Rating functional capabilities of veterans with traumatic brain injury by family members and veterans

Abstract

Background/Aims: People with a traumatic brain injury often perceive their everyday functional capabilities differently from their families. The tendency to underrate one's own limitations is often attributed to deficits in self-awareness. Yet the possibility that family ratings are subjective and may thus account for differences has been neglected despite its clinical relevance. The present study examined possible factors influencing family member's ratings, testing two hypotheses: (1) Different types of relatives (i.e. spouses versus non-spouses) may rate functioning differently (2) Incongruence may be more pronounced in less observable domains of function. Methods: In a cross-sectional study, 83 veterans with a traumatic brain injury and a non-spousal family member or spouse were interviewed at home, using the Patient Competency Rating Scale and eliciting sociodemographic characteristics. Findings: Competence ratings differed by relationship type (spouse/other), with spouses rating veteran functioning lower (mean: 3.25, SD=0.762) than did non-spouses overall (mean: 3.55, SD=0.583; F [1, 81]=4.55, P=0.036). Incongruent ratings by veterans and family members (across relationship types) were found in the domain of cognitive functioning only (F [1, 81]=4.268, P=0.042). Conclusions: Treatment plans should not rely exclusively on family ratings of functional competence. Non-spousal family members in particular may underestimate functional difficulties, especially in the cognitive domain.