsign-)einstein.edu

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.

Journal: Archives of physical medicine and rehabilitation (Arch Phys Med Rehabil), published in United States. (Language: eng)

Reference: 2008-May; vol 89 (issue 5) : pp 966-73

Dates: Created 2008/05/02; Completed 2008/06/03;

PMID: 18452747, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent Adult Aged Aged, 80 and over Attention Brain Injuries - psychology Female

Humans Male Middle Aged Neuropsychological Tests Reproducibility of Results Sensitivity and Specificity Severity of Illness Index

Related articles

These are the highest related articles currently in the database:

• Reliability and validity of the RBANS in a traumatic brain injured sample. 29 Nov 2006
• Spatial-temporal characteristics of perceptual organization following acquired brain injury. 27 Feb 2006
• Cognitive and psychosocial correlates of alexithymia following traumatic brain injury. 30 Dec 2005
• Time perception depends on accurate clock mechanisms as well as unimpaired attention and memory processes. 30 Dec 2003
• Management of impaired self-awareness in persons with traumatic brain injury. 30 May 2006
• The effects of visual distraction following traumatic brain injury. 27 Feb 1998
• Latent structure of the Test of Everyday Attention: convergent evidence from patients with traumatic brain injury. 30 May 2006
• Validity of the WCST-64 after traumatic brain injury. 29 Apr 2003
• Reliability and validity of the Toglia Category Assessment Test. 30 Jan 1999
• Acute predictors of real-world outcomes following traumatic brain injury: a prospective study. 28 Feb 2004

See 100+ related articles.

Related Article Map

Legend: - FREE Full text Article. - Abstract only. - Title only. More help.

See a large map of 100+ related articles.