Measuring perceived difficulty in post-acute brain injury rehabilitation: The Sister Kenny Symptom Management Scale.

Primary Objective: Patients' perceptions of difficulty managing symptoms contribute to disability after brain injury. This study introduces the Sister Kenny Symptom Management Scale (KSMS) and reports on its factor structure, reliability, validity and clinical value.

Method: Archived data from (overlapping) samples of patients with brain injuries of mixed aetiologies, seen at an outpatient clinic over 16 years were used in development and validation studies of the KSMS. Comparison measures included the Profile of Mood States (POMS), neuropsychological test scores and employment.

Results: Factor analysis of 34 items (n = 328) identified five sub-scales with satisfactory internal consistency and test-re-test stability representing difficulty with executive functions, language, recent memory, aggressive behaviour and physical symptoms. A pattern of correlations (n = 336) with Profile of Mood States (POMS) sub-scales of similar and different content supported the concurrent validity of KSMS sub-scales. Only the Memory sub-scale correlated with its test index. The Language score and test index approached significance. The Executive sub-scale did not. Hierarchical regression analysis (n = 102) that included ratings of mood and symptom management showed that employment after discharge was only predicted by post-treatment ratings of difficulty with cognitive functions.

Conclusion: Self-assessments of difficulty managing symptoms can be reliably assessed and may contribute to understanding patients' disability, treatment response and future prospects.