Community mobility assessment for adolescents with an acquired brain injury: Preliminary inter-rater reliability study

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Abstract
Background: The Community Mobility Assessment (CMA) is an observational assessment that evaluates safety of an adolescent with an acquired brain injury (ABI) during a community outing. It consists of a 3-point level of accomplishment scale for 40 functional items, divided into two components (physical and cognitive). The CMA identifies areas of strength and weakness and facilitates development of compensating strategies. This study was undertaken to determine how reliably therapists rate a client's performance using the CMA on a community outing. Participants: Eight adolescents between the ages of 12 and 18 participated. All had an ABI and were involved in rehabilitation either as a day-patient or inpatient. Methods: Each teen was independently evaluated by one expert rater and one of two student raters (A or B), using the CMA during a standard 2-h community outing. Analysis: Descriptive statistics were computed for physical and cognitive component summary scores. Inter-rater reliability analyses used weighted Kappa statistics. A minimum Kappa score >0.70 was hypothesized a priori to indicate good reliability. Results: The mean score for the physical component = 92% (min = 82%, max = 100%), and for the cognitive component = 77% (min = 58%, max = 97%). Minimum weighted Kappa scores for the two rater pairings were 0.80 for the physical component and 0.70 for the cognitive component. Conclusions: An acceptable Kappa score was reached for both components, indicating that with appropriate rater training, the CMA has good inter-rater reliability. Construct validity and responsiveness to change over a clinically meaningful follow-up period should now be evaluated.

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