Development and validation of the mirror image comfort and avoidance scale (MICAS)

Abstract: Purpose: The purpose of this study was to develop an instrument to measure the experience of viewing one’s reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies
designed to improve the mirror-viewing experience for those who have suffered psychological or bodily
trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument.
Methods: The developed items went through content expert validation, exploratory and confirmatory
factor analyses, and internal consistency reliability testing. Results: Using an exploratory factor analysis (n ¼ 137) and a confirmatory factor analysis (n ¼ 142), we validated a 17-item instrument for two distinct populations: veterans (n ¼ 108) and individuals with upper and lower limb loss (n ¼ 210). The mirror viewing comfort subscale (9 items; a ¼ 0.90) and the mirror avoidance subscale (8 items, a ¼ 0.94) were deemed reliable. Strong, significant correlations between preand post-comfort scores (r ¼ 0.81, p < 0.001), as well as pre-and post-avoidance scores (r ¼ 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. Conclusions: This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure.