Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Standardisation of the principal subscale to assess awareness in patients with disorders of consciousness

Abstract

Establishing valid and reliable measures for use with patients with disorders of consciousness (DOC) following profound brain injury is challenging due to a number of factors including the complex presentation of such patients and assessor variability. The auditory modality has been demonstrated to have greater sensitivity for detecting awareness in DOC patients. However, there are no measures developed to assess auditory responsiveness specifically. The objective of this study was to examine the psychometric properties of the principal subscale of a music therapy assessment tool (MATADOC) developed for use with adult DOC patients. The subscale assesses behavioural domains essential for diagnosis of awareness. Twenty-one adult patients were recruited from a specialist rehabilitation unit. In a prospective study with repeated measures, internal consistency, inter-rater and test-retest reliability and dimensionality were examined. The five-item scale showed satisfactory internal reliability (α = .76) and a strong first principal component. Corrected item-total correlations were all > .45. Inter-rater intra-class correlations (ICCs) ranged from 0.65-1.00 and intra-rater ICCs from 0.77-0.90. Rasch analysis confirmed these impressions of a reliable, unidimensional and homogenous scale. Diagnostic outcomes had 100% agreement with a validated external reference standard. The results indicate that the MATADOC principal subscale provides a new behavioural measure that can contribute to interdisciplinary assessment of awareness with DOC patients.

Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC): Reliability and Validity of a Measure to Assess Awareness in Patients with Disorders of Consciousness

“…These are considered "essential" domains to assess in DOC measures. The psychometric properties and reliability of this subscale have been reported previously as having good interrater reliability (mean = 0.83, sd = 0.11) and good test-retest reliability (mean = 0.82, sd = 0.05) (Magee et al, 2014). Internal consistency for the five-item Principal Subscale was rated as good (α = 0.76) for a four-six-item scale for DOC populations (Seel et al, 2010) with a strong first principal component.…”

“…The auditory modality has been the focus of greater empirical inquiry due to evidence that it is the more sensitive modality for identifying awareness (Gill-Thwaites & Munday, 1999;Owen et al, 2005), provided by clinical reports of persons with DOC who have demonstrated cognitive capacity through the auditory modality even in the absence of movement and language (Giacino et al, 2009;Owen et al, 2006). Despite the increased evidence for using auditory stimuli to assess awareness, the existing standardized measures for DOC populations fail to address auditory responsiveness adequately (Lichtensztejn, Macchi, & Lischinsky, 2014;Magee, Siegert, Daveson, Lenton-Smith, & Taylor, 2014). The recommended evidence-based measures reduce auditory stimuli to verbal material or stimuli that cause a startle response (e.g., blowing a whistle, clapping hands, banging wooden blocks) or involve calling the patient's name (Seel et al, 2010).…”

“…Music is receiving increasing attention as a stimulus for assessment of awareness given its properties of being a non-languagebased stimulus within the auditory modality that has emotional saliency (Boyle & Greer, 1983;Formisano et al, 2001;Jones et al, 2000;Lichtensztejn et al, 2014;Magee, 2005Magee, , 2007Magee et al, 2014;Okumura et al, 2014;Perrin et al, 2006;Puggina, da Silva, & Santos, 2011;Verger et al, 2014;Verville et al, 2012;Wilson, Cranny, & Andrews, 1992). Neurophysiological studies have revealed that music can promote behavioral responses indicative of arousal and attention in PDOC patients, and most importantly, that significant cortical and autonomic nervous system activity suggest discriminative ability rather than reflex responses .…”

“…Given a previous study to explore the reliability and dimensionality of the MATADOC Principal Subscale (Magee et al, 2014), the purpose of this study was i) to examine the reliability (interrater and test-retest) of subscales two and three of the MATADOC, including those items that previously had not been examined; and ii) to explore the internal consistency of the two items in the second subscale that use binary rating for a group of behaviors given their clinical rather than diagnostic utility.…”

“…Fourth, criterion validity was examined through a comparison of the MATADOC to a standardized reference standard, the SMART (Gill-Thwaites & Munday, 1999), which has been evaluated as having good content validity and may be used to assess DOC with moderate reservations (Seel et al, 2010). Fifth, construct validity based on the Rasch model has been examined for the MATADOC Principal Subscale, which is the only subscale that carries diagnostic utility (Magee et al, 2014). MATADOC subscales two and three have utility primarily for goal setting and intervention planning.…”