Evaluation of autonomies in the severely brain injured: the Progression of Autonomies Scale

Abstract

The aim of this study was to validate the Progression of Autonomies Scale (PAS) for the evaluation of autonomies in severe acquired brain injury patients. The PAS design is based on a model of progressive recovery of autonomies and is organized in three domains (Personal, Domestic and Extra-domestic). Scores assigned range from zero to three. The PAS items gather information about the patient's perception and awareness of his/her disability(ies) on admission and perception of his/her improvement at the end of a rehabilitation process. The PAS was administered to 127 inpatients on admission to and at discharge from a rehabilitation program. All 127 inpatients, recruited in a prospective multicenter study, completed the rehabilitation program. The statistical analysis identified a total of 38 items to be retained in the PAS, out of an initial 82 items. The results provide evidence of the validity and reliability of the PAS in its final version.

Figure 1

PAS global scores, on admission and at discharge, as assigned by the therapist, patient and caregiver.

Figure 2

PAS global scores versus Functional Independence Measure global scores on admission and at discharge.

Figure 3

Eigenvalue plots for PAS single domain and global scores. The red lines refer to admission, and the blue ones to discharge. Both on admission and at discharge, and both for PAS global score and subdomain scores, the first eigenvalue is considerably higher than the remaining ones, suggesting the presence of a unique latent factor in all cases.

Figure 4

PAS global scores versus Community Integration Questionnaire global scores at discharge.