Volume 42, Number 1, January/February 2005
Pages 1 — 18

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A measure of neurobehavioral functioning after coma. Part I: Theory, reliability, and validity of the Disorders of Consciousness Scale

Theresa Louise-Bender Pape, DrPH, MA, CCC-SLP/L;1-4* Allen W. Heinemann, PhD, ABPP;3-5
James P. Kelly, MA, MD;6 Anita Giobbie Hurder, MS;7 Sandra Lundgren, PhD, LP, ABPP8

1The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Research Service, Edward Hines Jr. VA Hospital, Hines, IL; 2Marianjoy Rehabilitation Hospital, Wheaton, IL; 3Northwestern University, Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, 4Institute for Health Services Research and Policy Studies, Chicago, IL; 5Rehabilitation Institute of Chicago, Center for Rehabilitation Outcomes Research, Chicago, IL; 6University of Colorado School of Medicine, Department of Neurosurgery, Denver, CO; 7Cooperative Studies Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL; 8Minneapolis VA Medical Center, Mental and
Behavioral Health Patient Service Line (M/C 116 B), Minneapolis, MN

Abstract — This longitudinal validation study describes the psychometric properties of the Disorders of Consciousness Scale (DOCS). This is Part I of a two-part series. Part II illustrates and describes the clinical and scientific implementation of the DOCS measure. The study was conducted at one intensive care unit, two acute rehabilitation hospitals, and one long-term acute chronic care hospital. Participants were unconscious after severe brain injury (BI). We conducted interrater reliability analyses using ratings from interdisciplinary pairs. Results indicated a higher-than-expected level of agreement and no significant difference between any pairs (chi-square = 85df, p = 0.15) (df = degrees of freedom). Examinations of ratings by discipline groups indicated that the DOCS is impacted minimally by discipline. Validity analyses demonstrate that 23 of 34 test stimuli remain stable over time with no floor or ceiling effect. DOCS measures obtained within 94 days of injury predicted recovery of consciousness up to 1 year after injury (c-indices of 0.70 and 0.86). Positive (0.71) and negative (0.68) predictive values indicate that the DOCS predicts recovery and lack of recovery. Twenty-three of the DOCS test stimuli produce a reliable, valid, and stable measure of neurobehavioral recovery after severe BI that predicts recovery and lack of recovery of consciousness 1 year after injury.

Key words: brain injury, coma, consciousness, measure, outcome, psychometrics, recovery.

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