A comparative study on assessment procedures and metric properties of two scoring systems of the Coma Recovery Scale-Revised items: Standard and modified scores

Davide Sattin, Piergiorgio Lovaglio, Greta Brenna, Venusia Covelli, Davide Rossi Sebastiano, Dunja Duran, Ludovico Minati, Ambra Mara Giovannetti, Cristina Rosazza, Anna Bersano, Anna Nigri, Stefania Ferraro, Matilde Leonardi

Research output: Contribution to journalArticle


Objective: The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. Design: Cross sectional design/methodological study. Setting: Inpatient, neurological unit. Participants: A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013. Intervention: All patients were assessed with the Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2) procedures. Main outcome measures: Coma Recovery Scale-Revised score, number of cognitive and reflex behaviours and diagnosis. Results: Regarding patient assessment, rater 1 using standard and rater 2 using inverted procedures obtained the same best scores for each subscale of the Coma Recovery Scale-Revised for all patients, so no clinical (and statistical) difference was found between the two procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery Scale-Revised codified behavioural responses were not found during assessment, although higher response categories were present. A total of 51 (36%) patients presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard score, whereas no overlap was found using the modified score. Unidimensionality was confirmed for both score systems. Conclusion: The Coma Recovery Scale Modified Score showed a higher discriminant capacity than the standard score and a monofactorial structure was also supported. The inverted assessment procedure could be a useful evaluation method for the assessment of patients with disorder of consciousness diagnosis.

Original languageEnglish
Pages (from-to)1226-1237
Number of pages12
JournalClinical Rehabilitation
Issue number9
Publication statusPublished - Sep 1 2017



  • behavioural assessment
  • disorder of consciousness
  • minimally conscious state
  • Persistent vegetative state
  • scoring technique

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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