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Mayo-Portland Adaptability Inventory-4 (MPAI-4)
The instrument is freely available here: Mayo-Portland Adaptability Inventory-4.
Supplemental: Traumatic Brain Injury (TBI)
Exploratory: Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persisent/Chronic (3 months and greater post concussion)
Short Description of Instrument
The Mayo-Portland Adaptability Inventory-4 (MPAI-4) consists of thirty items rated on a 5-point scale. Items represent key indicators in three inter-related sub domains represented by three subscales: Ability Index (physical and cognitive abilities), Adjustment Index (emotional and behavioral self-regulation, interpersonal activities), and Participation Index (community integration). Specified modifications to the rating scales allow the measure to be applied across the age span from childhood through adulthood.
Specified modifications to the rating scales allow the measure to be applied across the age span from childhood through adulthood.
The test may be completed by consensus of a professional team, by a single professional, by a person with brain injury, or by a significant other.
Completion usually requires 20–30 minutes.
Sport-Related Concussion Specific:
Advantages: 30 item Likert-type scale including items for three domains: 1) ability index, 2) adjustment index, and 3) participation index. Can be adapted for children through adults. It can be completed by patients, providers or informant. Reliable scale with normative data available (adults only). Total and index scores can be calculated. Developed for post-acute chronic clinical evaluation of acquired brain injury. It addresses multiple post concussive symptoms, ranging from physical, cognitive and emotional difficulties. It is widely used in rehabilitative settings and has been translated to multiple languages. Has been shown to be effective in addressing mild TBI.
Limitations: Require professional administration and interpretation. Lengthy measure— ~25-30 min. Limited previous use in sport concussion. Many items are not relevant with sport concussion. Sports related concussion studies utilizing MPAI4 are lacking, and there is only one report of use in a pediatric TBI population (which was mostly comprised of children with severe TBI).
Age Range: 18+ (pediatric version is available)
Adolescent (14) to Adults (77)
A 5-point scale (0-4) ranging from normal for age to severely restricted is used to score each question. Total score range = 0-115. An overall score and scores from each index may be obtained.
Raw total and index scores may be converted to T-scores with reference to a national sample of 386 individuals with brain injury.
Psychometric Properties
The measure was selected to provide more detailed assessment of global outcome as well as restrictions in abilities, adaptation, and participation after brain injury. It possesses sound psychometric properties with development grounded in both item response and classic psychometric theory. Published studies document concurrent, construct, and predictive validity. The measure is widely used for planning and evaluating post acute rehabilitation. There is limited use in research studies to-date.
Malec, J. (2005). The Mayo-Portland Adaptability Inventory. The Center for Outcome Measurement in Brain Injury. (accessed January 3, 2017).
Kean J, Malec JF, Altman IM, Swick S. Rasch measurement analysis of the Mayo-Portland Adaptability Inventory (MPAI-4) in a community-based rehabilitation sample. J Neurotrauma. 2011;28(5):745-753.
Lukow HR 2nd, Godwin EE, Marwitz JH, Mills A, Hsu NH, Kreutzer JS. Relationship Between Resilience, Adjustment, and Psychological Functioning After Traumatic Brain Injury: A Preliminary Report. J Head Trauma Rehabil. 2015;30(4):241-248.
Malec JF, Moessner AM, Kragness M, Lezak MD. Refining a measure of brain injury sequelae to predict post acute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory. J Head Trauma Rehabil. 2000;15(1):670-682.
Malec JF. The Mayo-Portland Participation Index: A brief and psychometrically sound measure of brain injury outcome. Arch Phys Med Rehabil. 2004;85(12):1989-1996.
Murrey GJ, Hale FM, Williams JD. Assessment of anosognosia in persons with frontal lobe damage: clinical utility of the Mayo-Portland Adaptability Inventory (MPAI). Brain Inj. 2005;19(8):599-603.
Oddson B, Rumney P, Johnson P, Thomas-Stonell N. Clinical use of the Mayo-Portland Adaptability Inventory in rehabilitation after paediatric acquired brain injury. Dev Med Child Neurol. 2006;48(11):918-922.
Scott KL, Strong CA, Gorter B, Donders J. Predictors of Post-concussion Rehabilitation Outcomes at Three-month Follow-up. Clin Neuropsychol. 2016;30(1):66-81.


Document last updated July 2019