Research Reports - Impact of rehabilitation on self-concept following traumatic brain injury

Neuropsychol Rehabil. 2014 Nov 10:1-35

Ownsworth T(1), Haslam C

To date, reviews of rehabilitation efficacy after traumatic brain injury (TBI)
have overlooked the impact on sense of self, focusing instead on functional
impairment and psychological distress. The present review sought to address this
gap by critically appraising the methodology and efficacy of intervention studies
that assess changes in self-concept. A systematic search of PsycINFO, Medline,
CINAHL and PubMed was conducted from inception to September 2013 to identify
studies reporting pre- and post-intervention changes on validated measures of
self-esteem or self-concept in adults with TBI. Methodological quality of
randomised controlled trials (RCTs) was examined using the Physiotherapy Evidence
Database (PEDro) scale. A total of 17 studies (10 RCTs, 4 non-RCT group studies,
3 case studies) was identified, which examined the impact of psychotherapy,
family-based support, cognitive rehabilitation or activity-based interventions on
self-concept. The findings on the efficacy of these interventions were mixed,
with only 10 studies showing some evidence of improvement in self-concept based
on within-group or pre-post comparisons. Such findings highlight the need for
greater focus on the impact of rehabilitation on self-understanding with improved
assessment and intervention methodology. We draw upon theories of identity
reconstruction and highlight implications for the design and evaluation of
identity-oriented interventions that can supplement existing rehabilitation
programmes for people with TBI.

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