School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
Neuropsychology and Applied Cognitive Neuroscience Laboratory CAS Key Laboratory of Mental Health, Institute of Psychology Chinese Academy of Sciences, Griffith University, Beijing, China.
Disabil Rehabil. 2020 Mar;42(5):651-659. doi: 10.1080/09638288.2018.1504993. Epub 2018 Nov 18.
To investigate the evidence for domain-specific deficits in self-awareness on the Patient Competency Rating Scale (PCRS) and the relationship to psychosocial outcomes after severe traumatic brain injury (TBI). Fifty-six adults with severe TBI (75% males, age =36.96, = 12.96), and 50 age- and gender-matched controls (72% male, age =34.12, = 11.43) were administered the PCRS self-report form, and the Depression, Anxiety, Stress Scales. Relatives of TBI and control participants completed the PCRS informant version. Relatives of the TBI group also completed the Sydney Psychosocial Rating Scale. A within-group analysis indicated that self-awareness varied according to PCRS domain ( <.01). Relative to their own profile, TBI participants displayed significantly poorer self-awareness on the activities of daily living (ADLs) domain than on the interpersonal and emotional domains ( < 0.01). Further, TBI participants displayed significantly poorer self-awareness of ADLs than controls ( < 0.001), but there were no significant between-group differences in other domains. Hierarchical regression analyses revealed that poorer self-awareness of cognitive difficulties was related to lower occupational functioning ( = 0.01), whereas poorer self-awareness of difficulties with ADLs was related to lower independent living skills ( < 0.001). The results provide only limited support for domain-specific deficits in self-awareness after severe TBI, with impairment most evident for ADLs. Poorer self-awareness in the ADLs and cognitive domains were associated with lower independence and occupational functioning, respectively. The findings highlight the potential benefits of targeting self-awareness related to difficulties with ADLs in the rehabilitation of people with severe TBI.Implications for rehabilitationPeople with severe traumatic brain injury had poorest self-awareness of difficulties regarding activities of daily living, which was related to less independenceDifficulties with complex activities of daily living were more likely to be under-reported than difficulties with basic self-careIt may be beneficial to target self-awareness of difficulties relating to complex activities of daily living in rehabilitation.
研究目的在于调查在《患者能力评定量表》（PCRS）中自我意识特定领域缺陷的证据，以及这些缺陷与严重创伤性脑损伤（TBI）后心理社会结局之间的关系。共有 56 名严重 TBI 成年患者（75%为男性，年龄=36.96，SD=12.96）和 50 名年龄和性别匹配的对照者（72%为男性，年龄=34.12，SD=11.43）接受了 PCRS 自评表和抑郁、焦虑、压力量表的评估。TBI 组和对照组患者的家属分别完成了 PCRS 知情评定量表和悉尼心理社会评定量表。组内分析表明，自我意识因 PCRS 领域而异（ <.01）。与自身情况相比，TBI 患者在日常生活活动（ADL）领域的自我意识明显较差，而在人际关系和情绪领域则相对较好（ < 0.01）。此外，TBI 患者的 ADL 自我意识明显差于对照组（ < 0.001），但在其他领域两组间无显著差异。分层回归分析显示，认知困难的自我意识较差与职业功能较低相关（ = 0.01），而 ADL 困难的自我意识较差与独立生活技能较低相关（ < 0.001）。结果仅为严重 TBI 后自我意识特定领域缺陷提供了有限的支持，ADL 受损最为明显。ADL 和认知领域的自我意识较差与独立性和职业功能较低分别相关。研究结果突出了针对严重 TBI 患者 ADL 相关困难的自我意识进行康复治疗的潜在获益。
严重创伤性脑损伤患者对日常生活活动困难的自我意识最差，这与独立性较低有关；与基本自我护理相比，复杂日常生活活动的困难更有可能被低估；在康复中，针对与复杂日常生活活动相关的困难进行自我意识的靶向治疗可能会有所帮助。
