(Research Hub Theater) Development of Rating Scales of the Stage of Recovering Self-leadership in Patients with Disability Due to Acquired Brain Injury: A Pilot Study

Background and/or Objectives: Earlier parts of our study series focused on the concept of self-leadership that promotes recovery in people with disabilities, and the process of long-term recovery of self-leadership for people with disabilities due to acquired brain injury. The objective of this study is to establish an appropriate method of assessing the stage of recovering the self-leadership in patients with disabilities due to acquired brain injury.

Design: cross sectional study.

Setting: A clinic, two hospitals and two welfare centers for persons with disabilities.

Participants: Fifteen patients with disabilities due to acquired brain injury (12 stroke and three traumatic brain injury) more than 3 months after the onset or injury.

Interventions: not applicable.

Main Outcome Measures: The stage of five constructs (Cognition, Motivation, Self-reliance, Confidence, and Standards of values) of recovering self-leadership using our original evaluation form. Inter-rater reliability was evaluated using the kappa coefficient.

Results: The mean age ± standard deviation of the participants was 60.1 ± 16.1 years, and 53% were men. The participants had a median Barthel index score of 95, with an interquartile range (IQR) of 100 to 70. Their median EQ-5D-5L score was 0.736, with an IQR of 0.936 to 0.564. Kappa coefficients (95%CI) for inter-rater agreement were 0.64 (0.36-0.92), 0.24 (0.04-0.52), 0.30 (0.01-0.60), 0.51 (0.21-0.80), and 0.05 (-0.23-0.33) for "Cognition," "Motivation," “Self-reliance,” “Confidence,” and "Standards of values," respectively.

Conclusions: The Inter-rater agreement with regards to the constructs of "Cognition" and "Confidence" was satisfactory, as it was high. Nevertheless, the agreement regarding the other constructs appeared to be deficient, hence indicating a need to improve the scale.