An exploratory study of verbal feedback on occupational performance for improving self‐awareness in people with traumatic brain injury

Abstract

Introduction Impaired self‐awareness negatively impacts on how well persons with traumatic brain injury (TBI) learn and use strategies needed in daily life. Verbal feedback is a component of metacognitive strategy training recommended for addressing impaired self‐awareness in TBI rehabilitation. Yet, it remains unknown how effectively verbal feedback on occupational performance improves self‐awareness for the specific occupation involved. This study investigated the effect of verbal feedback on task‐specific self‐awareness for individuals with TBI. Methods A secondary analysis was conducted on selected data extracted from a randomised, assessor‐blinded controlled trial in which 36 participants with impaired self‐awareness post‐TBI were allocated into two feedback intervention groups, verbal feedback and a control condition of experiential feedback only. All participants engaged in four sessions of meal preparation with an occupational therapist using a metacognitive strategy training approach. Participants in the verbal feedback group received feedback on their performance in a discussion with the occupational therapist following each session. Task‐specific self‐awareness was measured using discrepancy scores (therapist ratings minus self‐ratings) on a Meal Independence Rating Scale (MIRS). Data were analysed using a mixed 2 × 2 analysis of variance. Results Positive MIRS discrepancy scores at pre‐intervention reflected the propensity of participants to over‐estimate their abilities There was a significant main effect of time, indicating overall gains in task‐specific self‐awareness at post‐intervention (p = .01), but no significant group‐by‐time interaction. Changes in participants’ self‐ratings post‐intervention were minimal. Instead, reduced MIRS discrepancy scores resulted largely from changes in therapists’ ratings, indicating improvement in occupational performance. Conclusion Participants in both groups demonstrated improvements in occupational performance, but this did not correspond with changes in task‐specific self‐awareness. In this small sample, there was no statistically significant improvement in self‐awareness associated with the provision of verbal feedback after occupational performance over and above the benefits of experiential feedback.