The Moss Attention Rating Scale for traumatic brain injury: Initial psychometric assessment

Objective: To examine the psychometric properties of the Moss Attention Rating Scale (MARS), a new observational rating scale for attention-related behaviors in traumatic brain injury (TBI). Design: Prospective observational study. Setting: Eight acute inpatient rehabilitation facilities that are part of the Traumatic Brain Injury Model Systems program. Participants: Two hundred twenty-eight patients with TBI requiring acute inpatient rehabilitation treatment. Interventions: Not applicable. Main Outcome Measures: Rasch analysis on the 53-item MARS (45 attention items, 8 control items) as rated separately by the treating occupational therapist and physical therapist. Results: The MARS appeared to measure a single dimension and demonstrated good person separation (5.69) and reliability (.97). In post hoc assessment, misfitting attention items may not have required attention and control items that fit the dimension may have required at least rudimentary attention. Occupational therapists rated patients as slightly less attentive than did physical therapists. Overall, the scale was well targeted to an acute inpatient rehabilitation population. Conclusions: Our results provide: preliminary support for the viability of developing an observational attention rating scale for use in inpatient TBI rehabilitation. Further research will need to explore the existence of subdimensions and provide further validation with reference to other neuropsychologic measures of attention and knowledge of lesion severity and localization.