The purpose of this study was to demonstrate an application of Rasch analysis\nto identify differences in disability profiles resulting from traumatic brain injury\n(TBI) and cerebral vascular accident (CVA) and to examine outcome\ndifferences between the two groups following post-hospital residential rehabilitation.\nParticipant data were collected from 32 facilities in 16 states. From\n2990 neurologically impaired individuals with consecutive admissions from\n2011 through 2017, 874 met inclusion criteria: TBI (n = 687) or CVA (n =\n187), 18 years or older, minimum length of stay of one month, and maximum\nchronicity of 1 year. Participants were evaluated at admission and discharge\non the Mayo Portland Adaptability Inventory-Version 4 (MPAI-4). Rasch\nanalysis was performed to establish item reliability, construct validity and\nitem difficulty. A Repeated Measures Multivariate Analysis of Covariance\n(RM MANCOVA) determined group differences and improvement from\nadmission and discharge. Rasch Analysis demonstrated satisfactory construct\nvalidity and internal consistency (Person reliability > 0.90, Item reliability >\n0.98 for admission and discharge MPAI-4s). Both groups showed significant\nimprovement on the MPAI-4 (p < 0.0005). The TBI group was more impaired\non the adjustment scale at both admission and discharge (p < 0.001).\nRasch analysis identified two distinct impairment patterns. CVA participants\nexhibited deficits characteristic of focal impairment while the TBI group presented\nwith deficits reflective of diffuse impairment. Rehabilitation was\nshown to be beneficial in reducing disability following neurologic injury in\nboth groups. Importantly, Rasch Analysis accurately produced unique disability\nprofiles that differentiated the treatment groups. This unique statistical technique offers a promising prescriptive hierarchical model for guiding\nneurological rehabilitation treatment.
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