The Cognitive Awareness Scale for Basic and Instrumental activities of daily living to measure self-awareness after acquired brain injury: Preliminary evidence of its validity

Abstract

Objective: There is a crucial need for reliable tools to measure impaired self-awareness (ISA) in patients with acquired brain injury (ABI) across cognitive-functional domains. The aim of this study was to assess the psychometric properties of the Cog-Awareness ADL Scale, which is a novel self-proxy discrepancy method for measuring ISA in both basic and instrumental activities of daily living. Methods: This multicenter study included 54 patients (no-low ISA n = 33; severe ISA, n = 21) from four outpatient rehabilitation units in Málaga-Granada, Spain, and 51 healthy controls. The participants and proxy raters completed the Cog-Awareness ADL Scale and the Patient Competency Rating Scale (PCRS). Agreement between both scales was assessed using Spearman’s correlations and the Bland-Altman plot. Group comparisons were made on measures of SA, cognitive abilities and demographic variables. Sensitivity and specificity were analysed by ROC curve analysis. Results: Convergent validity was supported by strong correlations with the PCRS and its subscales (rho’s ranging from 0.51 to 0.80, p < 0.01 for all). The Bland-Altman plot confirmed measurement agreement (only 3.70% of the scores were outside the 95% limits). External validity was demonstrated by effectively discriminating between healthy controls and ABI patients with no-low and severe ISA on each discrepancy index while controlling for cognitive/demographic variables. The Cog-Awareness ADL Scale showed optimal diagnostic accuracy (AUC = 0.95, sensitivity = 0.90, specificity = 0.90). Conclusions: The Cog-Awareness ADL Scale proved to be a feasible, valid, and clinical tool to assess ISA across different cognitive-functional domains, in Spanish ABI-patients.

Keywords:

• Activities of daily living
• self-awareness
• executive functions
• occupational therapy
• executive functions
• neuropsychology

Acknowledgments

The authors would like to thank the collaboration of the participants, their caregivers, the occupational therapists and the neuropsychologists of the 4 healthcare centers for their active involvement.

Author contributions

DS-F: Methodology; Investigation; Formal analysis; Visualisation; Writing–Original Draft; Writing–Review & Editing.

MJF: Conceptualisation; Methodology; Visualisation; Writing–Review & Editing; Supervision.

AN-E: Methodology; Investigation

GR: Methodology; Investigation

MR-B: Conceptualisation; Methodology; Visualisation; Writing–Review & Editing; Supervision.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, DS-F, upon reasonable request.

Additional information

Funding

This research was funded by the Spanish Ministry of Economy and Competitiveness (MINECO) research project PSI2016-80331-P awarded to MJF. MJF and GR were funded by Junta de Andalucía through a research project (P20.00693). DS-F is supported by the National Council of Science and Technology (CONACYT) scholarship (CVU- 349933).