Validation of Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with CRS-R

Research

Objectives: To examine the concurrent validity of the MATADOC with the criterion standard Coma Recovery Scale (CRS-R) for diagnostic outcomes of awareness; To explore the function of comparable MATADOC items and CRS-R function scales across similar domains (e.g. auditory, visual).

Design: Prospective multisite cohort study collected concurrent MATADOC and CRS-R data using repeated measures with patients with disorders of consciousness (DOC). Raters were blinded. Setting: Three specialist inpatient rehabilitation units for DOC (US, UK, Ireland). Participants: 74 adults with prolonged DOC stemming from acquired brain injury recruited using convenience sampling. Interventions: The MATADOC protocol elicits behavioral responsiveness using live music in five tasks during four clinical contacts of 15-30 minutes duration (60-120 mins total). Observed behavioral responses are rated across motor, communication, arousal, visual and auditory domains using a 14-item measure. Pre and post observation period records spontaneous behaviors. The CRS-R protocol delivers tasks in the motor, visual, auditory and communication domains in clinical contacts of 15-30 minutes duration (60 – 120 minutes in total for 4 contacts). Observed responses are rated in six function scales. Main Outcome Measures: Two measures of awareness: MATADOC and CRS-R.

Results: Fair (Cohen’s kappa or “k”=0.238, p=.006) ranging to moderate (k=0.419, p<.001) significant agreement for diagnostic outcomes across four timepoints, increasing over timepoints. Moderate agreement found for overall diagnostic outcomes ranging across VS, MCS and EMCS (k=0.397, p<.001) with highest agreement for MCS cases (N=23). Moderate significant agreement found between measures for motor diagnostic outcomes (.551≤k.571, p<.001) and visual diagnostic outcomes (.192≤k.415, .001≤p <.005). No agreement was found for item outcomes assessing auditory responsiveness.

Conclusions: The MATADOC may identify responsiveness to auditory stimuli in the absence of other responses. MATADOC auditory items score complexity of auditory localization as MCS in line with recent recommendations whereas the CRS-R scores auditory localization as VS. This may explain differences between the MATADOC and CRS-R outcomes for diagnosis and auditory responsiveness. The MATADOC can be used as a complementary measure of awareness with the CRS-R in interdisciplinary programs for PDoC. Author(s) Disclosures: None