Article

OBJECTIVE: To provide evidence for psychometric properties of the Disorders of
Consciousness Scale (DOCS). DESIGN: Prospective observational cohort. SETTINGS:
Seven rehabilitation facilities. PARTICIPANTS: Patients (N=174) with severe brain
injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE DOCS RESULTS: Initial
analyses suggested eliminating 6 items to maximize psychometrics, resulting in
the DOCS-25. The 25 items form a unidimensional hierarchy, rating scale
categories are ordered, there are no misfitting items, and differential item
functioning was not found according to sex, type of brain injury, veteran status,
and days from onset. Person separation reliability (.91) indicates that the
DOCS-25 is appropriate for individual patient measurement. Items are well
targeted to the sample, with the difference between mean person and item
calibrations less than 1 logit. DOCS-25 Rasch measures result in a 62% gain in
relative precision over total raw scores. Internal consistency is very good
(Cronbach alpha=.86); interrater agreement is excellent (intracIass correlation
coefficient=.90) for both the DOCS-25 and the sensory subscales. The DOCS-25
total measure, but not subscale measures, correlates with the Glasgow Coma Scale
and the Coma/Near-Coma Scales and distinguishes significantly between vegetative
and minimally conscious states, indicating concurrent validity. CONCLUSIONS: The
DOCS-25 is psychometrically strong. It has excellent measurement precision and
captures a broad range of patient function, which is critical for capturing
recovery of consciousness. The sensory subscales are clinically informative but
should not be reported as separate measures. The Keyform synthesizes clinical
observations to visualize response patterns with potential for informing clinical
decision-making. Future studies should determine sensitivity to change, examine
issues of rater severity, and explore the usefulness of the Keyform in clinical practice.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.
- NBF (Neurobehavioral functioning)

Langue : ANGLAIS