Are the subjective complaints of traumatically brain injured patients reliable?

Abstract

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.

Awareness problems following moderate to severe traumatic brain injury: Prevalence, assessment methods, and injury correlates

“…In addition, family members rated the patients more impaired in all domains except attention/memory. Similarly, in a study of individuals with a range of mild to severe TBI who were pursuing compensation litigation an average of 30 months postinjury, clinical interview data indicated that individuals post-TBI reported fewer cognitive-behavioral and emotional problems than their family members did [25]. No differences, however, were noted in the number of physical complaints.…”

“…In general, concrete behaviors are easier to quantify. For example, physical and basic self-care activities typically do not result in rating discrepancies between patients and family members [25,27]. Sander and colleagues found good to "almost perfect" concordance on the Community Integration Questionnaire, which contains very concrete functional items [28].…”

Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury

“…For example, in a sample of 50 TBI patients with mixed severity (33 severe TBI), patients did not differ in accuracy of self-reported physical problems when compared with ratings by their family caregivers. However, TBI patients consistently underreported cognitive/behavioral problems and emotional symptoms as compared with family responses [9]. It is important to appreciate that the accuracy of familyreported symptoms is also questionable.…”

Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism

“…The cerebral lesions in TBI patients often involve the frontal lobe region, and therefore the patients may lack awareness and insight into their own dysfunctions. QoL items reporting of these dysfunctions may consequently be underestimated (36). As posttraumatic QoL scores from significant others (closest relatives) were only random, we were not able to correct for this potential bias.…”