Reliability and Validity of the Lowenstein Communication Scale

The Lowenstein Communication Scale (LCS) is a tool for the evaluation of communicative performance in patients with disorders of consciousness (DOC). This study investigated the reliability and validity of the LCS.

We evaluated 23 inpatients with unresponsive wakefulness syndrome (UWS) and 18 in a minimally conscious state (MCS), at admission to a Consciousness Rehabilitation Department and one month later. The evaluations included assessments of LCS by two raters, and of the Coma Recovery Scale-Revised (CRS-R) by one rater.

Total inter-rater agreement in LCS task scoring was found in 58-100% of the patients. Cohen's kappa values were >0.6 for most tasks. High correlations were found between the two raters on total scores and most subscales (r = 0.599-1.000, p < 0.001), and the differences between them were small. LCS subscales and total score intraclass correlations (ICC) were high. Internal consistency was acceptable (Cronbach's α > 0.7) for most LCS subscales and total scores. Moderate to strong correlations were found between LCS and CRS-R scores (r = 0.554-0.949, p < 0.05), and the difference in responsiveness between LCS and CRS-R was non-significant.

The findings indicate that the LCS is reliable and valid, making it a valuable clinical and research assessment tool for patients with DOC.