Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationshipto outcome.
The purpose of this study was to investigate the relationship between self-awareness, emotional distress, motivation, and outcome in adults with severe traumatic brain injury. A sample of 55 patients were selected from 120 consecutive patients with severe traumatic brain injury admitted to the rehabilitation unit of a large metropolitan public hospital. Subjects received multidisciplinary inpatient rehabilitation and different types of outpatient rehabilitation and community-based services according to availability and need. Measures used in the cluster analysis were the Patient Competency Rating Scale, Self-Awareness of Deficits Interview, Head Injury Behavior Scale, Change Assessment Questionnaire, the Beck Depression Inventory, and Beck Anxiety Inventory; outcome measures were the Disability Rating Scale, Community Integration Questionnaire, and Sickness Impact Profile. A three-cluster solution was selected, with groups labeled as high self-awareness (n = 23), low self-awareness (n = 23), and good recovery (n = 8). The high self-awareness cluster had significantly higher levels of self-awareness, motivation, and emotional distress than the low self-awareness cluster but did not differ significantly in outcome. Self-awareness after brain injury is associated with greater motivation to change behavior and higher levels of depression and anxiety; however, it was not clear that this heightened motivation actually led to any improvement in outcome. Rehabilitation timing and approach may need to be tailored to match the individual's level of self-awareness, motivation, and emotional distress.
Fleming
J M
JM
Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Strong
J
J
Ashton
R
R
D000328:Adult; D001315:Australia; D001364:Awareness / Q000502:physiology*; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology; D016000:Cluster Analysis; D003072:Cognition Disorders / Q000145:classification* / Q000209:etiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008137:Longitudinal Studies; D008297:Male; D009042:Motivation; D012649:Self Concept; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology; D016896:Treatment Outcome