Research Reports - Self-awareness four years after severe traumatic brain injury

Clin Rehabil. 2017 Oct 1:269215517734294. doi: 10.1177/0269215517734294. [Epub
ahead of print]

Chesnel C(1), Jourdan C(1)(2), Bayen E(3)(4)(5), Ghout I(6), Darnoux E(7), Azerad
S(6), Charanton J(7), Aegerter P(6)(8), Pradat-Diehl P(4)(5), Ruet A(1), Azouvi
P(1)(2), Vallat-Azouvi C(2)(9)(10).

OBJECTIVE: To evaluate the patient's awareness of his or her difficulties in the
chronic phase of severe traumatic brain injury (TBI) and to determine the factors
related to poor awareness.
DESIGN/SETTING/SUBJECTS: This study was part of a larger prospective inception
cohort study of patients with severe TBI in the Parisian region (PariS-TBI
study). Intervention/Main measures: Evaluation was carried out at four years and
included the Brain Injury Complaint Questionnaire (BICoQ) completed by the
patient and his or her relative as well as the evaluation of impairments,
disability and quality of life.
RESULTS: A total of 90 patient-relative pairs were included. Lack of awareness
was measured using the unawareness index that corresponded to the number of
discordant results between the patient and relative in the direction of under
evaluation of difficulties by the patient. The only significant relationship
found with lack of awareness was the subjective burden perceived by the relative
(Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant
relationship between lack of awareness and injury severity, pre-injury
socio-demographic data, cognitive impairments, mood disorders, functional
independence (Barthel index), global disability (Glasgow Outcome Scale), return
to work at four years or quality of life (Quality Of Life after Brain Injury
scale (QOLIBRI)).
CONCLUSION: Lack of awareness four years post severe TBI was not related to the
severity of the initial trauma, sociodemographic data, the severity of
impairments, limitations of activity and participation, or the patient's quality
of life. However, poor awareness did significantly influence the weight of the
burden perceived by the relative. 

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