title: Multilevel modeling of self-esteem change during acute inpatient stroke rehabilitation.
abstract: OBJECTIVE
  To explore self-esteem change during inpatient stroke rehabilitation and moderators of change.
  
  
  METHODS
  One hundred twenty survivors of stroke serially completed the State Self-Esteem Scale (SSES) during inpatient rehabilitation, as well as measures of mood and perceived recovery as potential moderators of change. Age, gender, prior stroke, prestroke depression, stroke laterality, and admission Functional Independence Measure (FIM) self-care, mobility, and cognitive scores were also included as moderators.
  
  
  RESULTS
  Multilevel modeling of the repeated administrations of the SSES indicated that self-esteem significantly improved during rehabilitation. Female gender, left hemisphere stroke, prior stroke, and lower admission FIM cognitive scores were associated with lower self-esteem ratings at admission, but only age and admission FIM self-care and mobility scores were associated with self-esteem change. Older individuals showed less self-esteem improvement than younger individuals, and higher self-care and mobility scores at admission were associated with greater self-esteem improvement. While mood change significantly covaried with self-esteem, the rate of mood change did not appear to influence rate of self-esteem change. Greater improvement in self-esteem over time was related to lower levels of perceived recovery, but this was likely because of the relationship between perceived recovery and self-esteem at rehabilitation admission.
  
  
  CONCLUSIONS
  These results suggest that self-esteem improves during inpatient rehabilitation, and this change may be partially dependent on functional status. Implications for facilitating self-esteem change by the clinician are discussed, as well as future research directions.
authors.affiliation: Department of Neuropsychology, Methodist Rehabilitation Center, Jackson, Mississippi 39216, USA. chadvickery@hotmail.com
authors.forename: Chad D
authors.initials: CD
authors.lastname: Vickery
authors.forename: Clea C
authors.initials: CC
authors.lastname: Evans
authors.forename: Jae Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Arash
authors.initials: A
authors.lastname: Sepehri
authors.forename: Linsa N
authors.initials: LN
authors.lastname: Jabeen
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000328:Adult; D000339:Affect; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004292:Dominance, Cerebral; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010555:Personality Inventory; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012648:Self Care / Q000523:psychology; D012649:Self Concept; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation