Translating the Coma Recovery Scale-Revised into Clinical Practice Using Person-Centered Measurement Principles

Abstract

<h3>Research Objectives</h3> To co-create a Recovery Ruler, that visualizes Coma Recovery Scale-Revised (CRS-R) assessment results, reflecting person-centered measurement principles (co-created, patient-driven, holistic, transparent, comprehensible and timely). We examined pre-implementation factors (usability, acceptability, appropriateness, and feasibility) to determine whether the Recovery Ruler was ready for usability testing. <h3>Design</h3> Concurrent mixed methods using two design groups and four surveys. <h3>Setting</h3> N/A. <h3>Participants</h3> 6 family care partners (FCP) and 8 rehabilitation practitioners (RP) who have experience caring for a person with disorders of consciousness following a brain injury. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> System Usability Scale (SUS), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). <h3>Results</h3> An initial prototype of a Recovery Ruler visualized the CRS-R keyform from Rasch analysis. Content analysis identified Recovery Ruler elements that could be added, removed, or changed. During design group 1, participants added a descriptive text box to incorporate the patient's preferences (patient driven), suggested the Recovery Ruler be laminated to place at the patient's bedside (transparent), and changed words to clarify concepts (comprehensible). These changes were reflected in a revised Recovery Ruler during Design Group 2. There was a significant increase between the SUS scores from the revised Recovery Ruler shown during Design Group 2 (M=83.3, SD=11.9) and initial Recovery Ruler prototype shown in Design Group 1 (M= 77.9, SD=13.3) indicating improved usability; t(11) 1.84, p=0.045. The Wilcoxon singed rank test suggested that results from Design Group 2 on the AIM and IAM were statistically significantly higher than the results on these scales from Design Group 1 indicating improved acceptability and appropriateness. The FIM did not show a statistically significant difference between scores from each design group, but the median and mean were consistently > 4 (agree) on the average scale score indicating good feasibility. <h3>Conclusions</h3> Complex information from a Rasch co-calibration was embedded into the Recovery Ruler that reflects person-centered measurement principles. FCPs and RPs determined the Recovery Ruler is usable, acceptable, appropriate, and feasible, ultimately ready for usability testing. <h3>Author(s) Disclosures</h3> N/A.