Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA.
Department of Occupational Therapy, College of Applied Health Sciences, George Washington University, Washington, DC, USA.
J Neurotrauma. 2022 Oct;39(19-20):1417-1428. doi: 10.1089/neu.2022.0095. Epub 2022 Jun 16.
This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Revised (CRS-R) rating scale categories and their alignment with the Aspen consensus criteria for determining disorders of consciousness (DoC) following a severe brain injury. CRS-R data from 262 patients with DoC following a severe brain injury were analyzed applying the partial credit Rasch Measurement Model. Rasch Analysis produced logit calibrations for each rating scale category. Twenty-eight of the 29 CRS-R rating scale categories were operationalized to the Aspen consensus criteria. We expected the hierarchical order of the calibrations to reflect Aspen consensus criteria. We also examined the association between the CRS-R Rasch person measures (indicative of performance ability) and states of consciousness as determined by the Aspen consensus criteria. Overall, the order of the 29 rating scale category calibrations reflected current literature regarding the continuum of neurobehavioral function: category 6 "Functional Object Use" of the Motor item was hardest for patients to achieve; category 0 "None" of the Oromotor/Verbal item was easiest to achieve. Of the 29 rating scale categories, six were not ordered as expected. Four rating scale categories reflecting the Vegetative State (VS)/Unresponsive Wakefulness Syndrome (UWS) had higher calibrations (reflecting greater neurobehavioral function) than the easiest Minimally Conscious State (MCS) item (category 2 "Fixation" of the Visual item). Two rating scale categories, one reflecting MCS and one not operationalized to the Aspen consensus criteria, had higher calibrations than the easiest eMCS item (category 2 "Functional: Accurate" of the Communication item). CRS-R person measures (indicating amount of neurobehavioral function) and states of consciousness, based on Aspen consensus criteria, showed a strong correlation (r = 0.86; < 0.01). Our study provides empirical evidence for revising the diagnostic criteria for MCS to also include category 2 "Localization to Sound" of the Auditory item and for Emerged from Minimally Conscious State (eMCS) to include category 4 "Consistent Movement to Command" of the Auditory item.
这项研究旨在通过实证评估昏迷恢复量表修订版（CRS-R）评分等级的层次结构及其与重度颅脑损伤后意识障碍（DoC）判定的 Aspen 共识标准的一致性。对 262 例重度颅脑损伤后 DoC 患者的 CRS-R 数据进行了分析，应用部分信用 Rasch 测量模型。Rasch 分析为每个评分等级类别生成了对数校准值。29 个 CRS-R 评分等级类别中的 28 个都可以通过 Aspen 共识标准进行操作化。我们预计校准值的层次顺序反映 Aspen 共识标准。我们还检查了 CRS-R Rasch 个体测量值（表示表现能力）与 Aspen 共识标准确定的意识状态之间的关联。总体而言，29 个评分等级类别的校准顺序反映了神经行为功能连续体的现有文献：运动项目的第 6 类“功能性物体使用”最难让患者达到；口运动/言语项目的第 0 类“无”最容易达到。在 29 个评分等级类别中，有 6 个没有按预期顺序排列。反映植物状态（VS）/无反应觉醒综合征（UWS）的四个评分等级类别具有较高的校准值（反映了更大的神经行为功能），高于最简单的最小意识状态（MCS）项目（视觉项目的第 2 类“注视”）。两个评分等级类别，一个反映 MCS，一个未操作化到 Aspen 共识标准，其校准值高于最简单的 eMCS 项目（沟通项目的第 2 类“功能：准确”）。基于 Aspen 共识标准的 CRS-R 个体测量值（表示神经行为功能的量）和意识状态之间显示出很强的相关性（r=0.86； < 0.01）。我们的研究为修订 MCS 的诊断标准提供了实证证据，以包括听觉项目的第 2 类“定位到声音”，并为 Emerged from Minimally Conscious State (eMCS) 纳入听觉项目的第 4 类“一致的命令运动”。
