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.
in the ability to recognize deficits has been observed in a number
of neurologic syndromes including stroke, dementia, and traumatic
brain injury (TBI). In moderate and severe TBI, impaired self-awareness
is a common phenomenon that can interfere with rehabilitation efforts.
Impaired self-awareness has also been linked to less favorable outcome
in this population. It is, therefore, worthwhile to measure self-awareness
quantitatively in order to monitor changes over time, evaluate the
efficacy of treatments designed to improve accuracy of self-appraisal,
and predict functional outcomes.
are several approaches to the quantitative measurement of self-appraisal
in clinical settings. The most common of these is the questionnaire
approach, in which the subject and an informant who is familiar
with the subject's abilities both rate the subject using the same
items and rating criteria. Discrepancies between the ratings, particularly
when the subject provides higher or more favorable ratings than
the other informant, are interpreted as impaired self-awareness.
This is the approach used by the PCRS, a 30-item questionnaire completed
by the subject and a significant other (relative or therapist).
On each item, ratings are made as to "how much of a problem" the
subject would have in completing various activities, on a 5-point
Likert scale from "1 - can't do" to "5 - can do with ease."
questionnaire is given to subjects and respondents to fill out after
the Instructions (first paragraph on the rating form) are explained
orally. Subjects may ask questions as needed to clarify the meaning
of items. If necessary, the examiner may read the questions orally
and record the responses. In this case, the subject should have
a copy of the response scale (printed on the questionnaire) in front
of him/ her as a reminder of the response options.
PCRS consists of 30 items, each scored 1 to 5. Total scores therefore
range from 30 to 150, with higher scores indicating greater competency.
Studies using the PCRS have described 3 different approaches to
calculating discrepancy scores (adapted from Fleming et al., 1996):
The total score, or the average score across all items (average
competency rating), may be calculated for both subject and significant
other and then compared. This approach gives an overall measure
of the discrepancy between self- and other-ratings but is insensitive
to differences that may exist as a function of the type of item.
The following 3 scores may be computed: The # of items on which
the subject's rating is higher than the respondent's; the # of items
on which the respondent's rating is higher; and the # of items on
which the ratings are identical. Subjects may then be classified
according to which of these 3 scores is highest.
The actual magnitude difference between the subject's and respondent's
ratings on specific items may be calculated. This method is sensitive
not only to the degree of discrepancy, but to differences as a function
of item type (e.g., cognitive/ behavioral versus physical).