Early impaired self-awareness after traumatic brain injury.
OBJECTIVE
To evaluate predictors of early impaired self-awareness after traumatic brain injury (TBI); to examine interrelationships of the perceptions of patient, clinician, family, and significant other of how patients are functioning after TBI; and to determine how early impaired self-awareness helps to predict employability at rehabilitation discharge.


METHODS
Inception cohort.


METHODS
Two inpatient rehabilitation programs.


METHODS
A total of 129 patients with TBI seen for inpatient rehabilitation at 1 of 2 rehabilitation centers. All subjects had emerged from posttraumatic amnesia before being assessed for this study.


METHODS
Not applicable.


METHODS
Impaired self-awareness as measured by the Awareness Questionnaire (patient self-ratings, clinician ratings) and employability (rated on the Disability Rating Scale) at discharge from inpatient rehabilitation.


RESULTS
Regression analysis revealed that early impaired self-awareness was predicted by age and functional status (FIM instrument total score) at admission to inpatient rehabilitation. Spearman correlation coefficients revealed that clinician, family, and significant other ratings of patient functioning were related (r(s) =.42, P<.001), but were not related to patient self-ratings. Multiple logistic regression analysis revealed that early impaired self-awareness was predictive of employability at discharge from inpatient rehabilitation. Clinician ratings of patient functioning showed a positive relation to employability (P =.05), whereas patient self-ratings showed a trend toward a negative relation to employability (P =.09).


CONCLUSIONS
Our results support the importance of early impaired self-awareness assessment, its predictive value for complex functional activities, and the need for further research to determine if treatment programs for impaired self-awareness enhance functional outcomes.
Sherer
Mark
M
Methodist Rehabilitation Center, Jackson, MS 39216, USA. marks@mmrcrehab.org
Hart
Tessa
T
Nick
Todd G
TG
Whyte
John
J
Thompson
Risa Nakase
RN
Yablon
Stuart A
SA
D000328:Adult; D001364:Awareness; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000209:etiology*; D004651:Employment; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome