Article

OBJECTIVE: The study compared the metric characteristics (discriminant capacity
and factorial structure) of two different methods for scoring the items of the
Coma Recovery Scale-Revised and it analysed scale scores collected using the
standard assessment procedure and a new proposed method. DESIGN: Cross sectional
design/methodological study. SETTING: Inpatient, neurological unit. PARTICIPANTS:
A total of 153 patients with disorders of consciousness were consecutively
enrolled between 2011 and 2013. INTERVENTION: All patients were assessed with the
Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2)
procedures. MAIN OUTCOME MEASURES: Coma Recovery Scale-Revised score, number of
cognitive and reflex behaviours and diagnosis.
RESULTS: Regarding patient
assessment, rater 1 using standard and rater 2 using inverted procedures obtained
the same best scores for each subscale of the Coma Recovery Scale-Revised for all
patients, so no clinical (and statistical) difference was found between the two
procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery
Scale-Revised codified behavioural responses were not found during assessment,
although higher response categories were present.
A total of 51 (36%) patients
presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard
score, whereas no overlap was found using the modified score. Unidimensionality
was confirmed for both score systems. CONCLUSION:
The Coma Recovery Scale
Modified Score showed a higher discriminant capacity than the standard score and
a monofactorial structure was also supported. The inverted assessment procedure
could be a useful evaluation method for the assessment of patients with disorder
of consciousness diagnosis.

Langue : ANGLAIS