Co-creating and Evaluating Pre-Implementation Outcomes of the Recovery Ruler for the Coma Recovery Scale-Revised: A Concurrent Mixed Methods Study.

Abstract

To describe the co-creation, using the Knowledge-to-Action framework and person-centered measurement principles, of a data visualization tool that presents results from the previously validated Coma Recovery Scale-Revised (CRS-R). The five person-centered measurement principles include 1) relationship-driven, 2) holistic, 3) transparent, 4) comprehensible and timely, and 5) co-created. We also examined the tool's usability, acceptability, appropriateness, and feasibility for use by care teams. Concurrent mixed methods using two design sessions and surveys. A semi-structured interview guide facilitated design sessions. International PARTICIPANTS: Fourteen individuals (practitioners and care partners) with experience caring for people with disorders of consciousness. Surveys included the System Usability Scale (SUS), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure. Content analysis of the transcripts identified Recovery Ruler elements that could be added, removed, or revised. Participants added a descriptive text box to indicate the patient's preferences (relationship-driven) provided by their care partner, suggested the tool could be laminated and placed at the patient's bedside (transparent and timely), and changed words to clarify concepts (comprehensible). There was a statistically significant increase between the SUS scores from Design Session 1 (M= 77.9, SD=13.3) and Design Session 2 (M=83.3, SD=11.9) indicating improved usability; t(11) 1.84, p=0.045. AIM and IAM results from Design Session 2 were statistically significantly higher than Design Session 1 (Wilcoxon signed-rank test; z=1.71 and 1.99, p<0.05), indicating improved acceptability and appropriateness, respectively. CRS-R assessment result information was embedded into a data visualization tool named the Recovery Ruler. Participants indicated the Recovery Ruler was usable, acceptable, appropriate, and feasible. The Recovery Ruler may provide a mechanism to make assessment result information immediately available to share with care partners (transparent and timely) in an easy-to-understand format (comprehensible). The methodological approach describes a process for incorporating person-centered measurement principles with existing rehabilitation assessments.