Verlaufsbeobachtung von Wachkomapatienten - Validierung des Basler Vegetative State Assessments (BAVESTA)

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, inter-rater-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.