Comparing indices of responsiveness for the Coma Near-Coma Scale with and without pain items: An Exploratory study

Authors

Jennifer A. Weaver, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado.
Vera Pertsovskaya, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Jasmine Tran, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado.
Allan J. Kozlowski, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan.
Ann Guernon, Speech-Language Pathology Program, College of Nursing and Health Sciences, Lewis University, Romeoville, Illinois.
Theresa Bender Pape, Neuroplasticity in Neurorehabilitation Lab, Hines Veterans Affairs Hospital, Hines, Illinois.
Trudy Mallinson, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

6-11-2023

Journal

Brain and behavior

DOI

10.1002/brb3.3120

Keywords

brain injuries; consciousness disorders; pain; rehabilitation

Abstract

INTRODUCTION: This study aimed to establish the indices of responsiveness for the Coma/Near-Coma (CNC) scale without (8 items) and with (10 items) pain test stimuli. A secondary purpose was to examine whether the CNC 8 items and 10 items differ when detecting change in neurobehavioral function. METHODS: We analyzed CNC data from three studies of participants with disorders of consciousness: one observational study and two intervention studies. We generated Rasch person measures using the CNC 8 items and CNC 10 items for each participant at two time points 14 ± 2 days apart using Rasch Measurement Theory. We calculated the distribution-based minimal clinically important difference (MCID) and minimal detectable change using 95% confidence intervals (MDC ). RESULTS: We used the Rasch transformed equal-interval scale person measures in logits. For the CNC 8 items: Distribution-based MCID 0.33 SD = 0.41 logits and MDC = 1.25 logits. For the CNC 10 items: Distribution-based MCID 0.33 SD = 0.37 logits and MDC = 1.03 logits. Twelve and 13 participants made a change beyond measurement error (MDC ) using the CNC 8-item and 10-item scales, respectively. CONCLUSION: Our preliminary evidence supports the clinical and research utility of the CNC 8-item scale for measuring the responsiveness of neurobehavioral function, and that it demonstrates comparable responsiveness to the CNC 10-item scale without administering the two pain items. The distribution-based MCID can be used to evaluate group-level changes while the MDC can support clinical, data-driven decisions about an individual patient.

APA Citation

Weaver, Jennifer A.; Pertsovskaya, Vera; Tran, Jasmine; Kozlowski, Allan J.; Guernon, Ann; Bender Pape, Theresa; and Mallinson, Trudy, "Comparing indices of responsiveness for the Coma Near-Coma Scale with and without pain items: An Exploratory study" (2023). GW Authored Works. Paper 2732.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2732

Department

Clinical Research and Leadership