The impact of impaired self-awareness on the assessment of fatigue and rehabilitation in brain injury

Di Somma, Rebecca

Clinical psychology
August 2022

Thesis or dissertation

© 2022 Rebecca Di Somma. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

This portfolio thesis involves three parts. Part one includes a systematic literature review, part two includes an empirical paper and part three includes the appendices.
Part one- Systematic Literature Review The Systematic Literature Review explored the impact of impaired self-awareness (ISA) on the process of rehabilitation in acquired brain injury populations. This review identified 16 studies which were analysed using Narrative Synthesis. Four key themes arose from the analysis, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. The findings explored the impact that ISA can have on different areas of the rehabilitation process and how this can impact on recovery. The clinical implications and areas for further research are described.
Part two- Empirical Paper The empirical paper is part of a larger project to validate and explore the Brain Injury Fatigue Scale (BIFS). The BIFS is an unpublished measure of fatigue that is widely used in clinical practice. This study investigated the degree of agreement between the self and proxy (i.e., carer/relative/friend) ratings of the BIFS and explored what variables best predict any differences in scores, including level of awareness and patients’ mood. Eleven individuals with acquired brain injuries (ABI) or neurological conditions and their proxies completed the BIFS and Patient Competency Rating Scale (PCRS). Patients also completed the Hospital Anxiety and Depression Scale (HADS) and their demographic data was collected. This study found that that 63.64% of patients rated their fatigue within the same clinical cut off category as their proxies’ ratings. It was also found that ISA and mood did not predict BIFS-Discrepancy scores. This study therefore found a moderate level of agreement between patient and proxy BIF ratings; however, it also emphasises the importance of using proxy ratings scales within this area, which has not previously been explored. Further self and proxy ratings of fatigue is required.
Part three-
Part three includes the appendices relating to the systematic literature review and the empirical paper, as well as the epistemological and reflective statements.

Department of Psychological Health, Wellbeing and Social Work, The University of Hull
Fleming, Pete; Evans, Stephen (Clinical psychologist)
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