Validation of the Russian-language version of the Self-Awareness Deficit Interview (SADI)

Thorough and early assessment of self-awareness deficits after brain injury is an important problem in neurorehabilitation that requires the development of both qualitative and quantitative methods to assess different levels of self-awareness to increase the efficacy of rehabilitation. Although there is no consensus on the determination and measurement of self-awareness impairment, several quantitative assessment methods have been developed in international practice. The Self-Awareness of Deficits Interview (SADI) technique is one of the most used structured interviews to assess self-awareness impairment in neurological patients.
Objective: to conduct validation study and to develop the official Russian-language version of SADI.
Material and methods. The study comprised two stages: in the first stage (n=17), a direct and reverse translation of the methodology was performed, followed by a pilot test; in the second stage (n=31), the reliability of the inter-rater and test-retest reliability, and the internal consistency of the methodology were evaluated. Three neuropsychological experts and two students took part in the evaluation of the results. Interviews were conducted with patients who were hospitalized to the Research Center of Neurology and N.I. Pirogov National Medical and Surgical Center of Ministry of Health of Russia. Inclusion criteria: verified neurological diagnosis, no pronounced speech disorders, Russian language fluency.
Results. The study resulted in the cross-cultural SADI adaptation, leading to the development of the SADI-RU, the Russian-language version, including a scoring guide and a list of questions for patient's relatives. Pilot tests showed the suitability of the SADI-RU for clinical practice. An analysis of the psychometric indicators of the tool showed a “good” level of inter-rater consistency (ICC=0.81), high test-retest reliability (r=0.92) and internal consistency (α=0.77).
Conclusion. The results of the study have shown that the developed SADI-RU is a reliable tool for assessing the self-awareness deficits, which is suitable for clinical practice and scientific research in neurological patients.

1. Katz N, Hartman-Maeir A. Occupational Performance and Metacognition. Can J Occup Ther. 1997 Jun;64(2):53-62. doi: 10.1177/000841749706400201

2. O'Keeffe F, Dockree P, Moloney P, et al. Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online-awareness. J Inter Neuropsych Soc. 2007 Jan;13(1):38-49. doi: 10.1017/S1355617707070075

3. Sansonetti D, Fleming J, Patterson F, Lannin NA. Conceptualization of self-awareness in adults with acquired brain injury: A qualitative systematic review. Neuropsychol Rehabil. 2022 Sep;32(8):1726-73. doi: 10.1080/09602011.2021.1924794. Epub 2021 May 19.

4. Sunderaraman P, Cosentino S. Integrating the Constructs of Anosognosia and Metacognition: a Review of Recent Findings in Dementia. Curr Neurol Neurosci Rep. 2017 Mar;17(3):27. doi: 10.1007/s11910-017-0734-1

5. Toglia J, Kirk U. Understanding awareness deficits following brain injury. NeuroRehabilitation. 2000;15(1):57-70. doi: 10.3233/NRE-2000-15104

6. Prigatano GP, Schacter DL. Awareness of deficit after brain injury: Clinical and theoretical issues. New York, NY, US: Oxford University Press; 1991. P. 13.

7. Stuss DT. Disturbance of self-awareness after frontal system damage. In: Prigatano GP, Schacter DL, editors. Awareness of deficit after brain injury: Clinical and theoretical issues. New York, NY, US: Oxford University Press; 1991. P. 63-83.

8. Rubinshtein SL. Foundations of General Psychology. Moscow: Piter; 2015. 705 p. (In Russ.).

9. Luriya AR, Tsvetkova LS. Neuropsychological Analysis of Problem Solving: Impairment and Recovery of Intellectual Functioning in Local Brain Damage. 2nd ed. Moscow: MPSI; 2010. 367 p. (In Russ.).

10. Bakanova IV, Zeigarnik BV, Nikolaeva VV. Attitude to illness as a condition for the formation of conscious and unconscious motives for activity. In: The Unconscious: Nature, Functions, and Research Methods. Vol. 2. Tbilisi: Metsniereba; 1978. P. 76-81 (In Russ.).

11. Zeigarnik BV. Pathopsychology: A Study Guide for University Students. 5th ed. Moscow: Akademiya; 2007. 206 p. (In Russ.).

12. Nikolaeva VV. The Impact of Chronic Illness on the Mind. Moscow: Publishing House of MSU; 1987. 166 p. (In Russ.).

13. Rubinshtein SYa. Examination and rehabilitation of working capacity after military brain injuries. In: Grashchenkov NI, editor. Military Neurology. Moscow: Publishing House of AMS of USSR; 1949. P. 294-308 (In Russ.).

14. Kozhukhovskaya II. Impairment of Self-Awareness in the Mentally Ill. Moscow: Publishing House of MSU; 1985. 79 p. (In Russ.).

15. Fleming JM, Ownsworth T. A review of awareness interventions in brain injury rehabilitation. Neuropsychol Rehabil. 2006 Aug;16(4):474-500. doi: 10.1080/09602010500505518

16. Sherer M, Hart T, Nick TG. Measurement of impaired self-awareness after traumatic brain injury: a comparison of the patient competency rating scale and the awareness questionnaire. Brain Inj. 2003 Jan;17(1):25-37. doi: 10.1080/0269905021000010113

17. Ownsworth TL, McFarland KM, Young RM. Development and standardization of the Self-regulation Skills Interview (SRSI): a new clinical assessment tool for acquired brain injury. Clin Neuropsychol. 2000 Feb;14(1):76-92. doi: 10.1076/1385-4046(200002)14:1;1-8;FT076

18. Bivona U, Lucatello S, Costa A. Selfawareness after severe traumatic brain injury: From impairment of self-awareness to psychological adjustment. In: Cellular, Molecular, Physiological, and Behavioral Aspects of Traumatic Brain Injury. MA: Academic Press (Elsevier); 2022. P. 539-52. doi: 10.1016/B978-0-12-823036-7.00034-7

19. Mahoney D, Gutman SA, Gillen G. A Scoping Review of Self-Awareness Instruments for Acquired Brain Injury. Open J Occupat Ther. 2019 Apr;7(2). doi: 10.15453/2168-6408.1529

20. Bivona U, Ciurli P, Ferri G, et al. The SelfAwareness Multilevel Assessment Scale, a New Tool for the Assessment of SelfAwareness After Severe Acquired Brain Injury: Preliminary Findings. Front Psychol. 2020 Jul 24;11:1732. doi: 10.3389/fpsyg.2020.01732

21. Fleming J, Strong J. Self-Awareness of Deficits following Acquired Brain Injury: Considerations for Rehabilitation. Brit J Occupat Ther. 1995 Feb;58(2):55-60. doi: 10.1177/030802269505800204

22. Fleming JM, Strong J, Ashton R. Selfawareness of deficits in adults with traumatic brain injury: how best to measure? Brain Inj. 1996 Jan;10(1):1-15. doi: 10.1080/026990596124674

23. Crosson B, Barco PP, Velozo CA, et al. Awareness and compensation in postacute head injury rehabilitation. J Head Trauma Rehabil. 1989 Sep;4(3):46-54. doi: 10.1097/00001199-198909000-00008

24. Simmond M, Fleming J. Reliability of the self-awareness of deficits interview for adults with traumatic brain injury. Brain Inj. 2003 Jan;17(4):325-37. doi: 10.1080/0269905021000013219

25. Fleming JM, Strong J, Ashton R. Cluster Analysis of Self-Awareness Levels in Adults with Traumatic Brain Injury and Relationship to Outcome. J Head Trauma Rehabil. 1998 Oct;13(5):39-51. doi: 10.1097/00001199-199810000-00006

26. Novik AA, Ionova TI. Language and cultural adaptation of the quality of life questionnaire. In: Shevchenko YuL, editor. Guidelines for Studying Quality of Life in Medicine. Moscow: OLMA Media Grupp; 2007. P. 57-61 (In Russ.).

27. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000 Dec;25(24):3186-91. doi: 10.1097/00007632-200012150-00014

28. Kottner J, Audige L, Brorson S, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011 Jan;64(1):96-106. doi: 10.1016/j.jclinepi.2010.03.002

29. Serdar CC, Cihan M, YЯcel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochem Med (Online). 2021 Feb;31(1):27-53. doi: 10.11613/BM.2021.010502

30. Kersey J, Juengst SB, Skidmore E. Effect of Strategy Training on Self-Awareness of Deficits After Stroke. Am J Occupat Ther. 2019 May;73(3):7303345020p1-7. doi: 10.5014/ajot.2019.031450

31. Winkens I, Prinsen A, Meijerink A, et al. Psychometric evaluation of the Self-Awareness in Daily Life-3 Scale (SADL-3) for the assessment of self-awareness after acquired brain injury. Brain Inj. 2019 Apr;33(5):598-609. doi: 10.1080/02699052.2019.1566969