Purpose
The PCRS evaluates self-awareness of abilities following TBI.
Link to Instrument
Acronym
PCRS
Cost
FreeDiagnosis/Conditions
- Brain Injury Recovery
Primary Image
Patient Competency Rating Scale
Populations
Key Descriptions
- The PCRS is a 30-item self-report that asks the person with brain injury to rank ability to accomplish common daily activities (ADL, behavioral and emotional functions, cognitive and physical abilities) on a 5-point scale:
1 = can’t do
2 = very difficult to do
3 = can do with some difficulty
4 = fairly easy to do
5 = can do with ease - An informant (relative, caregiver, or therapist) also rates the person with brain injury on the same items.
- Scoring includes 3 approaches:
1 - A total score or average competency rating across all items.
2 - Number of items which score is higher by person with brain injury, number of items which score is higher by informant, and number of items which have same score. The person with brain injury can be classified by which category is the largest of these three.
3 - The difference in ratings for each item can be calculated, examining patterns of responses that may be different for physical vs. cognitive abilities.
Number of Items
30
Time to Administer
Less than 10 minutes
Required Training
No TrainingInstrument Reviewers
Initially reviewed by Karen McCulloch, PT, PhD, NCS, an the TBI EDGE task force of the Neurology Section of the APTA in 6/2012
ICF Domain
ActivityParticipation
Professional Association Recommendation
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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TBI EDGE |
NR |
NR |
NR |
NR |
NR |
Recommendations for use based on ambulatory status after brain injury:
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Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
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TBI EDGE |
NR |
NR |
NR |
NR |
Recommendations for entry-level physical therapy education and use in research:
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Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
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TBI EDGE |
No |
No |
No |
Not reported |
Considerations
It is assumed that the informant offers an accurate assessment, that may be difficult for some items including those related to emotional control. A standard approach for scoring is not recommended. Guidance for interpretation is limited.
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Brain Injury
back to PopulationsCut-Off Scores
(Sherer et al, 2003; n=58 patients with TBI who had emerged from PTA; mean age 33 years; mean PTA duration 28 days)
- PCRS Clinician-PCRS Patient scores:
- <28 mild or no impaired self-awareness
- 28-51 moderate impaired self-awareness
- >51 severe self-awareness
Normative Data
(Prigatano et al, 1998; n=28; matched controls for individuals with TBI in study by age, sex and education level, mean age 27.4 (9.9) years)
- Most rated themselves between 130 and 150 on PCRS, closely concurring with ratings by relatives. A smaller percentage of healthy controls (10.7%) overestimated abilities compared to their relatives ratings than individuals with TBI (30%).
Test/Retest Reliability
(Prigatano et al, 1990; n=17 patients with TBI and their relatives)
- Excellent correlation in two tests for patients (r=.97) and relatives (r=.92)
(Fleming et al, 1998; n=20 patients with severe TBI; mean age 25(9) years; mean duration of PTA 54(33) days; Australian sample)
- Excellent test-retest reliability one week apart (ICC=.85)
Interrater/Intrarater Reliability
(Fordyce and Roueche,1986; n=28 patients with TBI; ages 19-44; time post injury 3-28 months)
- Excellent interstaff ratings (r=.92)
Internal Consistency
(Fleming et al, 1998; n=55 patients with severe TBI; mean age 25(9) years; mean duration of PTA 554(33) days; Australian sample)
- Excellent internal consistency for patient and relative versions of PCRS with alphas of .91 and .93 respectively.
Criterion Validity (Predictive/Concurrent)
Predictive validity:
- PCRS difference scores were better able than Awareness Questionnaire difference scores to predict employability in a regression model (accounting for 22% of variability in employability) (Sherer et al, 2003).
Construct Validity
Traumatic brain injury: (Prigatano et al, 1998; n=30; mean age 29(10.4) years; who had sustained TBI with mean GCS 6.6(2.8) and mean PTA of 69.6 (69.5) days; mean time post injury= 24.8 months (14.5))
- Agreement of individual ratings and relative ratings differed between the group with brain injury and a group of healthy controls (X2 analysis, p=.0014).
- Adequate correlation of patient difference scores on PCRS (compared to relative) and admitting GCS (r=-.39) and PTA (r=0.41).
Traumatic Brain Injury: (Prigatano et al, 2005; n=25, average age 35.1(11.65) years; diagnosed with TBI)
- Adequate correlation with relatives’ emotional distress (r=-.52) with decreased awareness of deficits identified by individuals with brain injury.
- The PCRS helped identify recovery patterns in individuals with severe TBI including a group with high self-awareness of TBI deficits who were more emotionally distressed and motivated to improve, in contrast with a group with low self-awareness and lack of distress or motivation to change and a group that had achieved a good recovery, with lack of emotional distress or motivation to change because they had few deficits. (Fleming et al, 1998)
- Patient rated abilities were not correlated with clinician or family PCRS ratings, reflecting impaired self-awareness; Adequate to excellent correlations for clinician/family PCRS ratings (r=.36) and clinician/family difference scores (r=.64); Excellent correlation of PCRS to Awareness Questionnaire scores (r=.69) (Sherer et al, 2003)
Bibliography
Fleming, J. M., Strong, J., et al. (1998). "Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationshipto outcome." J Head Trauma Rehabil 13(5): 39-51. Find it on PubMed
Fordyce, D. J. and Roueche, J. R. (1986). "Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury." Rehabil Psychol 31(4): 217-229.
Fordyce, David J. Leathem, J. J. M., Murphy, L. L. J., et al. (1998). "Self- and Informant-Ratings on the Patient Competency Rating Scalein Patients with Traumatic Brain Injury." Journal of Clinical & Experimental Neuropsychology 20(5): 694. Find it on PubMed
Prigatano, G. P., Bruna, O., et al. (1998). "Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury." J Head Trauma Rehabil 13(5): 29-38. Find it on PubMed
Prigatano, G. P., Fordyce, D. J., et al. (1986). Neuropsychological rehabilitation after brain injury, Johns Hopkins University Press Baltimore.
Sherer, M., Hart, T., et al. (2003). "Measurement of impaired self-awareness after traumatic brain injury : a comparison of the patient competency rating scale at the awareness questionnaire." Brain Injury 17(1): 25. Find it on PubMed