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Increasing Quality of Life and Awareness of deficits in persons with traumatic brain injury: a pilot study.

According to the Center for Disease Control (2002), estimates of the number of people who have survived traumatic brain injury range from 2.5 million to 6.5 million, representing two percent of the U.S. population. The average incidence rate is currently 95 people with traumatic brain injury per 100,000 in the population (Center for Disease Control). During the years 1990 to 1995, the mean annual incidence rate of persons with traumatic brain injury, who were hospitalized and survived, was 260,000. Of these 260,000 persons with traumatic brain injury, thirty-five percent experienced the onset of a longterm disability (Center for Disease Control). Consequently, the estimated number of persons with traumatic brain injury who will incur long-term disability each year is estimated to be between 80,000 to 90,000 Americans (Center for Disease Control).

For persons with traumatic brain injury, awareness of deficits and positive perceptions of quality of life are essential prerequisites to successful rehabilitation after the injury (Trudel, Tryon, & Purdum, 1998; Brown, Gordon, & Haddad, 2000). Persons with traumatic brain injury who have low perceptions of quality of life often experience feelings of guilt, failure, and unhappiness, which may lead to depression (Fisher, 2005). Persons with traumatic brain injury who have a lack of awareness of deficits often have lack of insight into planning, lack of social judgment, impulsivity, difficulties adjusting to change and interpersonal problems, and low long-term psychological adjustment (Newman, Garmoe, Beatty, & Ziccardi, 2000; Wallace & Bogner, 2000). A clear understanding of how awareness of deficits and perceptions of quality of life can improve through group intervention can be helpful to rehabilitation professionals. Rehabilitation professionals can assist persons with traumatic brain injury better deal with their lack of awareness of deficits and low quality of life. This may, in turn, allow persons with traumatic brain injury to better adapt to the physical, mental, and emotional losses that they have incurred.

The failure to recognize the existence of a disease and its limitations is known as anosognosia, the absence of emotional concern or distress regarding one's losses or deficits (Giacino & Cicerone, 1998). Persons with traumatic brain injury go through the process of awareness of their deficits in a three-stage process: intellectual awareness, emergent awareness, and anticipatory awareness (Crosson et al., 1989). Intellectual awareness is the ability to understand at a certain level that a function is impaired or to understand the complications of the impairment. Emergent awareness is the ability to recognize a problem when it is occurring, which requires that the person reach a prior level of intellectual awareness before. Anticipatory awareness is the ability to anticipate that a problem will occur as a result of having some type of deficit. The failure for persons with traumatic brain injury to understand and recognize deficits reduces motivation for rehabilitation, leads to setting unattainable goals, unsuccessful community reentry, unsuccessful employment, and a high risk of conflicts with family members (Trudel, et al.).

Quality of life has become a very influential concept within rehabilitation and disability studies. The term 'quality of life' has been operationalized and defined in many ways by researchers. In rehabilitation and disability studies, quality of life includes social, psychological, physical well-being as well as health perceptions and opportunities (Patrick & Erickson, 1993). Physicians have often used the term quality of life to measure the effects of chronic illness in their patients in order to better understand how an illness interferes with a person's day-to-day life (Center for Disease Control, 2002). Similarly, public health professionals use health-related quality of life to measure the effects of numerous disorders, short and long-term disabilities, and diseases in different populations.

Researchers have examined awareness of deficits among persons with traumatic brain injury. Prigatano and Altman (1990) looked at the degree persons with traumatic brain injury underestimate their deficits. Sixty-four persons with traumatic brain injury and their family members were given the Patient Competency Rating Scale. The results showed persons with traumatic brain injury underestimated their deficits on ten out of 14 items on the scale (Prigatano & Altman). Also, the most underestimated deficits were associated with lack of emotional control and minimal social interaction.

Newman et al. (2000) examined persons with traumatic brain injury at eight weeks post-injury and at the time of discharge in the rehabilitation process to gain an understanding about how awareness of deficits changes over time. Participants who were an average of eight weeks post-injury underestimated their deficits compared to staff's perceptions and rated themselves as nearly independent long before independence was demonstrated. Between the two times that participants and staff were rated, the staff showed a marked improvement in rating participants' awareness of deficits over time while participants' awareness of deficits remained the same over time (Newman et al.).

Sherer, Hart, and Nick (2003) also examined the awareness of persons with traumatic brain injury, family members, and clinicians using the Awareness Questionnaire. Using the Wilcoxon's matched paired signed rank tests, clinicians rated the persons with traumatic brain injury as having less awareness of deficits than the persons themselves and family members (medians of 32 and 39, p<0.001). Also, family members' scores were significantly lower than persons with traumatic brain injury (medians of 39 and 48, p<0.001).

Researchers have examined persons with traumatic brain injury and quality of life. Dawson, Levine, Schwartz, and Stuss (2000) examined the quality of life of persons with traumatic brain injury. Forty-three participants were given the Quality of Life Scale at four years after the injury. Each of the participants was to rate 11 situations from the scale of "does not describe my situation" to "fully describes my situation". The majority of participants in the study reported a good or high perceived quality of life. The results showed 13 (18.4%) reporting a poor or fair quality of life, 27 (38.8%) reporting good quality of life, and 32 (42.8%) reporting a high quality of life. For the 32 participants who reported a high quality of life, health, close relationships with a significant other, family, and friends, work, and learning or improving one's knowledge such as coping skills were reported as important factors in high quality of life (Dawson et al.).

Brown and Vandergoot (1998) examined how persons with spinal cord injury, traumatic brain injury, and no disability perceive their quality of life differently. Persons with traumatic brain injury did not perceive an improved quality of life with the passage of time. However, persons with spinal cord injury did improve in perceived quality of life as the years post injury increased. Persons without disability had a strong perceived quality of life in all areas of life during the study.

Kolakowsky-Hayner, Miner, and Kreutzer (2001) assessed the quality of life of persons with traumatic brain injury. Thirtyone and a half percent indicated they were "somewhat dissatisfied", 25.9% indicated they were "very dissatisfied", and 22.2% indicated they were "somewhat satisfied" with their quality of life perceptions. The families were asked to identify needs that they felt contributed to positive quality of life for the participants in the study. They identified health education and involvement in participant's care as important needs.

Stancin et al. (2002) examined what characteristics of persons with moderate and severe traumatic brain injury were associated with health-related quality of life. Participants were four years post injury. Participants who had severe traumatic brain injury reported lower health-related quality of life related to overall psychosocial functioning in the areas of behavior, mental health, general health, and family impact than participants with moderate traumatic brain injury (Stancin et al.). Participants with severe traumatic brain injury reported the most problems in the areas of communication skills, daily living skills, and general adaptive functioning. Parents indicated lower health related quality of life of their children in areas of communication skills, daily living skills, and general adaptive functioning (Stancin et al.). Also, the risks for poorer health-related quality of life outcomes were related to the participant's environment, family economical disadvantage, and poorer pre-injury behavioral and academic functioning.

Unlike many earlier studies, this study sought to determine if a training intervention makes a difference in the perceived quality of life and awareness of deficits of persons with traumatic brain injury. Persons with traumatic brain injury who participated in six weeks of the Quality of Life and Awareness Training (QLAT) were compared to persons who did not participate in six weeks of the QLAT to see if they differed significantly in the way that they perceived quality of life and awareness of their deficits. Specifically, the research questions sought to determine if persons with traumatic brain injury who participate in six weeks of the Quality of Life and Awareness Training differ significantly from persons who do not participate in six weeks of the Quality of Life and Awareness Training in the way that they perceive their quality of life. Secondly, if persons with traumatic brain injury who participate in six weeks of the Quality of Life and Awareness Training differ significantly from persons who do not participate in six weeks of the Quality of Life and Awareness Training in awareness of their deficits.

Method

Participants

Thirty-six persons with traumatic brain injury participated in the study. Twelve participants were receiving services at an outpatient agency in rural Illinois, three participants were receiving services at a comprehensive agency in rural Illinois, seven participants were receiving services from an outpatient agency in a urban setting in rural Illinois, and 14 participants were from an outpatient agency in an urban setting in Missouri. Nineteen participants were assigned to the QLAT and formed the experimental group, and 19 participants did not take part in the QLAT and formed the control group. Two participants who were assigned to the experimental group dropped out of the study resulting in an unequal number of participants in the control (N=19) and experimental (N=17) groups.

The Human Subjects Committee at Southern Illinois University approved this study prior to its implementation. After approval, participants and guardians were contacted through the four agencies. The researcher explained the study to participants and guardians (if necessary). Then, if participants and guardians (if necessary) agreed to participate in the study, they signed an informed consent form approved by the Human Subjects Committee at Southern Illinois University.

This study used a sample of convenience. The assigning of the sample was done by the staff members at the four different agencies who were not aware if a group was to be an experimental or control group. The researcher did not have a role in assigning participants to the groups. Each of the participants was placed into the experimental group or control group based on the availability of their schedule. For example, if the experimental group was in the morning and the control group was in the afternoon and a participant was able to participate in the group if it was in the morning, then he or she was automatically placed in the experimental group. Participants' schedules decided what group they would attend in this study. The staff members did not use any other criteria to decide which participants would attend.

Instruments

The Wisconsin HSS Quality of Life Inventory and Awareness Questionnaire were used in this study. The Wisconsin HSS Quality of Life Inventory is a measure that assesses the quality of life of persons with disabilities through the level of need satisfaction as conceptualized in Maslow's Hierarchy of Needs. This inventory is a self-report inventory containing 60 items, which are grouped into five 12-item subscales. These subscales represent the physiological (PHY), safety and security (SS), love and belongingness (LB), self-esteem (SE), and self-actualization (SA) dimensions of Maslow's Hierarchy of Needs. Using a sample of 414 persons with traumatic brain injury, psychometric properties were established. For the Wisconsin HSS Quality of Life Inventory, The alpha coefficients were .85 Physiological (PHY), .86 Safety and Security (SS), .89 Love and Belongingness (LB), .93 Self-Esteem (SE), and .79 Self-Actualization (SA), demonstrating internal consistency (Collins, Lanham, & Sigford, 2000). Persons with moderate to severe traumatic brain injury were given the instrument twice over a one-week period and established test-retest reliability at r =0.90 (Collins et al.).

The Awareness Questionnaire is a measure of self-awareness of impairment after traumatic brain injury. The Awareness Questionnaire is a self-administered questionnaire containing 17 items. Sixty-six persons with traumatic brain injury were used to establish the reliability and validity of this instrument. The internal consistency for the Awareness Questionnaire was rated at .88 for all the scales together (Sherer, Bergloff, Boake, High, & Levin, 1998). Sherer et al. (1998) assert criterion validity was demonstrated by the eventual productivity outcome for persons with TBI in their study.

Procedures

Seventeen participants participated in the Quality of Life and Awareness Training (QLAT) and 19 participants did not participate in the QLAT. First, all 36 participants were given a demographic information sheet, Wisconsin HSS Quality of Life Inventory, and Awareness Questionnaire prior to the QLAT. Then, the experimental group participated in six weeks of the QLAT. Six sessions in six weeks, with one session per week made up the QLAT. Each session was one hour and 30 minutes in length. Based on data from Ownworth, McFarland, & Young (2002) conducted workshops of various lengths for persons with traumatic brain injury and found that one hour and 30 minutes in length with a ten minutes break was optimal for persons with traumatic brain injury.

The Wisconsin HSS Quality Of Life Inventory measures quality of life based on Maslow's Hierarchy of Needs Theory. The quality of life training goals and activities were established and operationalized from each of the needs in Maslow's Hierarchy of Needs Theory. Awareness training goals and activities were established and operationalized from activities from Ownworth et al. (2002) s' workbook on group activities for persons with traumatic brain injury. The training goals of the QLAT were to increase self-esteem, belongingness, safety and perceptions of the physiological needs, and perceptions of self-actualization. Also, training goals included realization of difficulties in memory, concentration, attention, relationships, communication, emotional changes, motivation changes, and difficulties in leisure activities after traumatic brain injury.

The control group also met for the six weeks of the study for an hour and a half once a week in order to provide both groups with equal contact with the researcher. The researcher did not give any instruction to control group participants during the six week sessions. Participants in the control group played board games and cards. After six weeks, participants in both groups were given the Wisconsin HSS Quality of Life Inventory and the Awareness Questionnaire again.

Results

The demographics for this study are shown in Table 1 including data for the experimental group, control group, and total demographics for all participants.

Analysis of Variance (ANOVA) was used to compare the control group and experimental group means on the pretests. The Wisconsin HSS Quality of Life Inventory and the Awareness Questionnaire were administrated to both the control and experimental groups prior to the six weeks of the study. The dependent variables were the scores on the Wisconsin HSS Quality of Life Inventory and Awareness Questionnaire and the independent variable was the QLAT. The levels of the independent variable were participation and no participation in the QLAT. Mean scores were calculated. In calculating mean scores, participant raw scores were added for each subscale and divided by 17 for the experimental group and 19 for the control group for the five subscales of the Wisconsin HSS Quality of Life Inventory and Awareness Questionnaire. The mean scores for the pretest are represented in Table 2. In comparing the mean scores on the pretest of the experimental group and control group, the mean scores that the experimental group received on the subscales of the Wisconsin HSS Quality of Life Inventory and Awareness Questionnaire were not statistically different from mean scores received by the control group. Results of the pretest ANOVA for both groups are represented in Table 3. This suggests that differences in posttest scores can most likely be as a result of the participation in the study.

To investigate perceptions of quality of life after the six weeks, ANOVAs were conducted comparing the experimental and control groups' posttest scores on the Wisconsin HSS Quality of Life Inventory. Mean scores for the posttest are represented in Table 4. Table 5 shows only the mean scores the experimental group received on the subscale, physiological, of the Wisconsin HSS Quality of Life Inventory, were different from mean scores received by the control group, and that difference was statistically significant, F(1, 34)=5.50, p = .02 at a level of significance of .05. No within group changes occurred for the experimental and control groups in this study on the Wisconsin HSS Quality of Life Inventory.

To investigate perceptions of awareness of deficits after the six weeks, ANOVAs were run comparing the Awareness Questionnaire experimental group and control group posttest scores. The score of the Awareness Questionnaire could range from 17 to 85. In answering this research question, mean scores received by the experimental group on the Awareness Questionnaire were not different from the mean scores received by the control group as shown in Table 5. No within group changes occurred for the experimental and control groups in this study on the Awareness Questionnaire.

Discussion

Limitations and Directions for Future Research Generalization of the results.

Generalizing the results of this study should be done with caution. Whether the sample is a sound representation of the population is in question. The results of this study should only be cautiously generalized to persons with traumatic brain injury in Southern Illinois and the Missouri area. The differences in demographics of the participants may not represent the environments in which other persons with traumatic brain injury may live across the country. In future research, the population of persons with traumatic brain injury could be expanded from only persons with traumatic brain injury in Southern Illinois and Missouri to persons with traumatic brain injury throughout the country.

The location of the four different agencies might have contributed to the results in the study. Participants who were receiving services from three of the agencies were all living in small rural areas in Illinois. The remaining agency is located in Missouri, where the participants also lived. Prior research has examined the availability of resources and social support in urban versus rural settings. In prior research, fifty-six participants with traumatic brain injury were given the Hesitation Scale along with the Living Life After Traumatic Brain Injury Scale to measure quality of life in urban versus rural areas in the Midwest and perceptions of availability of resources (Farmer, Clark, & Sherman, 2003). Participants with traumatic brain injury in rural areas reported more positive perceptions of quality of life and this was associated with more willingness to seek out resources in the community (Farmer et al.).

The sample age in this study was ages 20-40. Adolescents and young adults between the ages 15-24 are the most common age group to incur traumatic brain injury in the United States (Brain Injury Resource Foundation, 2006), Generalizing the results of this study should be cautiously generalized to persons with traumatic brain injury who are specifically ages 20-60. Not including persons with traumatic brain injury between the ages 15-20 may not represent persons with traumatic brain injury in the country. In addition, the majority of participants in the experimental group were ages 20-40 (59%) while the majority of participants in the control group were ages 40-60 (53%). A sample of more participants who are ages 20-40 in the control group could yield different results.

The participants in this study were receiving rehabilitation services from four different rehabilitation agencies. Participants in this study who were receiving services from two of the agencies were asked to attend the group sessions at these agencies. These participants had never come to these agencies, but were receiving services in the home. Therefore, participants from these two agencies were experiencing the agency setting for the first time and also getting to know others with traumatic brain injury for the first time, possibly. In contrast, participants who were receiving services from the other two agencies were receiving vocational training and other rehabilitation services at the same location as the study. Therefore, these participants were more familiar with these agencies and since the participants were already receiving services at the same location, many participants were familiar with each other prior to this study. This difference in agencies and the participation level may have had an impact on the results of this study.

Social Desirability.

Social desirability provides a possible explanation for the non-significant results on the other subscales of the Wisconsin HSS Quality of Life Inventory as well as the significant results. Social desirability is the possibility that exists when a person wants to represent himself or herself in a positive light by giving socially acceptable answers whether the answers are honest or not (Syque, 2005). Participants in this study may have wanted to project themselves positively in the areas of self-esteem, love and belongingness, self-actualization, and safety. This supports previous research, which indicated that persons tend to give socially desirable answers on questionnaires relating to love, belongingness, and self-esteem (Riketta, 2004). Also, previous research indicates that when persons are asked questions about self-actualization, they tend to give socially desirable answers (Tosi & Lindamood, 1975). In this study, participants may have viewed the Physiological subscale on the Wisconsin HSS Quality of Life Inventory as not as threatening, because it measures knowledge about resources and not about their feelings about themselves. Therefore, they were possibly more honest about learning about assistive devices, because it does not involve their personal feelings.

The instruments in this study do not correct for social desirability. In future research, administering a social desirability measure that has pairs of items that are matched for social desirability may be beneficial. Also, if the study included a two matched samples might control for social desirability. Conducting this study with two samples that are similar may be able to detect if social desirability is a factor.

Assignment of Participants.

In this study, the assigning of the participants to the experimental or control group was done by the staff members at the four different agencies. Each of the participants was placed into the experimental group or control group based on the availability of their schedule by a staff member. This study used a sample of convenience, so there was no guarantee that the participants in this study were an accurate representation of the population. It is possible that the participants were the only persons with traumatic brain injury who were willing to participate in the study and available at the times when the study took place.

In future research, randomly assigning persons with traumatic brain injury to the control and experimental groups may be beneficial. This may provide a clearer representation of how persons with traumatic brain injury perceive their quality of life and awareness of deficits by ensuring that the groups are similar to each other prior to the study.

Activities for the Control Group.

Participants in the control group met for an hour and a half once a week for six weeks. All the participants had equal contact with the researcher to control for effect of contact with the researcher. During the six weeks, the control group was involved in group games. The activities, themselves, may have affected the results of the study. Even though the control group was in an unstructured setting, the games they played involved working together similar to the experimental group. The experimental and control groups both had social interaction opportunities. Raush and Ferry (2001) reviewed social networks in persons with traumatic brain injury. Persons with traumatic brain injury who had a social network, such as family and friends, tended to have more positive perceptions of quality of life than persons with traumatic brain injury who did not have close family and friends (Raush & Ferry). So, it is possible that this study, that attempted to improve perceptions of quality of life through the QLAT, in fact, was influenced by the social interactions among participants in both the control and experimental groups. Therefore, future studies should include activities for the control group that are completely different from the QLAT. An example of this could be watching movies for six weeks without having to communicate with others in the control group.

Implications for Rehabilitation

This study can provide data to rehabilitation professionals, especially rehabilitation counselors, for developing services that better assist persons with traumatic brain injury by understanding their disability. This will allow persons with traumatic brain injury to develop better strategies to increase awareness of their deficits and improve perceptions of quality of life. In increasing awareness of deficits in persons with traumatic brain injury, participation in rehabilitation services can be more successful (Trudel et al., 1998).

Rehabilitation professionals should include participation in specific group counseling programs for persons with traumatic brain injury. Persons with traumatic brain injury often experience social isolation, which can be a barrier to the rehabilitation process (Brooks, 1984). To improve persons' awareness of deficits, identifying inappropriate behaviors in the group will help group members with traumatic brain injury to gain insight into how others react to their behaviors. This will assist persons with traumatic brain injury to redevelop family and work relationships (Lynch & Kosciulek, 1995). Also, the group model can provide positive interpersonal communication, which can, in turn, create more positive perceptions of their quality of life (Lynch & Kosciulek).

In order for persons with traumatic brain injury to adjust successfully at independent living centers, the availability of daily structured activities with social interaction is essential (McColl et al., 1999). This study attempted to improve perceptions of quality of life through the QLAT, however, it may have been influenced by the social interactions among participants in both the control and experimental groups. From self-report in this study, participants felt socially isolated prior to the study and had not met anyone with traumatic brain injury. In this study, both the control and experimental groups made gains in their scores on the Wisconsin HSS Quality of Life Inventory and Awareness Questionnaire from before the six weeks to after the six weeks. Merely having the social interaction with people with traumatic brain injury, participants reported similar perceptions of quality of life and were aware of their deficits regardless of whether the participant was in the experimental or control group. Therefore, independent living centers can use the information from this study to encourage persons with traumatic brain injury to participate in groups around the community. This will allow the persons with traumatic brain injury to exchange ideas and information about reintegrating independently into the community.

This study also can provide data to rehabilitation educators to better train rehabilitation professionals, in particular, rehabilitation counselors in serving persons with traumatic brain injury. First, rehabilitation educators should provide training in group counseling techniques specific to the traumatic brain injury population. An emphasis should be placed on the importance of social interactions of persons with traumatic brain injury. Also, emphasis can be specifically placed on the importance of awareness of deficits and quality of life for successful outcomes in the rehabilitation process. Rehabilitation educators also can present the activities from the QLAT in this study that could be used in practice. Especially, the Physiological activities from the QLAT can be presented to rehabilitation counseling students. Finally, offering internships and practicums to rehabilitation counseling students at rehabilitation centers serving persons with traumatic brain injury can provide practical training to gain first hand knowledge about persons with traumatic brain injury. Rehabilitation counseling students with training in the traumatic brain injury population will be able to see how improving awareness of deficits and perceptions of quality of life can improve the rehabilitation process of persons with traumatic brain injury.

References

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Rupa Chandrashekar

Southern Illinois University

John J. Benshoff

Southern Illinois University

Rupa Chandrashekar, Ph.D., Rehabilitation Institute, Southern Illinois University, Mailcode 4609; Carbondale, IL 62901: Email: dr_rupac@yahoo.com
Table 1
Demographics of the control group, experimental group, and total
participants to the Wisconsin Quality of Life Inventory and Awareness
Questionnaire (frequency of the occurrence and percent of
the total)

Demographic variable Control Experimental Total
 Group Group

Male 12 (63%) 11 (65%) 23 (64%)
Female 7 (37%) 6 (35%) 13 (36%)
Did not finish 1 (5%) 2 (12%) 3 (8%)
 high school
High school diploma 7 (37%) 5 (29%) 12 (33%)
High school diploma + 7 (37%) 5 (29%) 12 (33%)
 some college
Associate's Degree 2 (11%) 4 (24%) 6 (17%)
Bachelor's Degree 2 (11%) 0 (0%) 2 (6%)
Master's Degree 0 (0% ) 1 (6%) 1 (3%)
Age 20-40 years 9 (47%) 10 (59%) 19 (53%)
Age 40-60 years 10 (53%) 7 (41%) 17 (47%)
5 years and more 15 (79%) 9 (53%) 24 (67%)
 post injury
1-4 years post injury 4 (21%) 8 (47%) 12 (33%)

Table 2
Mean Scores of the Experimental and Control Groups on the Pretest

 Control Group Experimental Group

 Wisconsin HSS Quality of Life Inventory
Subscales
Physiological 35.25 32.23
Safety and Security 31.89 31.59
Self-Esteem 31.37 33.65
Love and Belongingness 33.78 33.82
Self-Actualization 35.63 35.58

 Awareness Questionnaire

Awareness 45.68 41.88

Note: p < .05

Table 3
Analysis of Variance for the Wisconsin HSS Quality of Life
Inventory and Awareness Questionnaire on the Pretest

Source df F p

Wisconsin HSS Quality of Life Inventory Subscales

Physiological 1 3.73 0.06
Safety and Security 1 0.04 0.84
Self-Esteem 1 0.94 0.34
Love and Belongingness 1 0.00 0.99
Self-Actualization 1 0.01 0.98
Error for all subscales 34

 Awareness Questionnaire

Awareness 1 0.74 0.39
Error 34

Note: p < .05

Table 4
Mean Scores of the Experimental and Control Groups on the Pretest

 Control Group Experimental Group

 Wisconsin HSS Quality of Life Inventory

Subscales
Physiological 30.29 34.32
Safety and Security 32.42 31.50
Self-Esteem 31.16 32.76
Love and Belongingness 33.53 31.89
Self-Actualization 34.05 34.18

 Awareness Questionnaire

Awareness 50.58 44.65

Note: p<.05

Table 5
Analysis of Variance for the Wisconsin HSS Quality of Life
Inventory and Awareness Questionnaire on the Pretest

Source df F p

Wisconsin HSS Quality of Life Inventory Subscales

Physiological 1 5.50 0.02
Safety and Security 1 0.32 0.57
Self-Esteem 1 0.47 0.49
Love and Belongingness 1 0.49 0.48
Self-Actualization 1 0.01 0.94
Error for all subscales 34

 Awareness Questionnaire

Awareness 1 1.74 0.19
Error 34

Note: p <.05
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Author:Benshoff, John J.
Publication:The Journal of Rehabilitation
Date:Apr 1, 2007
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