by Tessa Hart, PhD, John Whyte, MD, PhD, Scott Millis, PhD, Rita Bode, PhD, James Malec, PhD, Risa Nakase Richardson, PhD, Flora Hammond, MD.Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
OBJECTIVES: To investigate the factor structure of disordered attention in moderate to severe, acute traumatic brain injury (TBI) and to use factor analysis and item response theory to further validate and refine an observational rating scale of attention for clinical and research purposes.
DESIGN: Multicenter inception cohort.
SETTING: Inpatient rehabilitation units.
PARTICIPANTS: Patients with TBI (N=372) consecutively admitted to 8 Traumatic Brain Injury Model System centers within 2 weeks prior to observation, who consistently followed commands and who were on stable doses of all psychotropic medications for a 3-day rating period.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: Participants were rated independently by treating occupational and physical therapists at an average of 1 month postinjury on the Moss Attention Rating Scale (MARS), a 45-item, Likert-type scale of attention-related behavior.
RESULTS: Exploratory and confirmatory factor analyses revealed 3 correlated factors of disordered attention, interpreted as restlessness/distractibility, initiation, and sustained/consistent attention. Item response (Rasch) analysis was used to eliminate redundant items and to fill gaps in item difficulty. The resulting MARS consists of 22 items that can produce 3 factor scores and a total score that covers the broad construct of disordered attention.
CONCLUSIONS: The factor-scored MARS has potential utility as a quantitative observational method with which to assess and study different dimensions of disordered attention in acute TBI, and to monitor change over time and treatment response within these dimensions.