Patient-Reported Outcome Measures for Evaluating Body Awareness: A Systematic Review Using the COSMIN Methodology

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals-detecting states and subtle reactions to internal and environmental conditions-modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify patient-reported outcome measures (PROMs) of BA and evaluate their psychometric properties and cross-cultural adaptation processes. Literature Survey: We searched PubMed, Scopus, and PsycINFO; the last search was conducted on 1 July 2025. Methodology: We included studies that psychometrically evaluated PROMs regarding BA in the general adult population and their translations into other languages, with no time-range restrictions. Study selection was performed independently by two reviewers in a blind manner. Evaluation followed COSMIN guidance for systematic reviews of PROMs: (1) risk of bias assessment, (2) application of quality criteria for measurement properties, and (3) GRADE rating of the certainty of evidence. Synthesis: We identified 12 BA questionnaires and more than 30 cross-cultural adaptations, from a total of 50 studies. In summary, the Revised Body Awareness Rating Questionnaire and the Multidimensional Assessment of Interoceptive Awareness (MAIA 1 and 2) showed good results for structural validity and internal consistency, which were the most frequently assessed psychometric properties. In contrast, construct validity was highly variable, and the findings on reliability were far from optimal. MAIA-2 was one of the most studied and showed stronger evidence and better pooled results (4 out of 5 properties) than other instruments. Conclusions: The psychometric quality of BA PROMs varies widely, reflecting challenges in operationalizing the construct of body awareness and related domains. While MAIA-2 currently presents the most acceptable-though still imperfect-evidence, further high-quality studies are needed to strengthen their measurement properties and clarify construct coverage.