Development of the Korean Moss Attention Rating Scale for Traumatic Brain Injury Patients: Reliability and Validity Study

Research Objectives: This study aimed to investigate the reliability and validity of the Korean version of the Moss Attention Rating Scale (K-MARS), a quantitative observational method to assess different dimensions of disordered attention following traumatic brain injury (TBI).

Design: Single center study

Setting: Inpatient rehabilitation units

Participants: The participants were traumatic brain injury patients who required cognitive rehabilitation due to attention deficits. Individuals who voluntarily agreed to participate and provided informed consent were included in the study.

Interventions: Not applicable

Main Outcome Measures: The MARS was translated and adapted through reverse translation and pilot studies, considering linguistic and cultural aspects, to develop the K-MARS. An occupational therapist independently evaluated participants on the 22-item K-MARS, which can be categorized into three factors: Restlessness/Distractibility (items 1, 10, 12, 17, 22), Initiation (items 7, 13, 19), and Consistent/Sustained Attention (items 6, 14, 15).

Results: We collected the sociodemographic factors of the participants and administered the 22-item K-MARS twice, with a two-day interval. Additionally, to evaluate convergent validity, we collected the Korean-Mini Mental Status Examination (K-MMSE), Global Deterioration Scale (GDS), Korean-Montreal Cognitive Assessment (K-MOCA), digit span test (DST), trail making test (TMT), and auditory Continuous Performance Test (CPT), which have been widely used in previous studies as tools for measuring general cognitive function and attention post-TBI. We conducted descriptive statistical analyses on participants' demographic characteristics and K-MARS scores, and performed internal consistency analysis, test-retest reliability, and convergent validity analysis to confirm reliability and validity. A total of 40 TBI patients participated in this study, with an average age of 49.1 years. The internal consistency of the K-MARS total score was 0.866, and the test-retest reliability showed high intraclass correlation coefficient (ICC) values ranging from 0.909 to 0.975 for the total score and each factor. Additionally, the total K-MARS score demonstrated significant positive correlations with the initiation factor, consistent/sustained attention factor, K-MMSE, K-MOCA, and T-score for T-score of DST, TMT, and auditory CPT, respectively. Furthermore, significant negative correlations were observed with GDS, time to complete TMT, and omission errors in auditory CPT.

Conclusions: The results of this study demonstrate that the K-MARS is a valid and reliable questionnaire for identifying and monitoring the symptoms and severity of attention-related behaviors in various dimensions among Korean TBI patients. By using the K-MARS, clinicians are expected to effectively identify attention deficits in TBI patients' activities of daily living, provide direct attention training, and teach strategies for generalization.

Author(s) Disclosures: Not applicable