Live Syllabus

DEFINITION:

Disability Rating Scale ratings are to be completed within 72 hours after rehab admission and within 72 hours before rehab discharge. Indicate ratings for all items. Information about the DRS is available from COMBI at these two links: Introduction to the DRS (http://www.tbims.org/combi/drs/index.html); Definition of DRS items (http://www.tbims.org/combi/drs/drssyl.html)

There are four acceptable versions of the DRS data collection form: 23b.DRS Rating Form (COMBI) (http://tbims.org/combi/drs/drsrat.html), PDF DRS form (COMBI) (http://www.tbims.org/combi/drs/drs.pdf), 23a.Disability Rating Scale Form (SCVMC 9/16/97), and 23h.DRS Form (SCVMC 9/2003). The version(s) your Center should be in Appendix J.

CODE:

1. Eye Opening:
0 Spontaneous
1 To Speech
2 To Pain
3 None
9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

2. Communication Ability (Verbal, writing, or letter board or sign - e.g. eye blink, head nod):
0 Oriented
1 Confused
2 Inappropriate
3 Incomprehensible
4 None
9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

3. Motor Response:
0 Obeying
1 Localizing
2 Withdrawing
3 Flexing
4 Extending
5 None
9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

Items 4,5,6,7 and 8 can be rated on a .5 scale. For example, if patient's feeding ability falls between 1.0 (Partial) and 2.0 (Minimal), use a rating of 1.5.

4. Feeding (cognitive ability only):
0.0 Complete
0.5 Between complete and partial
1.0 Partial
1.5 Between partial and minimal
2.0 Minimal
2.5 Between minimal and none
3.0 None
9.9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

5. Toileting (cognitive ability only):
0.0 Complete
0.5 Between complete and partial
1.0 Partial
1.5 Between partial and minimal
2.0 Minimal
2.5 Between minimal and none
3.0 None
9.9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

6. Grooming (cognitive ability only):
0.0 Complete
0.5 Between complete and partial
1.0 Partial
1.5 Between partial and minimal
2.0 Minimal
2.5 Between minimal and none
3.0 None
9.9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

7. Level of Functioning (physical and cognitive disability):
0.0 Completely Independent
0.5 Between completely indep and indep in special environ.
1.0 Independent in Special Environment
1.5 Between indep in special environ and mildly depend.
2.0 Mildly Dependent-limited assistance (non-resid helper)
2.5 Between mildly depend. and moderately dependent
3.0 Moderately Dependent-moderate assist (person in home)
3.5 Between moderately dependent and markedly dependent
4.0 Markedly Dependent-assist all major activities, all times
4.5 Between markedly dependent and totally dependent
5.0 Totally Dependent - 24 hour nursing care
9.9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

8. "Employability" (As a full time worker, homemaker, or student):
0.0 Not Restricted
0.5 Between not restricted and selective jobs, competitive
1.0 Selected Jobs, Competitive
1.5 Between selected jobs and sheltered workshop
2.0 Sheltered Workshop, Non-competitive
2.5 Between sheltered workshop and not employable
3.0 Not Employable
9.9 Unknown, or assessment not done, or does not reflect patient's status during the 72 hour window.

NOTE:

If DRS assessments cannot be completed within the 72 hour windows, they should still reflect the patients' status within that time period. If this is not possible and the assessments are done out of the 72 hour window, code with 9's. Every effort should be made to obtain the DRS assessments, however, if any items can not be assessed, use code 9. Do not leave blanks.

An example of an appropriate use of a .5 rating for the "Level of Functioning" item is: at the time of discharge, the patient requires set-up for all activities of daily living, including dressing, eating, grooming, etc. He can be left alone for 2-3 hours, but he needs more than a non-resident helper. Therefore he is more than mildly dependent (rating of 2). On the other hand, he does not need another person at all times, as he can be left alone for short periods, e.g. between lunch and dinner, and is therefore not moderately dependent (rating of 3). He falls between a rating of 2 and 3 and should be rated 2.5.

If a patient has an intermittent acute care stay during inpatient rehabilitation, use the DRS scores from the first rehabilitation admission and the last definitive discharge. In addition, if a patient has an intermittent stay which is longer than 30 days, it is then considered a system discharge and the discharge date from rehabilitation is the system discharge date and the DRS scores should correspond to that date.

There are times, especially in the "Employability" item, when a client does not fit in one category or another, but falls in between two descriptions. This is when to use the .5 rating, i.e., only when a case does not fit fairly well within an existing "whole number" category. The .5 ratings are available to increase the sensitivity of the scale.

Total DRS score is calculated using a computer program.

See: Frequently Asked Questions about DRS (COMBI) (http://www.tbims.org/combi/drs/drsfaq.html)

See: DRS properties (COMBI) (http://www.tbims.org/combi/drs/drsprop.html)