Comprehensibility in Measurement of Neurobehavioral Function in Disorders of Consciousness: Integrating Data Visualization and Change Indices for the Coma/Near-Coma Scale

Document Type

Journal Article

Publication Date

8-14-2025

Journal

Archives of physical medicine and rehabilitation

DOI

10.1016/j.apmr.2025.07.019

Keywords

Brain injuries; Coma; Communication; Consciousness disorders; Disorders of Consciousness; Measurement; Rehabilitation; Responsiveness

Abstract

OBJECTIVES: To apply a person-centered measurement principle, comprehensibility, to the reporting of Coma/Near-Coma Scale (CNC-8), a measure of neurobehavioral function (NBF) for patients with disorders of consciousness. We developed Rasch equal-interval measures and change indices on a 0-100 equal-interval scale to support comprehensibility and applied data visualization techniques to enhance transparency for interpreting change in CNC-8 measures over time. DESIGN: Secondary data set using the partial credit Rasch Measurement Model and a case example. SETTING: Post-acute care rehabilitation. PARTICIPANTS: Participants (n=40) with disorders of consciousness (DoC) following a severe brain injury. INTERVENTIONS: None. MAIN OUTCOME MEASURE: CNC-8. RESULTS: We transformed CNC-8 raw total scores to 0-100 equal-interval measures so that lower values indicated less NBF and higher values indicated more NBF. Indices of responsiveness, including minimal detectable change (MDC) = 15 units and conditional minimal detectable change (cMDC) ranged from 16-62 units. CONCLUSIONS: cMDCs provide a more precise method for examining NBF change; however, without an electronic approach to data visualization, a single MDC is easier and quicker to apply in clinical practice. Relationship to PCM principle(s): Person-centered measurement emphasizes the need for assessment results that are comprehensible to all relevant parties, including clinicians and family care partners. Integration of Rasch equal-interval measures, change indices, and modern data visualization techniques can facilitate comprehensibility of interpreting CNC-8 assessment results in real time at the bedside.

Department

Clinical Research and Leadership

Link to Full Text

Share

COinS