Self and near relative ratings of functional level one year after traumatic brain injury

Abstract

Purpose: To quantify traumatic brain injury (TBI) patients’ perceptions of own function by the Patient Competency Rating Scale (PCRS) one year after injury, and to examine self-awareness of functional deficits by comparing PCRS ratings from patients (PCRS-P) and PCRS ratings from near relatives (PCRS-R), and to identify predictors of awareness deficits. Method: A cohort of 50 severe (n = 33) and moderate (n = 17) TBI patients. Awareness of deficits was investigated by subtracting PCRS relative ratings from PCRS patient ratings. Predictors of PCRS ratings and differences were assessed by stepwise multiple regression analyses.Results: The average patient PCRS sum score was 122/150 (95% CI = 115; 129) as compared to a sum score of 117/150 (95% CI = 110; 125), given by their relatives (p = 0.93). The patients scored themselves slightly higher than their relatives in the domains of activities of daily living (ADL) and cognitive function (p < 0.001, p < 0.001). Regression analyses showed that Glasgow Coma Scale (GCS)score at admission to rehabilitation was the strongest predictor of patient PCRS (B = 3.314, p = 0.008). The strongest predictor of differences between patient and relative PCRS was GCS acute (B= −3.530, p = 0.001).Conclusions: TBI patients demonstrated a slight “awareness gap” in ADL and cognitive function. Low GCS in the acute phase and high age were the strongest predictors of self- awareness deficits.

Implications for Rehabilitation

• Traumatic brain injury (TBI) may result in various cognitive, motor, sensory, social and emotional deficits. How TBI patients perceive their own functional level is less described.

• Lack of awareness is associated with poorer functional outcome, higher caregiver distress and poor compliance with rehabilitation.

• TBI patients demonstrated a slight “awareness gap” in ADL and cognitive function.

• Low Glasgow Coma Scale score in the acute phase and high age were the strongest predictors of self-awareness deficits.

Keywords::

• Patient competency rating scale
• relatives
• self
• traumatic brain injury

Acknowledgements

We would like to thank statistician Are Hugo Pripp at Oslo University Hospital, for his supervision in statistics. Thanks to ward leader Lars-Otto Nome and physiatrist Rein Knoph and their team colleagues at Department of Rehabilitation, Sørlandet Hospital, Kristiansand, for co-operation and data collection.

Declaration of Interest: This study has been financed with the aid of extra funds from the Norwegian Foundation for Health and Rehabilitation. No previous presentation of the research, manuscript or abstract exists.