ORIGINAL ARTICLES   Free

European Journal of Physical and Rehabilitation Medicine 2015 October;51(5):627-34

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

An Italian multicentre validation study of the coma recovery scale-revised

Estraneo A. ¹, Moretta P. ¹, De Tanti A. ², Gatta G. ³, Giacino J. T. ^{4, 5}, Trojano L. ^{1, 6} ✉, for The Italian Crs-R Multicentre Validation Group

¹ Disorders of Consciousness Laboratory, Salvatore Maugeri Foundation, IRCCS Scientific Institute, Telese Terme, Benevento, Italy; ² Department of Rehabilitation, Cardinal Ferrari Hospital Fontanellato, Parma, Italy; ³ Rehabilitation Medicine Unit, Ravenna Hospital, Ravenna, Italy; ⁴ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA; ⁵ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; ⁶ Neuropsychology Lab., Department of Psychology, Second University of Naples, Caserta, Italy

BACKGROUND: Rate of misdiagnosis of disorders of consciousness (DoC) can be reduced by employing validated clinical diagnostic tools, such as the Coma Recovery Scale-Revised (CRS-R). An Italian version of the CRS-R has been recently developed, but its applicability across different clinical settings, and its concurrent validity and diagnostic sensitivity have not been estimated yet.
AIM: To perform a multicentre validation study of the Italian version of the Coma Recovery Scale-Revised (CRS-R).
DESIGN: Analysis of inter-rater reliability, concurrent validity and diagnostic sensitivity of the scale.
SETTING: One Intensive Care Unit, 8 Post-acute rehabilitation centres and 2 Long-term facilities
POPULATION: Twenty-seven professionals (physicians, N.=11; psychologists, N.=5; physiotherapists, N.=3; speech therapists, N.=6; nurses, N.=2) from 11 Italian Centres.
METHODS: CRS-R and Disability Rating Scale (DRS) applied to 122 patients with clinical diagnosis of Vegetative State (VS) or Minimally Conscious State (MCS).
RESULTS: CRS-R has good-to-excellent inter-rater reliability for all subscales, particularly for the communication subscale. The Italian version of the CRS-R showed a high sensitivity and specificity in detecting MCS with reference to clinical consensus diagnosis. The CRS-R showed good concurrent validity with the Disability Rating Scale, which had very low specificity with reference to clinical consensus diagnosis.
CONCLUSIONS: The Italian version of the CRS-R is a valid scale for use from the sub-acute to chronic stages of DoC. It can be administered reliably by all members of the rehabilitation team with different specialties, levels of experience and settings.
CLINICAL REHABILITATION IMPACT: The present study promote use of the Italian version of the CRS-R to improve diagnosis of DoC patients, and plan tailored rehabilitation treatment.