Validation of Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with CRS-R

Abstract

<h3>Research Objectives</h3> To examine the concurrent validity of the MATADOC with the criterion standard Coma Recovery Scale (CRS-R) for diagnostic outcomes of awareness To explore the function of comparable MATADOC items and CRS-R function scales across similar domains (e.g. auditory, visual). <h3>Design</h3> Prospective multisite cohort study collected concurrent MATADOC and CRS-R data using repeated measures with patients with disorders of consciousness (DOC). Raters were blinded. <h3>Setting</h3> Three specialist inpatient rehabilitation units for DOC (US, UK, Ireland). <h3>Participants</h3> 74 adults with prolonged DOC stemming from acquired brain injury recruited using convenience sampling. <h3>Interventions</h3> The MATADOC protocol elicits behavioral responsiveness using live music in five tasks during four clinical contacts of 15-30 minutes duration (60-120 mins total). Observed behavioral responses are rated across motor, communication, arousal, visual and auditory domains using a 14-item measure. Pre and post observation period records spontaneous behaviors. The CRS-R protocol delivers tasks in the motor, visual, auditory and communication domains in clinical contacts of 15-30 minutes duration (60 – 120 minutes in total for 4 contacts). Observed responses are rated in six function scales. <h3>Main Outcome Measures</h3> Two measures of awareness: MATADOC and CRS-R. <h3>Results</h3> Fair (Cohen's kappa or "k"=0.238, p=.006) ranging to moderate (k=0.419, p<.001) significant agreement found between CRS-R and MATADOC diagnostic outcomes for each contact, with significant correlations between scores (mean Pearson = 0.721, p<.001). Agreement increased over repeated contacts. Moderate agreement found for overall diagnostic outcomes ranging across VS, MCS and EMCS (k=0.397, p<.001). Moderate significant agreement found between measures for motor scores (k=.556, p<.001) and visual outcomes (mean k=0.326). No agreement was found for item outcomes assessing auditory responsiveness. <h3>Conclusions</h3> The MATADOC complements the CRS-R in treatment planning for DOC. MATADOC measures of auditory responsiveness suggest musical stimuli may elicit more complex behaviors than non-music protocols. The MATADOC rates complexity of auditory localization as MCS in line with recent recommendations which may explain diagnostic outcome differences with CRS-R outcomes. <h3>Author(s) Disclosures</h3> None.