Supervision rating scale: a measure of functional outcome from brain injury.

OBJECTIVE: To introduce a new outcome rating scale, the Supervision Rating Scale (SRS), which measures the level of supervision that a patient receives from caregivers. The SRS rates level of supervision on a 13-point ordinal scale that can optionally be grouped into five ranked categories (Independent, Overnight Supervision, Part-Time Supervision, Full-Time Indirect Supervision, and Full-Time Direct Supervision).
DESIGN: Descriptive correlational study of the scale's interrater reliability and criterion-related validity.
SETTING: Brain injury program of a freestanding rehabilitation hospital. PATIENTS: Referred case series of 114 patients with moderate to severe traumatic brain injury (mean time postinjury = 3.8 years) who resided in the community or a nonhospital facility. INTERVENTION: None. MAIN OUTCOME MEASURES: Functional outcome as measured by the Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), type of living arrangement and independence in selfcare and instrumental activities of daily living (ADL).
RESULTS: SRS ratings showed consistent relationships with type of living arrangement and with independence in self-care and instrumental ADL. SRS ratings were also strongly associated with ratings on the DRS and GOS. Interrater reliability of the SRS was evaluated in a subsample of 19 patients and found to be satisfactory (intraclass correlation = .86, weighted kappa = .64).
CONCLUSIONS: The results suggest that the SRS should have sufficient reliability and validity to serve as a measure of functional outcome from brain injury. Because SRS ratings are based on observed behaviors, the SRS may have a smaller subjective component as compared to the DRS and GOS.