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Introduction: Clinical assessments should meet the general psychometric properties of reliability and validity. Furthermore there are requirements in matters of diagnostic validity and usability. In regards to patients with severe brain damage, both issues can mainly be implemented by detecting and assessing returning abilities as early as possible, in order to use them for treatment planning. Main aim of this article is to investigate whether the newly developed and validated interprofessional Basel Vegetative State Assessment (BAVESTA) meets these practice criteria. Method: Data were collected as part of validity assessment of BAVESTA. Using the Glasgow Coma Scale as a reference, predictive parameters and measures of effect are calculated. Moreover, expert users were interviewed and results are presented in a descriptive way. Results: With a sensitivity of 0.84 and a specificity of 0.85, the BAVESTA can be regarded as suitable in differentiating between vegetative state and further states of remission such as the minimally conscious state. Expert users regard BAVESTA as eligible for mapping rehabilitative process of patients with severely impaired consciousness. They agree upon the fact that all relevant areas are covered by BAVESTA. Discussion: The BAVESTA displays high levels of differentiation, in regards to both sensitivity and specificity. However, measures of effect ought generally to be regarded with caution, as reference standards have not been developed for the area of rehabilitation. Considering time expenditure, BAVESTA is rated as only marginally feasible by expert users. It should be continued to investigate BAVESTA in regards to its diagnostic quality, integrating electrophysical diagnostic tools as reference standards.

Assessing the process of vegetative state is difficult. There are no observational tools so far which are sensitive enough to register the subtle changes in vegetative states. Besides, it is necessary to distinguish between measurements of consciousness and of functions. The »Basel Vegetative State Assessment« (BAVESTA) has been developed since 2007; its reliability and validity were examined in this study. Its main purpose is to bridge the gap between tools measuring the level of consciousness and tools observing functional capacities of a patient. Method: BAVESTA has been developed with the collaboration of experts and potential users. It has been applied at the vegetative state REHAB centre Basel for five years, in order to assess its validity. BAVESTA has been implemented in 126 patients with different aetiopathogeneses, for process evaluation and comparison with four further, well-established tools. Analyses: Cronbach’s alpha, interrater-reliability, retest-reliability, concurrent and prognostic validity were examined. Results: BAVESTA has been proven to be a reliable and valid assessment tool. It is able to consistently measure the subtle changes during the process of rehabilitation in vegetative state patients. Discussion: The results support that BAVESTA is a reliable and valid observational assessment tool. The validation process was undertaken at a rehabilitation centre with a highly specialized ward on patients with vegetative state. Hence, it remains unclear whether BAVESTA is generally comprehensive for users outside this centre. Furthermore, clinical day-to-day difficulties resulted in a considerable amount of missing data. Conclusion: BAVESTA bridges the gap between assessment of consciousness and of functions. Further institutions should investigate its validity.

Introduction: Clinical assessments should meet the general psychometric properties of reliability and validity. Furthermore there are requirements in matters of diagnostic validity and usability. In regards to patients with severe brain damage, both issues can mainly be implemented by detecting and assessing returning abilities as early as possible, in order to use them for treatment planning. Main aim of this article is to investigate whether the newly developed and validated interprofessional Basel Vegetative State Assessment (BAVESTA) meets these practice criteria. Method: Data were collected as part of validity assessment of BAVESTA. Using the Glasgow Coma Scale as a reference, predictive parameters and measures of effect are calculated. Moreover, expert users were interviewed and results are presented in a descriptive way. Results: With a sensitivity of 0.84 and a specificity of 0.85, the BAVESTA can be regarded as suitable in differentiating between vegetative state and further states of remission such as the minimally conscious state. Expert users regard BAVESTA as eligible for mapping rehabilitative process of patients with severely impaired consciousness. They agree upon the fact that all relevant areas are covered by BAVESTA. Discussion: The BAVESTA displays high levels of differentiation, in regards to both sensitivity and specificity. However, measures of effect ought generally to be regarded with caution, as reference standards have not been developed for the area of rehabilitation. Considering time expenditure, BAVESTA is rated as only marginally feasible by expert users. It should be continued to investigate BAVESTA in regards to its diagnostic quality, integrating electrophysical diagnostic tools as reference standards.

Introduction: Valid measurement instruments are necessary to evaluate the rehabilitation progress of brain-injured patients with severe disorders of consciousness such as persistent vegetative state and minimally conscious state. Method: Instruments and validation studies were identified by searching the databases MEDLINE, DIMDI, PEDro, OT Seeker, CINAHL, PsychInfo and PsychIndex and German journals according to following inclusion criteria: 1) the instrument should cover behavioural change in the rehabilitation of patients with persistent vegetative state and minimally conscious state, 2) it should be available as German version and 3) data on at least one psychometric property must be reported. A critical appraisal of the psychometric quality was carried out based on the identified validation studies. Results: 13 out of 28 instruments met the inclusion criteria. From these six were used to detect functional changes in everyday life and seven recorded the state of consciousness. The Glasgow Coma Instrument, the Early Functional Ability Assessment, the Functional Independent Measure and the Barthel Index demonstrated good metric properties. For the other instruments only in a few properties were reported. Conclusion: The Glasgow Coma Scale can be recommended for the assessment of coma depth in acute care, and the Functional Independent Measure to evaluate the progress of rehabilitation. Because only a few instruments were appropriately tested on reliability and validity, further validation studies are necessary.

Background:The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown.Methods:Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR−). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions.Results:11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR−: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%–24%, I 2 = 96, P < .001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = −.166, Q = 9.441, P = .002) outreach campaigns primarily targeting the general public (n = 11, β = −1.15, Q = 21.35, P < .001) along with higher proportions of self-referrals (n = 10, β = −.029, Q = 4.262, P = .039), which diluted pretest risk for psychosis in patients undergoing CHR assessment.Conclusions:There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.