Jessica Kersey1, Shannon B Juengst2, Elizabeth Skidmore3. 1. Jessica Kersey, MOT, OTR/L, is Occupational Therapist and Doctoral Student, Department of Occupational Therapy, School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA; jmk286@pitt.edu. 2. Shannon B. Juengst, PhD, CRC, is Assistant Professor, Department of Physical Medicine and Rehabilitation and Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas. 3. Elizabeth Skidmore, PhD, OTR/L, is Professor and Chair, Department of Occupational Therapy, School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA.
Abstract
IMPORTANCE: Self-awareness of deficits, or the ability to understand the effects of impairments on daily life, is often diminished after a stroke. Diminished self-awareness influences participation in rehabilitation and functional outcomes. OBJECTIVE: To examine whether self-awareness of deficits changed over time after a stroke (N = 43) and whether metacognitive strategy training (n = 21) resulted in improved self-awareness compared with direct skill training (n = 22). DESIGN: Secondary analysis of data collected from a randomized controlled trial. SETTING: Inpatient stroke rehabilitation. PARTICIPANTS: Adults with cognitive impairments after an acute stroke. INTERVENTION: Metacognitive strategy training is an approach in which clients are guided through a process of self-assessment and develop solutions for barriers to task performance. This approach was compared with direct skill training, in which the therapist provides specific instructions for task completion, removing the client-initiated assessment and problem-solving components. OUTCOMES AND MEASURES: Self-awareness measures included the Self-Regulation Skills Interview and Self-Awareness of Deficits Interview at baseline and 3 mo and 6 mo after the intervention. We used a one-way analysis of variance (ANOVA) to analyze change in self-awareness and a two-way ANOVA to examine differences between groups over time. RESULTS: There was a statistically significant and potentially meaningful difference over time in the self-awareness domain of strategy behavior, F(2) = 3.35, p = .039, but there were no differences in improvements between the metacognitive strategy and direct skill training groups. CONCLUSIONS AND RELEVANCE: Self-awareness warrants further investigation to determine whether it improves naturally over time or through both interventions after stroke. WHAT THIS ARTICLE ADDS: Self-awareness of deficits, and the use of strategies in particular, may improve in the early stages of stroke recovery, but the optimal approach for intervention remains unclear.
IMPORTANCE: Self-awareness of deficits, or the ability to understand the effects of impairments on daily life, is often diminished after a stroke. Diminished self-awareness influences participation in rehabilitation and functional outcomes. OBJECTIVE: To examine whether self-awareness of deficits changed over time after a stroke (N = 43) and whether metacognitive strategy training (n = 21) resulted in improved self-awareness compared with direct skill training (n = 22). DESIGN: Secondary analysis of data collected from a randomized controlled trial. SETTING: Inpatient stroke rehabilitation. PARTICIPANTS: Adults with cognitive impairments after an acute stroke. INTERVENTION: Metacognitive strategy training is an approach in which clients are guided through a process of self-assessment and develop solutions for barriers to task performance. This approach was compared with direct skill training, in which the therapist provides specific instructions for task completion, removing the client-initiated assessment and problem-solving components. OUTCOMES AND MEASURES: Self-awareness measures included the Self-Regulation Skills Interview and Self-Awareness of Deficits Interview at baseline and 3 mo and 6 mo after the intervention. We used a one-way analysis of variance (ANOVA) to analyze change in self-awareness and a two-way ANOVA to examine differences between groups over time. RESULTS: There was a statistically significant and potentially meaningful difference over time in the self-awareness domain of strategy behavior, F(2) = 3.35, p = .039, but there were no differences in improvements between the metacognitive strategy and direct skill training groups. CONCLUSIONS AND RELEVANCE: Self-awareness warrants further investigation to determine whether it improves naturally over time or through both interventions after stroke. WHAT THIS ARTICLE ADDS: Self-awareness of deficits, and the use of strategies in particular, may improve in the early stages of stroke recovery, but the optimal approach for intervention remains unclear.
Authors: Sanne M J Smeets; Rudolf W H M Ponds; Frans R Verhey; Caroline M van Heugten Journal: J Head Trauma Rehabil Date: 2012 Nov-Dec Impact factor: 2.710