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 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.