A longitudinal investigation of the concordance between individuals with traumatic brain injury and family or friend ratings on the Katz adjustment scale

Changes in the level of agreement (concordance) between self and family or friend reporting on the Katz Adjustment Scale (KAS) from 6 to 12 months postinjury were assessed in 55 individuals with traumatic brain injury (IwTBI). Although the concordance between self and family/friend reports significantly increased over the course of recovery, possibly reflecting improvements in awareness, the concordance showed limited relationship to measures of injury severity and neuropsychological functioning. Concordance did not significantly relate to clinicians' ratings of inaccurate insight and self-appraisal on the awareness item from the Neurobehavioral Rating Scale (NBRS). Clinicians' ratings of awareness demonstrated only limited relationship to measures of injury severity and neuropsychological functioning, as well. Although similar results in the literature have been interpreted as demonstrating that awareness, defined as concordance, is possibly a unique construct separate from injury severity and neuropsychological functioning, an alternative hypothesis is presented concerning other, noninjury factors that may affect the level of agreement in problem reporting between IwTBI and family/friend informants.