Journal of Rehabilitation Medicine 51-5 | Page 60

J Rehabil Med 2019; 51: 376–379 SHORT COMMUNICATION CONCORDANCE BETWEEN THE AWARENESS QUESTIONNAIRE AND SELF-AWARENESS OF DEFICITS INTERVIEW FOR IDENTIFYING IMPAIRED SELF-AWARENESS IN INDIVIDUALS WITH TRAUMATIC BRAIN INJURY IN THE COMMUNITY Tamara OWNSWORTH, PhD 1 , Jennifer FLEMING, PhD 2 , Emmah DOIG, PhD 2 , David H. K. SHUM, PhD 1,3,4 and Sarah SWAN, BOccThy (Hons) 2 From the 1 School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, 2 School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia, 3 Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China and 4 Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong Objective: To investigate concordance between the Awareness Questionnaire (AQ) and Self-Awareness of Deficits Interview (SADI) for identifying impaired self-awareness in the community after traumatic brain injury. Design: A retrospective file audit was conducted to retrieve data on the AQ and SADI for participants with traumatic brain injury involved in previous stu- dies on community-based outcomes. Concordance between the AQ and SADI was examined using re- ceiver operating characteristic curves for different scores on each measure. Participants: A total of 80 individuals with moderate- to-severe traumatic brain injury (81% male, mean age 2.25 years, standard deviation (SD) 11.5 years) living in the community. Methods: Participants were administered the AQ and SADI and their significant other completed the AQ and SADI checklist. Results: Consistency of classification of impaired self-awareness between the AQ and SADI was high (i.e. 80–84%) based on scores reflecting good sensi- tivity and specificity. Corresponding scores on the 2 measures and rates of impaired self-awareness were as follows: SADI > 3~AQ discrepancy > 4 (45–48% with impaired self-awareness); SADI > 4~AQ discre- pancy > 9 (26–34% with impaired self-awareness); SADI > 5~AQ discrepancy >12 (13–26% with impai- red self-awareness). Conclusion: The AQ and SADI yielded consistent in- formation regarding the presence of impaired self- awareness in community-based individuals with traumatic brain injury. The choice of measure may depend on how the tool is being used to guide reha- bilitation planning. Key words: traumatic brain injury; impaired self-awareness; assessment; concordance; sensitivity; specificity. Accepted Feb 5, 2019; Epub ahead of print Feb 25, 2019 J Rehabil Med 2019; 51: 376–379 Correspondence address: Tamara Ownsworth, School of Applied Psychology, Griffith University, Mt Gravatt, 4122 Australia. E-mail: [email protected] I mpaired self-awareness (ISA) or the inability to accurately perceive post-injury impairments often LAY ABSTRACT People often do not recognize changes in their abilities or skills after traumatic brain injury. Such problems with self-awareness can lower people’s motivation to take part in rehabilitation. Two common approaches used to assess self-awareness include a brief questionnaire (e.g. 5 min) and a longer interview process (e.g. 20 min). This study aimed to identify the consistency in infor- mation and opinions formed about self-awareness from these 2 approaches. The Awareness Questionnaire and Self-Awareness of Deficits Interview were administered to 80 people with traumatic brain injury. Their family members also provided information about the abilities of the person with brain injury. Overall, there was good consistency in information gained about self-awareness between these measures. These findings suggest that similar information can be gained from a questionnaire or interview; however, the choice of measure may de- pend on how the tool is being used to guide rehabilita- tion planning. reduces engagement in rehabilitation after traumatic brain injury (TBI). ISA can persist well beyond hos- pital discharge and influences community reintegra- tion. Geytenbeek and colleagues (1) found that 69% and 54% of individuals with TBI displayed ISA at discharge and 6 months post-discharge, respectively. ISA was associated with poorer psychosocial outcomes irrespective of injury severity. Given the adverse long-term effects of ISA, there has been considerable focus on interventions to improve self-awareness. Metacognitive interventions involving systematic feedback (e.g. pre-task predictions, audio- visual recordings) on functional tasks are considered a practice standard for treating ISA after TBI (2), with several randomized controlled trials supporting clinical efficacy (3, 4). As these interventions are more time- and resource-intensive than routine assessment feedback, reliable approaches for identifying ISA are needed to guide decision-making regarding the need for metacognitive interventions. The Self-Awareness of Deficits Interview (SADI) (5) is a validated semi-structured interview that uses open-ended questions and prompts to comprehensively examine individuals’ understanding of post-injury de- This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2537 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977