INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #25 Does Self-Awareness Impact Functional Outcome in a Residential Rehabilitation Program for Acquired Brain Injury? Lindsay Fruehauf, South Texas Veterans Health Care System, San Antonio, United States Kirstine Carter, South Texas Veterans Health Care System, San Antonio, United States Alicia Swan, South Texas Veterans Health Care System, San Antonio, United States Marissa Collier, Our Lady of the Lake University, San Antonio, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult) Keyword 1: brain injury Keyword 2: anosognosia Keyword 3: treatment outcome Objective: Acquired brain injury (ABI), including traumatic brain injury, stroke, and infection, is a common and potentially debilitating condition among military veterans and service members. For those with ABI, self-awareness of limitations is one aspect of cognition that can be affected. Impaired self-awareness is associated with poorer outcomes, reduced treatment gains while in rehab, poorer vocational participation, and increased burden on relatives. Prior studies have indicated that self-awareness, measured by the Mayo-Portland Adaptability Inventory – 4th Edition (MPAI-4), may be related to functional outcomes at discharge and thus may be an important target of intervention for patients in a rehabilitation setting. The present study aimed to show the degree to which self-awareness is predictive of treatment outcomes in an inpatient transitional rehabilitation program. Participants and Methods: Participants included active duty and veteran service members diagnosed with ABI admitted to a transitional rehabilitation program between 2015 and 2019. Variables included age, time since injury, MPAI-4 raw score ratings by staff (admission and discharge) and patients (admission only), and a measure of self-awareness at admission. Self-awareness at admission was computed for the MPAI-4 Total score by subtracting self-rated Total score from staff-rated Total score and then calculating the absolute value. Analyses included paired samples t-tests to quantify staff vs. patient perception of impairment at admission, Pearson’s r correlations to reveal the relationship between self-awareness at admission and functional outcome at discharge (using MPAI-4 scores), and hierarchical linear regression to determine whether self-awareness may account for variance in functional outcome at discharge after controlling for relevant covariates. Results: The sample (N=115) consisted of 64% veterans and 89% males, with 63% identifying as White, 18% as Hispanic, and 12% as Black. At admission, staff rated patients significantly higher on the MPAI-4 Total and Index scores than patients rated themselves (t=5.47–10.88, ps<.001). There were significant relationships between MPAI-4 Total self-awareness discrepancy score at admission and staff-rated Total, Ability, Adjustment, and Participation MPAI-4 scores at discharge (Pearson’s rs =.24–.43, ps<.01). However, when including age, time since injury, and staff-rated MPAI-4 Total score at admission as predictors of MPAI-4 Total score at discharge, in addition to self-awareness discrepancy scores, time since injury and staff-rated MPAI-4 Total score at admission were significant (ps<.001) while age and self-awareness discrepancy score were not (ps>.05). Conclusions: Patients were likely to rate themselves as having fewer symptoms and less impairment at admission than staff. Self-awareness at admission is significantly correlated with staff-rated MPAI-4 scores at discharge. However, self-awareness at admission is not a significant predictor of staff-rated MPAI-4 Total score at discharge when accounting for time since injury and staff-rated MPAI-4 Total score at admission, such that greater time since injury and higher MPAI-4 Total scores at admission significantly explained higher scores in MPAI-4 Total score at discharge. These results suggest that recency of injury and level of functioning at admission is more important in predicting rehabilitation outcomes at discharge than the patient’s initial awareness of their symptoms.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #25

Does Self-Awareness Impact Functional Outcome in a Residential Rehabilitation Program for Acquired Brain Injury?

Lindsay Fruehauf, South Texas Veterans Health Care System, San Antonio, United States
Kirstine Carter, South Texas Veterans Health Care System, San Antonio, United States
Alicia Swan, South Texas Veterans Health Care System, San Antonio, United States
Marissa Collier, Our Lady of the Lake University, San Antonio, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Adult)

Keyword 1: brain injury
Keyword 2: anosognosia
Keyword 3: treatment outcome

Objective:

Acquired brain injury (ABI), including traumatic brain injury, stroke, and infection, is a common and potentially debilitating condition among military veterans and service members. For those with ABI, self-awareness of limitations is one aspect of cognition that can be affected. Impaired self-awareness is associated with poorer outcomes, reduced treatment gains while in rehab, poorer vocational participation, and increased burden on relatives. Prior studies have indicated that self-awareness, measured by the Mayo-Portland Adaptability Inventory – 4th Edition (MPAI-4), may be related to functional outcomes at discharge and thus may be an important target of intervention for patients in a rehabilitation setting. The present study aimed to show the degree to which self-awareness is predictive of treatment outcomes in an inpatient transitional rehabilitation program.

Participants and Methods:

Participants included active duty and veteran service members diagnosed with ABI admitted to a transitional rehabilitation program between 2015 and 2019. Variables included age, time since injury, MPAI-4 raw score ratings by staff (admission and discharge) and patients (admission only), and a measure of self-awareness at admission. Self-awareness at admission was computed for the MPAI-4 Total score by subtracting self-rated Total score from staff-rated Total score and then calculating the absolute value. Analyses included paired samples t-tests to quantify staff vs. patient perception of impairment at admission, Pearson’s r correlations to reveal the relationship between self-awareness at admission and functional outcome at discharge (using MPAI-4 scores), and hierarchical linear regression to determine whether self-awareness may account for variance in functional outcome at discharge after controlling for relevant covariates.

Results:

The sample (N=115) consisted of 64% veterans and 89% males, with 63% identifying as White, 18% as Hispanic, and 12% as Black. At admission, staff rated patients significantly higher on the MPAI-4 Total and Index scores than patients rated themselves (t=5.47–10.88, ps<.001). There were significant relationships between MPAI-4 Total self-awareness discrepancy score at admission and staff-rated Total, Ability, Adjustment, and Participation MPAI-4 scores at discharge (Pearson’s rs =.24–.43, ps<.01). However, when including age, time since injury, and staff-rated MPAI-4 Total score at admission as predictors of MPAI-4 Total score at discharge, in addition to self-awareness discrepancy scores, time since injury and staff-rated MPAI-4 Total score at admission were significant (ps<.001) while age and self-awareness discrepancy score were not (ps>.05).

Conclusions:

Patients were likely to rate themselves as having fewer symptoms and less impairment at admission than staff. Self-awareness at admission is significantly correlated with staff-rated MPAI-4 scores at discharge. However, self-awareness at admission is not a significant predictor of staff-rated MPAI-4 Total score at discharge when accounting for time since injury and staff-rated MPAI-4 Total score at admission, such that greater time since injury and higher MPAI-4 Total scores at admission significantly explained higher scores in MPAI-4 Total score at discharge. These results suggest that recency of injury and level of functioning at admission is more important in predicting rehabilitation outcomes at discharge than the patient’s initial awareness of their symptoms.