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Brain Injury

DOCS-25: (Mallinson et al. 2016; n = 92. Mean age: 36.5 +/- 17 years. Time post injury: <90 days = 129, 91-180 days = 39, >180 days =4)

• Standard Error of Measurements for all participants (n=92) = 4.14
• Standard Error of Measurements for improvers (n=57) = 4.05
• Standard Error of Measurements for non-improvers (n=35) = 3.6

Brain Injury

DOCS-25: (Mallinson et al. 2016; n = 92. Mean age: 36.5 +/- 17 years. Time post injury: <90 days = 129, 91-180 days = 39, >180 days =4)

Minimal Detectable Change with 95% Confidence Interval (MDC₉₅)

• MDC₉₅ for entire group (n=92): 5.6 (using 0-100 transformed scale)
• MDC₉₅ for improvers (n=57): 5.5 (using 0-100 transformed scale)
• MDC₉₅ for non-improvers (n=57): 5.3 (using 0-100 transformed scale)

Brain Injury

DOCS-25: (Mallinson et al. 2016; n = 92. Mean age: 36.5 +/- 17 years. Time post injury: <90 days = 129, 91-180 days = 39, >180 days =4)

Anchor-based MCID (GCS change of 2): 8.6 (using 0-100 transformed scale)

Distribution based Minimal Clinically Important Difference:

• 0.20 SD: 2.6 (using 0-100 transformed scale)
• 0.33 SD: 4.4 (using 0-100 transformed scale)
• 0.50 SD: 6.6 (using 0-100 transformed scale)

Brain Injury (CHI, anoxia, aneurysm, open-head injury, AV malformation, hemorrhage)

Docs-23: (Pape et al, 2005a; n= 95; mean age at injury= 36 years old; mean time post injury= not documented) 

• Interrater reliability is based on ratings done by 44 clinicians (speech pathologists, PT, OT, RN, neuropsych doctoral candidates and respiratory therapists) where exact agreement on ratings was 54.4% (Pape et al, 2005a) A consensus process by American Congress of Rehabilitation Medicine, found fault with this method of reporting IRR (Seel et al., 2010). Pape et al.(2011) reported that the reliability is analogous to K=.95.

DOCS-25:

(Pape et al 2014; n = 39. Mean age & time since injury not reported for this subset of the sample of n=174)

       Inter-rater reliability

• Excellent overall Inter-rater reliability: (ICC = 0.90)
• Excellent Gustation/olfaction Inter-rater reliability: (ICC = 0.84)
• Excellent Somatosensory Inter-rater reliability: (ICC = 0.91)
• Excellent Auditory-language Inter-rater reliability: (ICC = 0.78)
• Excellent Visual Inter-rater reliability: (ICC = 0.91) 

Brain Injury (CHI, anoxia, aneurysm, open-head injury, AV malformation, hemorrhage)

DOCS-23:(Pape et al, 2005a)

• Excellent internal consistency (Cronbach¡¯s alpha .85 for closed head injury, .77 for other head injury)

Brain Injury

DOCS-25:(Pape et al 2014; n = 174. Mean age: 36.5 + 17 years. Mean time post injury: 69.4 + 51.0 days)

• Excellent internal consistency: Person separation reliability = 0.91, Separation Index = 3.22
• Excellent: Cronbach¡¯s Alpha: 0.86

Brain Injury (CHI, anoxia, aneurysm, open-head injury, AV malformation, hemorrhage)

DOCS-23:(Pape et al, 2005a)

• True positive and negative rates for the baseline DOCS <48 or ¡Ý 48 indicate that the baseline DOCS detects recovery and lack of recovery of consciousness 71% and 68% of the time.
• The AUC = .73 when comparing predicted recovery according to the baseline DOCS with actual recovery of consciousness indicates that the baseline DOCS accurately discriminates between these outcomes 73% of the time. 

Brain Injury, unconscious >28 days (closed head injury, anoxia, hemorrhage, aneurysm, blast injury):

DOCS-23: (Pape, et al., 2009; n= 113; mean age= 38 years old (TBI= 36 years old, OBI= 44.0 years old); mean days post injury= 48.3(TBI=45.93 days, OBI= 55.10 days))

• Excellent predictive validity at 4 months post injury (Area Under Receiver Operating Characteristic Curve - AUC = .87)
• Excellent predictive validity at 8 months post injury (AUC= .88)
• Excellent predictive validity at 12 months post injury (AUC= .89 )

Brain Injury

DOCS-25:

Concurrent Validity: (Pape et al 2014; n = 174. Mean age: 36.5 + 17 years. Mean time post injury: 69.4 + 51.0 days)

• Adequate concurrent validity using total DOCS-25 measures to GCS and CNC at baseline.
• Poor concurrent validity using DOCS-25 subscales measures to GCS and CNC at baseline.

Reported as Spearman's rho. CI= 95% confidence interval.

Reported as Spearman's rho. CNC= Coma/Near-Coma Scale. CI= 95% confidence interval.

Brain Injury (CHI, anoxia, aneurysm, open-head injury, AV malformation, hemorrhage)

DOCS-23: (Pape, et al., 2005a)

• The DOCS possibly has unidimensional hierarchic interval characteristics when used with persons with closed head injury.
• The unidimensional hierarchic structure in Other Brain Injury has not been adequately established.

Brain Injury

DOCS-25: (Pape et al 2014; n = 174. Mean age: 36.5 + 17 years. Mean time post injury: 69.4 + 51.0 days)

• The DOCS-25 has excellent construct validity. The hierarchical ordering of the items makes clinical sense and all 25 items fit the measurement model. The principal components analysis produced an eigenvalue of 3.2 and the percent of unexplained variance in the first contrast was 8.5%. While the eigenvalue is above the expected threshold of 2.0, further analysis of the disattenuated correlations between the item clusters (r=.97-.99) indicated the items represent the same construct. No differential item functioning was found.

The DOCS has acceptable content validity but only for differentiating persons in MCS from those in VS based on Aspen Workgroup criteria, the ability to detect emergence from MCS has not been studied.

Brain Injury

DOCS-25: (Mallinson et al. 2016; n = 92. Mean age: 36.5 +/- 17 years. Time post injury: <90 days = 129, 91-180 days = 39, >180 days =4)

• Moderate Change: Effect Size for all participants (n=92) = 0.45
• Large Change: Effect Size for non-improvers (n=35) = 0.58
• Moderate Change: Effect Size for improvers (n=57) = 0.45
• Moderate Change: Standardized Response Mean for all participants (n=92) = 0.43
• Large Change: Standardized Response Mean for non-improvers (n=35) = 1.3
• Large Change: Standardized Response Mean for improvers (n=57) = 1.3