Hart , PhD, Moss TBI Model System at
Citation Hart, T. (2008). The
Moss Attention Rating Scale. The Center for Outcome Measurement
in Brain Injury. http://www.tbims.org/
combi/mars ( accessed
MARS has been subjected to 2 large sample studies of inter-rater
reliability. The first (Whyte, Hart, Bode & Malec, 2003) compared
ratings of patients’ Occupational Therapists (OTs) and Physical
Therapists (PTs) done independently over the same 3-day window.
Agreement was good (Pearson r = .64). When there were disagreements,
OTs tended to rate attention as slightly worse than PTs. The second
study (Whyte, Hart, Ellis & Chervoneva, 2008) compared ratings
across 4 disciplines: OT, PT, Speech Therapy (ST) and Nursing, using
ratings conducted both early and late in the inpatient rehabilitation
stay. Agreement across disciplines was fairly robust, with Nursing
showing somewhat lower concordance with therapy disciplines. This
was interpreted as possibly relating to the less structured and
more variable observations available to nursing vs. therapy staff
on an inpatient rehabilitation unit.
Whyte, Ellis, & Chervoneva (2009) showed that total scores on
the MARS administered to rehabilitation inpatients in the subacute
phase of TBI (1) were more strongly correlated to concurrent measures
thought to assess attention (e.g., (Digit Span) than those thought
to be less demanding of attention (e.g., grip strength); (2) were
more strongly correlated to Cognitive than Motor FIM scores; and
(3) predicted 1-year outcomes of TBI (Disability Rating Scale scores)
better than a battery of psychometric measures of attention administered
concurrently with the MARS. These findings provide support for the
MARS as a measure of cognitive function, specifically attention,
which performs well as a predictor of outcome.
MARS is highly sensitive to the effects of “natural recovery
plus rehabilitation” in the subacute phase of TBI, i.e., MARS
scores are significantly higher near rehabilitation discharge compared
to rehabilitation admission several weeks earlier (Whyte et al.,
2008). However, its sensitivity to treatments specifically targeting
attention remains to be determined. The MARS did not discriminate
groups of inpatients with TBI with attention deficits who had received
a 3-day course of methylphenidate or placebo (Hart et al., 2009).
However, it was unclear whether the MARS was insensitive or the
treatment was not sufficiently powerful—e.g., too short, not
strong enough to add-on to natural recovery—to show an effect.