title: Life goal attainment in the adaptation process after acquired brain injury: the influence of self-efficacy and of flexibility and tenacity in goal pursuit.
abstract: OBJECTIVE
  To investigate attainment of important life goals and to examine whether self-efficacy, tenacity in goal pursuit and flexibility in goal adjustment contribute to adaptation by affecting levels of emotional distress and quality of life in patients with newly acquired brain injury.
  
  
  METHODS
  Data were collected from a prospective clinical cohort study of 148 patients assessed after discharge home (mean time since injury = 15 weeks) and one year later. At follow-up, attainment of life goals (set at baseline) and satisfaction with attainment was scored (10-point scale) and patients were asked how they adjusted unattained goals. Emotional distress was measured with the Hospital Anxiety and Depression Scale (HADS), quality of life with the Life Satisfaction Questionnaire (LiSat-9), self-efficacy with the TBI Self-efficacy Questionnaire (SEsx) and tenacity and flexibility with the Assimilative/Accommodative Coping Questionnaire (AACQ). Random effects regression analyses and structural equation modelling were used.
  
  
  RESULTS
  In total, only 13 % of initial life goals were achieved in one year. Patients who maintained efforts to reach their original goals had higher average levels of tenacity, but did not differ in level of self-efficacy compared with patients that disengaged. Patients with higher self-efficacy were more successful in attaining important life goals, which correlated with higher quality of life. Patients with higher self-efficacy, higher tenacity in goal pursuit, and higher flexibility in goal adjustment were less emotionally distressed, again correlating with higher quality of life.
  
  
  CONCLUSIONS
  To optimise adaptation it seems appropriate to promote self-efficacy and both tenacity and flexibility during rehabilitation treatment.
authors.affiliation: Department of Neurorehabilitation, Libra Rehabilitation Medicine and Audiology, Eindhoven, The Netherlands i.brands@libranet.nl.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Brands
authors.affiliation: Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sven
authors.initials: S
authors.lastname: Stapert
authors.affiliation: School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.affiliation: Oxford Centre for Enablement, Oxford, UK Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, The Netherlands.
authors.forename: Derick
authors.initials: D
authors.lastname: Wade
authors.affiliation: Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: van Heugten
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000523:psychology*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Adaptation; brain injury; coping skills; goals; quality of life; self efficacy