Preprint · Jul 15, 2026
Alignment Between Objective Ability and Perceived Function: A Scoping Review Across Neurological Conditions and Older Adults
By Conklin SJ, de Paiva TAF, Monaghan P et al.
This scoping review maps the existing evidence on alignment between objective physical ability and self-perceived function across neurological conditions and older adults. Alignment refers to the degree of correspondence between what a person can physically do, as measured by a standardized objective assessment, and what they believe they can do, as captured by a validated self-report measure. When a meaningful gap exists between the two, behavior and outcomes diverge from what physical capacity alone would predict. Individuals who underestimate their ability may restrict activity unnecessarily, leading to deconditioning, social withdrawal, and reduced participation. Those who overestimate their ability may engage in activities that exceed their safe capacity, elevating fall risk. Both directions of misalignment carry documented clinical consequences, yet the literature on this construct has not been systematically mapped. This construct has been studied under varied terminology across disciplines and populations, including discordance, concordance, misalignment, overconfidence, underconfidence, calibration, and insight. The review is designed to capture this full breadth of terminology and examine how the construct has been defined, measured, and studied across Parkinson's disease, stroke, multiple sclerosis, traumatic brain injury, mild cognitive impairment, vestibular disorders, cerebellar ataxia, and community-dwelling older adults without a specific neurological diagnosis. The review is guided by three research questions: (1) How has alignment between objective ability and perceived function been defined and operationalized across the literature? (2) What factors are associated with alignment or misalignment? (3) What consequences of misalignment have been documented? The review follows JBI methodology for scoping reviews and will be reported in accordance with PRISMA-ScR. Searches are being conducted across Ovid MEDLINE, CINAHL, PsycINFO, Embase, and grey literature sources in collaboration with a health sciences librarian. Two independent reviewers will screen all records in Rayyan. Data will be extracted by the lead reviewer and synthesized narratively around the three research questions. The review is intended for submission as a standalone publication following dissertation defense.