the implications of their deficits and can set realistic
goals. Due to the semi-structured interview format
the SADI also offers opportunity for rapport building,
observation of emotional responses, and asking patients
and significant others for their perspective rather than
focusing on standard set of questions (12).
Such information can greatly assist with client-
centred goal-setting and tailoring metacognitive
interventions; for example, an intervention may tar-
get self-awareness of memory problems that affect
progress on the goal to live independently. Feedback
on occupational performance on goal-salient activities
can enhance self-awareness and self-regulation skills
(3, 4, 13).
Study limitations
Due to the convenience sample and potential for selec-
tion bias, caution is needed in broadly generalizing the
findings to the broader TBI population. Participants
in the current sample were more likely to have been
admitted to a major metropolitan hospital than a rural
or regional hospital, and hence due to their locality
were able to access specialist brain injury outpatient
and community-based rehabilitation. Therefore, the
findings are likely to be most applicable to patients ac-
cessing metropolitan-based outpatient or community
rehabilitation. It is also important to acknowledge the
reliance on significant others/family members reports
for comparison with patients’ self-report, as is typical
for measurement of self-awareness. The potential
biases associated with significant others’ reports have
been well documented in the literature (8). As there
is no “gold standard” for measuring ISA, the SADI
was used as the state variable in the ROC analysis
due to research supporting its concurrent validity in
the community setting (6). It is important to note that,
although classification consistency was good using a
4-point AQ discrepancy, 20% were incorrectly clas-
sified as having or not having ISA. Further research
is needed to determine the predictive validity of AQ
and SADI cut-off scores for community re-integration
outcomes.
Conclusion
The AQ and SADI yielded consistent information
regarding the presence of ISA in community-based
individuals with TBI. The AQ may be more feasible
for routine administration to detect ISA, whereas the
379
SADI provides a more comprehensive assessment of
the nature of ISA and capacity to set realistic goals.
ACKNOWLEDGEMENTS
Data collection in this study was funded by 2 grants from the
National Health and Medical Research Council (APP1083064
& APP210347).
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