Effect of strategy training on self-awareness of deficits after stroke

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 selfassessment 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.