When stroke survivors' self-ratings are inconsistent with the ratings of others: a cohort study examining biopsychosocial factors associated with impaired self-awareness of functional abilities.

Background Stroke survivors' self-ratings of functional abilities are often inconsistent with ratings assigned by others (e.g. clinicians), a phenomenon referred to as 'impaired self-awareness' (ISA). There is limited knowledge of the biopsychosocial contributors and consequences of post-stroke ISA measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of ISA during subacute rehabilitation (inpatient) and at 4 months post-discharge (community-dwelling). Methods Forty-five subacute stroke survivors participated (Age M (s.d.) = 71.5 (15.6), 56% female), and 38 were successfully followed-up. Self-assessments were compared to those of an independent rater (occupational therapist, close other) to calculate ISA at both time points. Survivors and raters completed additional cognitive, psychological and functional measures. Results Multivariate regression (multiple outcomes) identified associations between ISA during inpatient admission and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close other depression and anxiety. Regression models applied cross-sectionally, including one intended for correlated predictors, indicated associations between ISA during inpatient admission and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping (adjusted R 2 = 0.60). ISA at community follow-up was associated with poorer functional cognition and close other anxiety (adjusted R 2 = 0.66). Conclusions Associations between ISA and poorer outcomes across the rehabilitation journey highlight the clinical importance of ISA and the value of assessment and management approaches that consider the potential influence of numerous biological and psychosocial factors on ISA. Future studies should use larger sample sizes to confirm these results and determine the causal mechanisms of these relationships.

Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?

This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = -4.21, p < .001) and instrumental activity limitation (Z = -4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = -4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.