Disability Rating Scale (for TBI)

Traumatic Brain Injury: (TBI Model Systems National Database data 2012; n=11,058; mean age at injury=40 years old; gender=74% male) 

• Average DRS Score: 
  • Rehab Admission (n=10837) 12.38 
  • Rehab Discharge (n=10832) 6.38 
  • 1 year post-jury (n=8134) 2.86 
  • 2 years post-injury (n=6875) 2.57

Traumatic Brain Injury: (Gouvier et al, 1987; n=40, gender=27 male, 13 female; setting: acute care; between ratings at one day intervals)

• Excellent test-retest relaibilty (r=0.95)

Traumatic Brain Injury: (Rappaport et al, 1982; n=88; tool administered at day one of admission and 12 months after injury)

• Excellent inter-rater reliability (r=0.97-0.98) among 3 raters 

Traumatic Brain Injury: (Novack et al, 1991; n=45 caregivers; n=33 male and 12 female with TBI; one member of the treatment team completed the DRS; mean age of patients with TBI=24.3 years; average days in in-patient rehab=40.1 days) 

• Comparison of family members to rehabilitation specialist: the correlation was excellent for both admission and discharge (r=.95 and r=.93 respectively) 

Traumatic Brain Injury: (Gouvier et al, 1987; n=40, gender=27 male, 13 female; setting: acute care; between ratings at one day intervals)

• Excellent intra-rater reliability (r=0.98) among three raters 

Traumatic Brain Injury: (Malec et al, 2012; n=406 (287-TBI, 119-caregivers)

• 1-20 year telephone follow up; used raw scores for all 406 subjects
• ICC between the ODRS and the DRS-PI-Beta= .909 
• ICC between the ODRS and the DRS-PI=.911
• ICC between the DRS-PI-Beta and DRS-PI= .997

Traumatic Brain Injury: (Malec et al, 2012; n=406 (287-TBI, 119-caregivers; 1-20 year telephone follow up; used raw scores for all 406 subjects)

• Original DRS: Cronbach’s alpha (.84) indicating excellent internal consistency 
• DRS-Post Acute Interview-Beta: Cronbach alpha (.83) indicated excellent internal consistency 
• DRS-Post Acute Interview: Cronbach alpha (.83) indicated excellent internal consistency 

Acquired Brain Injury: (stroke, traumatic brain injury): (Eliason and Topp, 1984; n=128; mean age=57.35 (20.46); gender=male, n=74; acute stroke=69%, traumatic brain injury=31%; assessment obtained within 72 hours of injury) 

• Significant correlations were obtained between initial Disability Rating scores and 1) length of acute care hospital stay (r = .50, p < .01), 2) Disability Rating scores at discharge (r = .66, p < .01), and 3) discharge status (r = .40, p < .01) 

Traumatic Brain Injury: (Evans et al, 2005; n=96; gender=female 27%; median age=32)

• DRS scores at admission to rehabilitation made independent contributions to prediction of subjective well-being as assessed with the Satisfaction With Life Scale( SWLS) at rehabilitation discharge (r=-0.31, p<.01)

Traumatic Brain Injury: (Rao et al, 1992; n=57; mean age= 30.8 years (14.6); gender=male 72%; return to work or school up to 26 months was assessed)

• Rehabilitation admission and discharge DRS scores predicted return to work with 86.8% accuracy 

Traumatic Brain Injury: (Gouvier et al., 1987; n=40; gender=27 male, 13 female; setting: acute care; between ratings at one day intervals)

• Predictive validity of the DRS at admission demonstrated excellent correlated with the Stover Zeiger Scale (r=0.65) at discharge.

Acquired Brain Injury: (Fryer and Haffey, 1987; training group n=18; mean age=29.8 years; training group diagnosis=TBI, anoxic brain intracranial hemorrhages; comparison group n=9; mean age=26.5 years; comparison group diagnosis: TBI)

• The need for cognitive rehabilitation is also predicated by the DRS. 
• DRS at admission to a cognitive rehabilitation program is a strong predictor of disability at follow up (r=.77, p< .001). 
• It also discriminated between those outpatients who received Cognitive Rehabilitation/Community Re-adaptation training vs. those who did not. 

Traumatic Brain Injury: (Fleming et al, 1999; n=209; mean age=35.8 (12.96); male gender=80.4%; assessed vocational outcome 2-5 years post-TBI) 

• Those who returned to work had a lower DRS total score (5.0 vs 6.2) compared to those who remained unemployed 

Acquired Brain Injury (cerebral hemorrhage, TBI, intracranial tumors): (Leung et al, 2005; n=79; mean age=42.85 (11.56); male gender=73.4%) 

• The DRS was predictive in discriminating among the three groups of patients (those who returned to the same job, those who changed jobs, and those who were unemployed) 

Traumatic Brain Injury: (Whyte et al., 2005; n=124; Patient with TBI in vegetative state or minimally conscious state; mean age of 122 participants=34.2 (13.3); assessment=DRS score at 16 weeks post injury, n=96) (assessed in all participants who had DRS score at 16 weeks post injury) and the time until first command following occurs (assessed in participants not following commands at enrollment, n=93)

• Date of enrollment (T enroll), DRS score at enrollment (DRS enroll) and daily rate of DRS score (Rate DRS) over first 2 weeks of enrollment are predictive of time until commands are followed 
• T enroll: later admission, later command following 
• DRS enroll:worse enrollment score, later command following 
• Rate DRS: Faster DRS change, earlier command following 

Traumatic Brain Injury: (Testa et al, 2005; n=TBI participants 195, orthopedic participants 82; mean age=young TBI (16-49 years, n=146), 29.1(10.6); older TBI (50-89 years, n=49), 65.8 (9.5); orthopedic injury younger (16-50 years, n=54), 31.1 (10.2); orthopedic injury older (50-89 years, n=28), 64.2 (11.3) 

• DRS was moderately predictive of long-term functional outcome, return to employment and independent living status post TBI 

Traumatic Brain Injury: (Evans et al, 2005; n=96; female gender=26%)

• DRS score at admission predicted Satisfaction with Life Score (SWLS) at rehabilitation discharge (r=-0.31, p<0.01) 

Traumatic Brain Injury: (Malec et al; 2012; n=406 (287-TBI, 119-caregivers); 1-20 year telephone follow up)

Traumatic Brain Injury: (Demakis et al, 2010; n=110; mean age=36.2 (17.2); male gender=73%)

• For the Anxiety scale, DRS at discharge was the only significant predictor (p=.005); individuals with a higher score (i.e., poorer disability) had lower levels of anxiety 
• For the Anxiety-Related Disorders scale, sex and DRS at discharge were both significant predictors (p=.004 and p=.03, respectively) 
• DRS at discharge was significantly related to depression; Similar to the Anxiety scale, the relationship between DRS and Anxiety-Related Disorders and Depression was negative-- greater disability was associated with lower levels of anxiety and depression

Traumatic Brain Injury: (Rappaport et al, 1982; n=88; tool administered at day one of admission and 12 months after injury)

Traumatic Brain Injury: (Hall et al, 1985; n= 70; average age=27; years; average length of coma=32 days; average days form injury to admission to rehab unit=87)

• Correlation of DRS and Glasgow Outcome Scale at two time intervals was adequate (r=0.50) at admission and excellent (r=0.67) at discharge 

Traumatic Brain Injury: (Gouvier et al, 1987; n=40, gender=27 male, 13 female; setting: acute care; between ratings at one day intervals)

• Rehabilitation admission DRS and Stover Zeiger (SZ) Scale Spearman rho correlation was excellent (r=0.92) 
• The rehabilitation discharge DRS and discharge SZ correlation was excellent (r=0.81) 

Traumatic Brain Injury: (Hall et al, 2001; n=48 who had previously received in-patient rehabilitation 2-9 years previously; male gender=77%)

• The Functional Assessment Measure (FAM) employment item correlated most highly with the DRS employability item (-.96) 
• The Neurobehavioral Functioning Inventory (NFI) motor subscale correlated most highly with DRS employment items (.83) 

Traumatic Brain Injury: (Zhang et al., 2010; n=70; % age=18-30 years (71.4%), 31-60 years (27.2%), >61 years (1.4%); gender=male 69%)

• Correlation coefficient of total ratings between the CHART and the DRS was .53 (P<.01); between the CIQ and DRS, was .43 (P<.01). 
• Subscales of the DRS correlated with each other

Traumatic Brain Injury: (Hall et al, 1996; n=133; time interval=admission, discharge, 1 and 2 years post-injury)

• No ceiling effects reported at discharge, year 1 and year 2 after injury 
• Ceiling effects at discharge and at 1 year postinjury are lower for the DRS than the FIM (6% vs 49% and 47% vs 84% of cases are independent, respectively)

Traumatic Brain Injury: (Hall et al, 1985; n= 70; average age=27; years; average length of coma=32 days; average days form injury to admission to rehab unit=87)

• In comparing the DRS with the Glasgow Outcome Scale, 71% of individuals showed improvements on the DRS compared to 33% with GOS between rehabilitation admission and discharge. 

Traumatic Brain Injury: (Rappaport et al, 1989; n=63; obtained DRS scrores at admission, discharge and up to 10 years post-injury)

• DRS has been shown to detect changes over the recovery process with a greater change in those admitted earlier to rehabilitation 

Traumatic Brain Injury: (Bowers et al, 1989; n=96; no other info available from abstract)

• It is sensitive to patient improvement in inpatient TBI rehabilitation, although the FIM is more sensitive for patients with a DRS score above 25.

Traumatic Brain Injury: (Hall et al, 1996; n=133; time interval=admission, discharge, 1 and 2 years post-injury)

• The DRS has poor sensitivity to evaluation of mild TBI (DRS <3) or very severe impairment (DRS>22).
• Authors recommended the addition of half-unit increments on the rating scale, in addition to whole units, for items 4 through 8 to increase sensitivity; however, in 2010, the TBIMS National Database members voted to omit the 0.5 rating option. Use of the 0.5 rating option after April 1, 2010 is not recommended. 

Traumatic Brain Injury: (Hammond et al, 2001; n=1160; male gender=879 (76%); age=16-24 years (n=337, 29%), 25-40 years (n=477, 41%), 41-60 years (n=245, 21%) and >60 years (n=101, 9%)

• Statistically significant differences for DRS years 1 and 3 (P = .0007), DRS years 1 and 5 (P =.0006)
• Statistical significance between years 1 and 5 for DRS Disability Categories (P = .001 and n = 150); by year 5, 42% of the subjects had attained the maximum DRS Disability Category 
• For those with lower functional baseline levels: statistical significance including only those with DRS >3.5 at year 1 (P = .001 for years 1 and 2 and years 1 and 5) 
• Item change: most change was accounted for by Level of Functioning (51% and 59% for the respective intervals) and Employability (51% and 65%), whereas each of the other six DRS items changed less than 11% at both intervals