Background and Objectives: Stroke survivors often disagree with others’ assessments of their functional abilities. Historically termed ‘impaired self-awareness’ we label this ‘appraisal discrepancy’ to focus on the presence of disagreement rather than assessment accuracy. There is limited knowledge of biopsychosocial contributors and consequences of post-stroke appraisal discrepancies (‘PSAD’) measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of PSAD during subacute rehabilitation (inpatient) and four months post-discharge (community-dwelling).
Methods: 45 subacute stroke survivors (Age M=71.5 SD=15.6, 56% female) participated, and 38 were successfully followed-up (Age M=69.6 SD=15.9, 53% female). We compared survivors’ self-assessments with those of an independent rater (occupational therapist, close other) to calculate PSAD at both time points. Survivors and raters completed additional cognitive, psychological and functional measures.
Results: Multivariate regression identified associations between larger inpatient PSAD and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close-other depression and anxiety. Cross-sectional regression analyses indicated associations between larger inpatient PSAD and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping. Larger PSAD at community follow-up was associated with poorer functional cognition and close-other anxiety.
Conclusions: Findings confirm the clinical importance of PSAD, and support biopsychosocial frameworks of appraisal discrepancy. Key risk factors for PSAD are identified which may help guide early screening. The importance of addressing PSAD to optimise outcomes post-discharge are also highlighted.