Measurement Characteristics and Clinical Utility of the Disorders of Consciousness Scale Among Individuals With Brain Injury

Published:April 26, 2019DOI:
      The Disorders of Consciousness Scale (DOCS) is a bedside assessment of neurobehavioral function (NBF) for individuals with disordered consciousness following a brain injury. The DOCS is different from other bedside assessments of NBF because it captures the person’s best response to sensory stimuli. The current version, the DOCS-25, evaluates 4 sensory domains: auditory-language, somatosensory, visual, and gustation and olfaction.
      Rasch analysis improved the scale’s precision by selecting items that best reflect the domain of NBF. The hierarchy of the items makes clinical sense and is consistent across sex, injury type, veteran status, and days from onset of injury based on a sample of traumatic and non-traumatic brain injuries.1 The ordinal raw score scale was transformed to a linear scale ranging from 0-100 units. The scale demonstrates excellent internal consistency, construct validity, predictive validity, and adequate concurrent validity with the Glasgow Coma Scale and the Coma/Near Coma Scale.1. 2. 3.
      The DOCS-25 is the first NBF assessment for disorders of consciousness to provide indices of responsiveness; essential information for therapists to interpret meaningful change and understand how the selected treatment is impacting patient recovery.4 The DOCS has been shown to be useful in practice for examining response to treatment and alerting practitioners to evaluate the possibility of secondary medical complications based on subtle declines from the DOCS measure.2. 3. 5. In sum, the reliability, validity, and responsiveness of the DOCS-25 supports clinical use in persons with a severe brain injury.
      This abbreviated summary provides a review of the psychometric properties of the DOCS in people with brain injury. A full review of the DOCS and reviews of over 425 other instruments for patients with various health conditions can be found at:
      Please address correspondence to [email protected] .
      This instrument summary is designed to facilitate the selection of outcome measures by clinicians. The information contained in this summary represents a sample of the peer-reviewed research available at the time of this summary’s publication. The information contained in this summary does not constitute an endorsement of this instrument for clinical practice or research applications. The views expressed are those of the summary authors and do not represent those of authors’ employers, instrument owner(s), the Archives of Physical Medicine and Rehabilitation, the Rehabilitation Measures Database or the United States Department of Health and Human Services. The information contained in this summary has not been reviewed externally.
      The Rehabilitation Measures Database and Instrument Summary Tear-sheets were initially funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, United States Department of Health and Human Services, through the Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (grant no. H133B090024).
      Supported in part by the Department of Defense, Congressionally Directed Joint Warfighter Medical Research Program (grant no. #JW150040).
      • 1.
        Pape TL, Mallinson T, Guernon A. Psychometric properties of the disorders of consciousness scale. Arch Phys Med Rehabil 2014;95:1672-84.
      • 2.
        Pape TL, Guernon A, Lundgren S, et al. Predicting levels of independence with expressing needs and ideas 1 year after severe brain injury. Rehabil Psychol 2013;58:253-62.
      • 3.
        Pape TL, Tang C, Guernon A, et al. Predictive value of the disorders of consciousness scale (DOCS). PM R 2009;1:152-61.
      • 4.
        Mallinson T, Pape TL, Guernon A. Responsiveness, minimal detectable change, and minimally clinically important differences for the disorders of consciousness scale. J Head Trauma Rehabil 2016;31:E43-51.
      • 5.
        Pape TL, Senno RG, Guernon A, Kelly JP. A measure of neurobehavioral functioning after coma. Part II: clinical and scientific implementation. J Rehabil Res Dev 2005;42:19.