PhD, Santa Clara Valley Medical Center
Citation Kolakowsky-Hayner, S.
(2010). The Patient Competency Rating Scale. The Center
for Outcome Measurement in Brain Injury. http://www.tbims.org/
combi/pcrs ( accessed
This citation is for the COMBI web material. Dr. Kolakowsky-Hayner
is not the scale author for the PCRS.
normative studies of the PCRS have not been conducted, and few studies
using the PCRS have employed a control group. However, Prigatano
et al. (1998) reported that a group of 28 Spanish control subjects
achieved a mean of 144 (range 120-150) on the PCRS while respondents
rating them produced a mean of 145 (range 134-150). This suggests
that control subjects and their respondents agreed closely, and
that the majority of items were rated at the maximum competency
(5, "can do with ease") for these uninjured controls.
study using a control group of 131 New Zealanders (Leathem et al.,
1998) did not report the total PCRS scores. Instead, these authors
grouped some of the PCRS items into 4 categories (ADL, emotional
behavior, interpersonal behavior, and cognition) and reported mean
control scores across items in each group. Means were between 4
("fairly easy to do") and 5 ("can do with ease") with the exception
of items relating to emotional control (mean = 3.81). Interestingly,
informants rated control subjects higher on these items than the
subjects rated themselves.
reliability of the PCRS has been reported as r = .97 for patients
and r = .92 for relatives (Prigatano, Altman & O'Brien, 1990).
One-week test-retest reliability for a group of uninjured college
students was .82 (Heilbronner et al., 1993). Fleming et al. (1998)
reported acceptable one-week test-retest reliability for patients
with TBI using intraclass correlations (ICC r = .85). In the same
study, internal consistency was strong for both patient ratings
(Cronbach's alpha = .91, n = 55) and relatives' ratings of patients
(Cronbach's alpha = .93, n = 50).
interpretation of the PCRS rests on the assumption that the rating
of the significant other (relative or clinician) is a true measure
of competency against which to assess the accuracy of the patient's
self-rating. The developers of the scale acknowledge that this assumption
remains to be validated (see Prigatano, 1996).
discrepancy scores correlate significantly with indices of injury
severity in some studies (Prigatano et al., 1998) but not others
(Prigatano & Altman, 1990). Attempts to correlate the PCRS with
specific neuropsychological findings have generally produced negative
or equivocal results (Prigatano & Altman, 1990; Ranseen et al.,
1990). In several studies PCRS discrepancy scores have correlated
negatively with measures of depression or emotional distress (Ranseen
et al., 1990; Fleming et al., 1998), lending support to the idea
that emotional reactions to disability follow the onset of deficit