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

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.