A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury

Abstract

Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.

Patient- and Family-Identified Problems of Traumatic Brain Injury: Value and Utility of a Target Outcome Approach to Identifying the Worst Problems

“…[13][14][15] Although these functional rating scales possess good psychometric properties, the wide breadth of functional problems they encompass may make it difficult to document change or the effect of an intervention. The impact of a targeted intervention may be difficult to detect using a measure that encompasses a broad range of problems but may not contain the patient's most important symptoms or complaints.…”

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

“…3,[5][6][7][8][9][10][11] To date, very little research has explored possible gender differences in SA of injury-related deficits among TBI patients during the acute phase of recovery. Accordingly, the first aim of our study was to characterize possible gender differences in SA of injury-related deficits in 121 inpatients with moderate and severe TBI.…”

Unraveling the Biopsychosocial Factors of Fatigue and Sleep Problems After Traumatic Brain Injury: Protocol for a Multicenter Longitudinal Cohort Study (Preprint)

“…Based on a linear mixed regression analysis with a medium effect size (f²=0.15), seven significant predictors, a statistical power of 0.8, alpha level of 0.05 and a high test-retest reliability of at least 0.8 of the main study variables, the required sample is 103 TBI patients [23]. A drop-out of 25% during the 1.5 year followup is expected based on previous studies [24,25]. Therefore, 137 patients will be recruited to lead to a total of 103 TBI patients being available for the analyses.…”