Early impaired self-awareness after traumatic brain injury

Objectives: 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. Design: Inception cohort. Setting: Two inpatient rehabilitation programs. Participants: 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. Interventions: Not applicable. Main Outcome Measures: 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(TM) 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.