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Psychometric Properties and Feasibility of Instruments Used to Assess Awareness of Deficits After Acquired Brain Injury: A Systematic Review

Smeets, Sanne M. J. MSc; Ponds, Rudolf W. H. M. PhD; Verhey, Frans R. PhD, MD; van Heugten, Caroline M. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p 433–442
doi: 10.1097/HTR.0b013e3182242f98
Original Articles

Background: Unawareness of deficits after acquired brain injury (ABI) is often reported in the clinic. Several methods have been developed to measure a patient's awareness of deficits after ABI; however, no criterion standard currently exists to measure this phenomenon.

Objective: To review all instruments for measuring awareness of deficits and evaluate their psychometric and conceptual properties as well as their feasibility.

Methods: Systematic literature search for available awareness measurement instruments used in experimental ABI studies. Instruments were divided into the following 4 assessment methods: clinician ratings, structured interviews, performance-based discrepancy, and self-other rating discrepancy methods. The quality of the instruments was evaluated.

Results: The literature search identified 39 instruments and 8 of these were selected. The following 3 instruments stood out in terms of quality: Self-Awareness of Deficits Interview, Patient Competency Rating Scale, and Awareness Questionnaire.

Conclusion: Although these quantitative instruments are useful tools in research, they have limited utility in the clinic because they only measure intellectual awareness. Therefore, in addition to these instruments, qualitative tools should also be used to gain a complete view of a patient's awareness problem.

School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology (Ms Smeets and Drs Ponds, Verhey, and Heugten) and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (Dr van Heugten), Maastricht University, The Netherlands; Mondriaan, Department PsyQ, Maastricht, The Netherlands (Dr Ponds); and Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC)/Alzheimer Center Limburg, Maastricht, The Netherlands (Drs Ponds and Verhey).

Corresponding Author: Caroline van Heugten, PhD, School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands (

These authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.