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Co-creating and Evaluating Preimplementation Outcomes of the Recovery Ruler for the Coma Recovery Scale-Revised: A

Jennifer A Weaver1, Christina Papadimitriou2, Alison McGuire3

  • 1Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO.

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|November 12, 2025
PubMed
Summary
This summary is machine-generated.

A new data visualization tool, the Recovery Ruler, was co-created for Coma Recovery Scale-Revised (CRS-R) results. It enhances communication for care teams and partners, proving usable, acceptable, appropriate, and feasible.

Keywords:
Brain injuryComatoseImplementationMixed methodsPerson-centeredRehabilitation

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Area of Science:

  • Rehabilitation Medicine
  • Health Informatics
  • Patient-Centered Care

Background:

  • Effective communication of assessment results is crucial for individuals with disorders of consciousness.
  • Existing tools may not adequately present Coma Recovery Scale-Revised (CRS-R) data in a person-centered manner.
  • The Knowledge-to-Action framework and person-centered measurement principles offer a structured approach for tool development.

Purpose of the Study:

  • To co-create a data visualization tool, the Recovery Ruler, for presenting Coma Recovery Scale-Revised (CRS-R) results.
  • To integrate person-centered measurement principles (relationship-driven, holistic, transparent, comprehensible, timely, co-created) into the tool's design.
  • To evaluate the usability, acceptability, appropriateness, and feasibility of the Recovery Ruler for care teams.

Main Methods:

  • Concurrent mixed methods design involving two design sessions with a semi-structured interview guide.
  • Fourteen international participants (practitioners and care partners) with experience in disorders of consciousness were involved.
  • Surveys included the System Usability Scale (SUS), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure.

Main Results:

  • Content analysis led to revisions, including adding patient preference details (relationship-driven) and suggesting bedside placement (transparent, timely).
  • Significant improvements in usability (SUS scores increased from M=77.9 to M=83.3, p=0.045) and acceptability/appropriateness (AIM/IAM scores increased, p<0.05) were observed between design sessions.
  • Participants' feedback guided modifications to enhance clarity and comprehensibility of the tool's concepts.

Conclusions:

  • The Recovery Ruler, a data visualization tool for CRS-R results, was successfully co-created and found to be usable, acceptable, appropriate, and feasible.
  • The tool facilitates immediate and understandable sharing of assessment results with care partners, enhancing transparency and timeliness.
  • This methodological approach demonstrates a process for integrating person-centered principles with established rehabilitation assessments.