Article

OBJECTIVES: (1) To appraise, by the means of Rasch analysis, the internal
validity and reliability of the Coma Recovery Scale-Revised (CRS-R) in a sample
of patients with disorder of consciousness (DOC); and (2) to provide information
about the comparability of CRS-R scores across persons with DOC across different
settings and groups, including different etiologies. DESIGN: Multicenter
observational prospective study. SETTING: Two rehabilitation wards, 1
intermediate care facility, and 2 nursing homes in Italy. PARTICIPANTS:
Consecutively admitted patients (N=129) for which assessments at 2 different time
points were available, giving a total sample of 258 observations. INTERVENTIONS:
Not applicable. MAIN OUTCOME MEASURE: CRS-R. RESULTS: After controlling for any
possible dependency between persons' measures collected at different time points,
and for uniform differential item functioning by etiology showed by the visual
subscale, Rasch analysis demonstrated adequate satisfaction of all the model's
requirements, including adequate ordering of scoring categories,
unidimensionality, local independence, invariance (chi(2)21=27.798, P=.146), and
absence of differential item functioning across patients' sex, age, time, and
setting. The reliability (person separation index=.896) was adequate for
individual person measurement. We devised a practical raw score to measure
conversion tables based on the CRS-R calibrations. CONCLUSIONS: The CRS-R is a
psychometrically sound and robust measurement tool. The linear measures of
ability derived from the CRS-R total scores do satisfy all the principles of
scientific measurement and are sufficiently reliable for high stakes assessments,
such as the diagnosis of the level of consciousness in individual patients.
Future studies are needed to directly explore the capabilities of the CRS-R
measures to reduce the risk of vegetative state misdiagnosis.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS