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

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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="" between="" ratings="" median="" range="" for="" each="" of="" the="" rating="" disciplines="" change="" scores="" ranging="" from="" points="" to="" factor="" also="" improved="" significantly="" during="" same="" interval.="" when="" different="" occupational="" therapists="" provided="" and="" ot="" these="" were="" lower="" but="" this="" pattern="" was="" not="" seen="" among="" other="" disciplines.="" conclusions:="" mars="" showed="" good="" interrater="" agreement="" pt="" slp="" still="" acceptable="" nursing="" two="" agreement.="" total="" score="" all="" highly="" sensitive="" occurring="" inpatient="" rehabilitation.="" results="" show="" that="" is="" a="" reliable="" instrument="" observational="" attentiveness="" in="" an="" acute="" tbi="" rehabilitation="" sample.="" suggests="" less="" structured="" environment="" unit="" therapy="" sessions="" reduces="" utility="" particularly="" least="" sustained="" consistent="" attention="" requires="" additional="" investigation.="" further="" research="" on="" construct="" validity="" impact="" use="" clinical="" practice="" are="" warranted.="">

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