Is the Nottingham Adjustment Scale a useful measure for assessing adjustment to chronic illness or disability in people with acquired brain injuries

Adjustment to acquired brain injury and/or chronic neurological illness is complex and may be multi-factorial. Psychosocial and emotional factors have been found to have an important influence on the process of adjustment. In a series of studies of adjustment in people with visual impairments, Dodds et al (1991, 1993, 1994) found that positive adjustment to visual impairment was related to psychological constructs such as self-esteem, attributional style and locus of control. The present series of studies aimed to expand on the work of Dodds et al by investigating the factor that contribute to psychological adjustment in people with acquired brain injury and/or chronic neurological illness. In order to ensure consistency of approach a modified version of the assessment measure used by Dodds et al, the Nottingham Adjustment Scale (NAS) was used in the present research. The reliability and construct validity of this measure in a mixed neurological population was investigated. Additional aims of the present research were to asses the influence of cognitive functioning on stability of responding on the NAS and to investigate the efficacy of the NAS subscales in predicting outcome of rehabilitation. Five of the subscales of the NAS were found to have acceptable test-retest reliability and construct validity in a mixed neurological sample attending for community based rehabilitation. Cognitive functioning did not significantly influence the reliability of the measure. Overall the NAS was not found to predict outcome of rehabilitation and the relationship between adjustment and cognitive functioning was not clear cut. It is concluded that a modified version of the NAS may be useful in the assessment of change in adjustment levels over a period of rehabilitation but it has limited utility in predicting general functional outcome of rehabilitation.