Co-creating and Evaluating Pre-Implementation Outcomes of the Recovery Ruler for the Coma Recovery Scale-Revised: A Concurrent Mixed Methods Study

Document Type

Journal Article

Publication Date

11-10-2025

Journal

Archives of physical medicine and rehabilitation

DOI

10.1016/j.apmr.2025.10.019

Keywords

brain injury; comatose; implementation; mixed methods; person-centered

Abstract

OBJECTIVE: To describe the co-creation, using the Knowledge-to-Action framework and person-centered measurement principles, of a data visualization tool that presents results from the previously validated Coma Recovery Scale-Revised (CRS-R). The five person-centered measurement principles include 1) relationship-driven, 2) holistic, 3) transparent, 4) comprehensible and timely, and 5) co-created. We also examined the tool's usability, acceptability, appropriateness, and feasibility for use by care teams. DESIGN: Concurrent mixed methods using two design sessions and surveys. A semi-structured interview guide facilitated design sessions. SETTING: International PARTICIPANTS: Fourteen individuals (practitioners and care partners) with experience caring for people with disorders of consciousness. MAIN OUTCOME MEASURES: Surveys included the System Usability Scale (SUS), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure. RESULTS: Content analysis of the transcripts identified Recovery Ruler elements that could be added, removed, or revised. Participants added a descriptive text box to indicate the patient's preferences (relationship-driven) provided by their care partner, suggested the tool could be laminated and placed at the patient's bedside (transparent and timely), and changed words to clarify concepts (comprehensible). There was a statistically significant increase between the SUS scores from Design Session 1 (M= 77.9, SD=13.3) and Design Session 2 (M=83.3, SD=11.9) indicating improved usability; t(11) 1.84, p=0.045. AIM and IAM results from Design Session 2 were statistically significantly higher than Design Session 1 (Wilcoxon signed-rank test; z=1.71 and 1.99, p<0.05), indicating improved acceptability and appropriateness, respectively. CONCLUSIONS: CRS-R assessment result information was embedded into a data visualization tool named the Recovery Ruler. Participants indicated the Recovery Ruler was usable, acceptable, appropriate, and feasible. The Recovery Ruler may provide a mechanism to make assessment result information immediately available to share with care partners (transparent and timely) in an easy-to-understand format (comprehensible). The methodological approach describes a process for incorporating person-centered measurement principles with existing rehabilitation assessments.

Department

Clinical Research and Leadership

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