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Post-acute Outcomes

The Mayo-Portland Adaptability Inventory (MPAI-4) is the industry standard in measuring functional outcomes for post-acute brain injury rehabilitation programs. The tool measures outcomes based upon 29 functional measures in three areas: ability, adjustment and participation.

“With the gains being held for most individuals at 12 months post discharge from a residential rehabilitation program, the return on investment is evident even if the person does not receive additional therapy following residential care. The return is also evident as costs reduce with each subsequent level of care yet gains are maintained, or continue with improvement of functional skills (Lewis & Horn, 2023).

Key Findings

  • On average, our participants demonstrated an increase in functional independence across all 29 items of the MPAI-4.
  • On average, our participants improved one severity level on each of the three MPAI-4 subscales.
    *This page was updated in January of 2023.

Improvement in MPAI-4 Participation, Adjustment and Abilities T-scores

Admission average Discharge average
No Limitation Severe Mild
0 10 20 30 40 50 60
  • Abilities
    Abilities Index: measures physical sensory and motor skills, communication, and cognitive skills.
    56.31
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    48.79
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Adjustment
    Adjustment Index: measures the functional impact of mood, neurobehavioral control, and interpersonal interactions.
    55.45
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    48.71
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Participation
    Participation Index: measures instrumental activities of daily living including initiation, social contact, self-care, home skills, productivity, and money skills.
    56.73
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    49.32
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • National Reference Sample

Average Age = 44.7, Average Length of Stay = 5.4 months. Outcomes for all persons treated in active rehabilitation. The mean reduction in disability was 8.67 points, a clinically and statistically significant improvement (p<.001).

On average, our participants demonstrated an increase in functional independence across all 29 items of the MPAI-4.

Improvement from Admission to Discharge on Key MPAI-4 Functional Measures: Active Rehabilitation All Diagnoses

Continued Below

Admission average Discharge average
None Severe Mild
0 0.5 1 1.5 2 2.5 3 3.5 4
  • Mobility
    Mobility: Problems walking or moving; balance problems that interfere with moving about.
    2.54
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.77
    Mild disability, but does not interfere in a person’s daily activities.
  • Fatigue
    Fatigue: Feeling tired; lack of energy; tiring easily; not due to mood.
    2.50
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.67
    Mild disability, but does not interfere in a person’s daily activities.
  • Verbal Communication
    Verbal Communication: Problems expressing or understanding language.
    2.11
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.60
    Mild disability, but does not interfere in a person’s daily activities.
  • Attention
    Attention: Problems ignoring distractions, shifting attention, keeping more than one thing in mind at a time.
    2.78
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.18
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Memory
    Memory: Problems learning and recalling new information.
    2.86
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.22
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Problem Solving
    Problem Solving: Problems thinking up solutions or picking the best solution to new problems.
    2.91
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.31
    Mild disability, but does not interfere in a person’s daily activities.
  • Initiation
    Initiation: Problems getting started on activities without prompting. May also include over initiation (impulsivity).
    2.75
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.08
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Anxiety
    Anxiety: Tense, nervous, fearful, phobias, nightmares, flashbacks of stressful events.
    1.92
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.45
    Mild disability, but does not interfere in a person’s daily activities.
  • Depression
    Depression: Sad, blue, hopeless, poor appetite, poor sleep, worry, self-criticism.
    1.78
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.32
    Mild disability, but does not interfere in a person’s daily activities.
  • Irritability
    Irritability: Physical expressions of anger.
    1.41
    Mild disability, but does not interfere in a person’s daily activities.
    1.13
    Mild disability, but does not interfere in a person’s daily activities.
  • Inappropriate Social
    Inappropriate Social: Acting childish, silly, rude, behavior not fitting for time and place.
    1.45
    Mild disability, but does not interfere in a person’s daily activities.
    1.15
    Mild disability, but does not interfere in a person’s daily activities.
  • Self-Awareness
    Self-Awareness: Lack of recognition of personal limitations and disabilities and interference with activities, work, and/or school.
    2.61
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.08
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Social Contact
    Social Contact: Social contact with friends, work associates, and other people who are not family, significant others, or professionals.
    2.97
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    2.30
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Leisure
    Leisure: Activities and interest development for skills application.
    3.21
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    2.47
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Self-Care
    Self-Care: Activities of daily living such as bathing, grooming, dressing, hygiene.
    2.55
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
    1.70
    Mild disability, but does not interfere in a person’s daily activities.
  • Home Skills
    Home Skills: Responsibilities of independent living and homemaking (e.g., meal preparation, home repairs and maintenance, personal health maintenance including medical management).
    3.49
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    2.79
    Mild disability that interferes up to 24% of the time in a person’s daily activities.
  • Transportation
    Transportation: bus trials, use of taxi, or learned use of public transportation; return to driving.
    3.54
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    3.03
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
  • Money Management
    Money Management: Shopping, keeping a check book or other bank account, managing personal income and investments.
    3.26
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.
    2.70
    Moderate disability that interferes from 25% to 75% of the time in a person’s daily activities.

Improvement in each of the items above represent a clinically meaningful reduction and disability and a statistically significant difference from admission to discharge (p<.01).