Generating a Comprehensible Rasch Keyform for the Coma Recovery Scale-Revised for Four Disorders of Consciousness Programs

Research Objectives: Following the Knowledge to Action framework’s Creation Cycle (Graham et al., 2006), we visualized the Coma Recovery Scale-Revised (CRS-R) assessment result information to include diagnostic cut-points (Schnakers et al., 2009) using Rasch Measurement Theory. Now, we are tailoring the tool for four Disorders of Consciousness (DoC) programs in the United States.

Design: Descriptive qualitative study within a larger exploratory sequential mixed methods implementation study (Creswell & Clark, 2018). We conducted two focus groups and usability tests with participants at four DoC programs. The first focus group centered on tailoring the Recovery Ruler, usability tests provided participants an in-depth understanding of how the Recovery Ruler could be implemented, and the second focus group presented revised Recovery Ruler prototypes and generated ideas for an implementation guide. The focus groups were video-recorded, transcribed verbatim, and de-identified. We used content analysis to examine what information needed to be changed, removed, or added to the Recovery Ruler.

Setting: Virtual web conferencing software.

Participants: 16 rehabilitation practitioners across four rehabilitation facilities (Site 1: 6 practitioners; Site 2: four practitioners; Site 3: 1 practitioner; and Site 4: 5 practitioners).

Interventions: N/A

Main Outcome Measures: N/A

Results: Each site identified the visualization of assessment result information as the most important element. Site 2 added Test Completion Codes. Site 1 emphasized the importance of having individual subscale graphs with thresholds for each DoC to track and monitor the patient’s progress; whereas Site 3 and 4 did not find the recovery tracking as beneficial.

Conclusions: Tailoring the CRS-R to the needs of the practitioners at each site may in improved adoption of the Recovery Ruler. The Recovery Ruler is a first step to visualizing assessment result information and may facilitate better information exchange and transparency of clinical assessment data.

Author(s) Disclosures: The authors have received funding from the American Occupational Therapy Foundation for this implementation research study.