Metacognitive knowledge and functional outcomes in adults with acquired brain injury: A meta-analysis

ABSTRACT

Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one’s cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition.

KEYWORDS:

• Metacognitive knowledge
• Self-awareness
• Functional outcomes
• Acquired brain injury (ABI)
• Meta-analysis

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Each study’s correlation was converted into a Fisher’s z (see Equation 1), then individual Fisher’s z scores were pooled into a summary Fisher’s $\overline{z}$, and then converted back to a summary correlation (Equation 2), along with the 95% confidence intervals (Borenstein et al., 2011). The standard error of the summary Fisher’s z is shown in Equation (3).(1) $z=0.5\times \mathrm{l}\mathrm{n}\left(\frac{1+r}{1-r}\right)$(1) (2) $\overline{r}=\frac{e^{2\overline{z}}-1}{e^{2\overline{z}}+1}$(2) (3) $S{E}_z=\sqrt{\frac{1}{n-3}}$(3)