Date Presented 03/23/24
We provide an empirical evaluation of the item hierarchy within the Coma Recover Scale–Revised (CRS–R), an assessment used with patients with disorders of consciousness.This evaluation is critical for determining whether the challenge of the items aligns with the order in which they are presented in the assessment.
Primary Author and Speaker: Jill Calvani
Additional Authors and Speakers: Trudy Mallinson, Jennifer Weaver
Contributing Authors: Katherine O’Brien
PURPOSE: Occupational therapy practitioners (OTPs) measure neurobehavioral function of patients with disorders of consciousness (DoC) following acquired brain injury. The Coma Recovery Scale-Revised (CRS-R) is commonly used and has six subscales. Items within each subscale are hierarchically arranged from hardest to easiest. OTPs administer the hardest items (i.e., stimuli), then easier items until the patient demonstrates a response. To date, the hierarchical arrangement of the items has not been empirically evaluated. The purpose of this study is to empirically examine the item hierarchy of the CRS-R items.
DESIGN: We conducted an observational, cross-sectional study at a rehabilitation hospital with a DoC program, using a convenience sample.
METHOD: An assessor administered every CRS-R item regardless of the patient’s behavioral responses to 28 participants with DoC. We used Rasch analysis to examine the structural validity of the selected items.
RESULTS: Preliminary results suggest the empirical hierarchical order of the motor subscale does not completely align with the assessment order. The easiest to hardest items were: deep pressure to nail bed, observed automatic response, functional object use (comb), object manipulation, familiar gestures, functional object use (toothbrush), oromotor, and localization to noxious stimulation.
CONCLUSION: It is possible that the item hierarchy may need to be revised. The sample size is low and additional data would facilitate more confidence in the findings. OTPs should consider administering all items on the CRS-R to better understand the motoric abilities of the patient in DoC.
References
O’Dell, M. W., Jasin, P., Lyons, N., Stivers, M., Meszaros, F. (1996). Standardized assessment instruments for minimally-responsive, brain-injured patients. NeuroRehabilitation, 6(1), 45–55. https://doi.org/10.3233/NRE-1996-6106
Weaver, J. A., Liu, J., Guernon, A., Pape, T. B., Mallinson T. Psychometric Properties of the Coma Near-Coma Scale for Adults in Disordered States of Consciousness: A Rasch Analysis. (2021). Archives of Physical Medicine and Rehabilitation, 102(4), 591–597. https://doi.org/10.1016/j.apmr.2020.10.119
