Updated Measurement Characteristics and Clinical Utility of the Coma Recovery Scale-Revised Among Individuals With Acquired Brain Injury

Published:October 14, 2020DOI:
      The Coma Recovery Scale-Revised (CRS-R) is a standardized neurobehavioral assessment measure designed for use in patients with disorders of consciousness.1 There are 6 subscales that assess behaviors mediated by language, visuoperceptual, and motor networks. The items are hierarchically arranged reflecting brainstem, subcortical, and cortically-mediated functions.2 Serial CRS-R assessment has high sensitivity for detecting signs of consciousness. The CRS-R can further distinguish between features of minimally conscious state plus and minimally conscious state minus. The CRS-R may be used to monitor behavioral recovery, predict outcome,3 and assess treatment effectiveness. The CRS-R is a National Institute of Neurological Diseases and Stroke Common Data Element and is recommended by the American Congress of Rehabilitation Medicine, the American Academy of Neurology, and the National Institute on Disability, Independent Living, and Rehabilitation Research for use in clinical practice.4
      CRS-R items demonstrate excellent content and construct validity, internal consistency, interrater and test-retest reliability1 as well as high sensitivity.5 Rasch analysis and item response theory support the use of the CRS-R for establishing diagnosis and monitoring recovery of consciousness.2 Translations and validations are available in 15 languages, and a pediatric version is validated in healthy children. The CRS-R can be used by a range of health professionals.
      CRS-R administration takes 15-30 minutes. The CRS-R Administration and Scoring Manual was updated in 2020 based on international survey responses from 63 clinicians and researchers who provided feedback on the clarity of administration and scoring of each CRS-R item. The updated manual, general guidelines, frequently asked questions, suggested training module, and reference list are on the Rehabilitation Measures Database.
      This abbreviated summary provides a review of the psychometric properties of the Coma Recovery Scale-Revised in acquired brain injury. A full review of the Come Recovery Scale-Revised and reviews of over 500 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. 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 (NIDILRR), Administration for Community Living, United States Department of Health and Human Services, through the Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (H133B090024). Current funding for the Rehabilitation Measures Database comes from the Shirley Ryan AbilityLab, the first-ever “translational” research hospital where clinicians, scientists, innovators, and technologists work together in the same space, applying research in real time to physical medicine and rehabilitation.
      • 1.
        Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 2004;85:2020-9.
      • 2.
        La Porta F, Caselli S, Ianes AB, et al. Can we scientifically and reliably measure the level of consciousness in vegetative and minimally conscious states? Rasch analysis of the Coma Recovery Scale-Revised. Arch Phys Med Rehabil 2013;94:527-35.e521.
      • 3.
        Portaccio E, Morrocchesi A, Romoli AM, et al. Improvement on the Coma Recovery Scale-Revised during the first four weeks of hospital stay predicts outcome at discharge in intensive rehabilitation after severe brain injury. Arch Phys Med Rehabil 2018;99:914-9.
      • 4.
        Giacino JT, Katz DI, Schiff ND, et al. Practice guideline update recommendations summary: disorders of consciousness: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Arch Phys Med Rehabil 2018;99:1699-709.
      • 5.
        Bodien YG, Carlowicz CA, Chatelle C, Giacino JT. Sensitivity and specificity of the Coma Recovery Scale--Revised total score in detection of conscious awareness. Arch Phys Med Rehabil 2016;97:490-2.e491.