Self-Awareness And Its Association With Functional Performance In Sub-Acute Stroke: A Cross-Sectional Study

Introduction

Awareness is the key to successful stroke rehabilitation and in practice poor knowledge of self-awareness and failure to recognise stroke deficits hinders efforts in the rehabilitation of patients. Stroke is associated with both functional and cognitive impairment, but the individual correlation between impairment, daily activities and self-awareness of deficit of stroke patients in the acute and sub-acute environment has yet to be explored. This research study aims to address the gap in the current evidence base, by identifying the degree of patient’s self-awareness of stroke-deficit in a sample of patients with sub-acute stroke and determine the strength of relationship between self-awareness and functional performance.

Aim and Objectives

The primary aim of this research was to examine the association between self- awareness and functional performance deficits across three domains (Basic ADL; Instrumental ADL and Cognition) in sub-acute stroke.

The objectives were:

1. To identify patients’ self-awareness of stroke-deficit within three months of stroke.

2. To investigate the association between functional outcomes of ADL performance and self-awareness.

Methods

A cross sectional study using a sample of convenience was completed. Nineteen participants admitted to an acute hospital with first event stroke were assessed for awareness of deficit post stroke. Self-awareness was measured using the Self- Regulation Skills Interview (SRSI). A range of outcome measures were used to assess functional and cognitive performance. They included the Modified Barthel Index (MBI), Kettle Test (KT), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB).

Results

The majority of participants presented with right sided stroke infarct of mild severity (74%). The majority of participants presented with low-moderate levels of awareness (53%) and were female (58%). Significant correlations were demonstrated between the SRSI, MoCA and KT. The strongest correlation was found between the SRSI and the MoCA (r= -0.814), with a strong relationship also demonstrated between the SRSI and the KT (r=0.521). There was no relationship between the SRSI and the MBI (p=0.951; r=-0.015). The association between functional performance outcome measures and other variables was further examined using linear regression analysis. The SRSI explained no variance on the MBI (0%), however explained 23.3% variance on the Kettle Test.

Conclusion

More than half of the participants in this study presented with only low-moderate self- awareness levels of stroke deficit. There was a strong association between self- awareness, cognition and one component of IADL performance as measured on the KT. No correlation was demonstrated between SRSI and MBI.

Implications of Findings

Self-awareness deficits are prevalent in the mild sub-acute stroke population. There is a high association between self-awareness, cognition and higher order activities of daily living (IADL). Screening of mild stroke patients for awareness deficits should be included as a standard measure of care. Future research should address the development of a stroke-specific measure of awareness and standardisation of assessment.