Physical impairment and perceived general health preceding critical illness is predictive of survival

Purpose: We hypothesized that item response based assessment of physical reserve preceding ICU admission is a predictor of survival. Methods: We evaluated physical functioning using the Academic Medical Center Linear Disability Score (ALDS) and quality of life using the first question (SF-1) and the physical component score (PCS-12) from the Short-form 12 (SF-12) before admission by patients or by close proxies within 72 h after ICU admission during 1 year. Results: We developed four logistic regression models to predict 1 year mortality using the predictors age, gender, ALDS, SF-1, PCS-12. A total of 510 patients participated. Twelve months after ICU discharge, 110 patients (22%) had died. Pre-admission ALDS (p =.004), and SF-1 (p =.012) improved the prediction models with age and gender PCS-12 showed no association with mortality (p =.062). Adding the ALDS (p =.049) and the SF-1 (p =.048) to a model with age, gender and the APACHE II score (improved the model. Adding PCS-12 showed no association with mortality (p =.355). Conclusions: Physical reserve as assessed by ALDS and perceived general health, preceding ICU admission is predictive of mortality. Obtaining patient's physical reserve or pre-existing perceived general health should be part of routine assessment whether a patient may benefit from ICU admission

Measuring Adaptive Coping of Hospitalized Patients With a Severe Medical Condition: The Sickness Insight in Coping Questionnaire

Objectives: Adaptive coping strategies are associated with less psychological distress. However, there is no brief, specific, and validated instrument for assessing adaptive coping among seriously ill patients. Our objective was to examine the validity and patient-proxy agreement of a novel instrument, the Sickness Insight in Coping Questionnaire. Design: A cross-sectional design which included two related studies. Setting: A single university-affiliated Dutch hospital. Subjects: Hospitalized patients (study 1) and ICU-patients and proxies (study 2). Interventions: None. Measurements and Main Results: Study 1 (n = 103 hospitalized patients) addressed the Sickness Insight in Coping Questionnaire’s performance relative to questionnaires addressing similar content areas. Coping subscales of the BRIEF COPE, Illness Cognition Questionnaire, and Utrecht Coping List were used as comparator measures in testing the construct validity of the Sickness Insight in Coping Questionnaire-subscales (fighting spirit, toughness, redefinition, positivism, and non-acceptance). The Sickness Insight in Coping Questionnaire had good internal consistency (0.64 ≤ α ≤ 0.79), a clear initial factor structure, and fair convergent (0.24 ≤ r ≤ 0.50) and divergent (r, ≤ 0.12) construct validity. Study 2 examined the performance of the Sickness Insight in Coping Questionnaire among 100 ICU patients and their close family members. This study showed that the Sickness Insight in Coping Questionnaire has good structural validity (confirmatory factor analyses with Comparative Fit Index > 0.90 and Root Mean Square Error of Approximation 0.50; fighting spirit, toughness, redefinition, and positivism) patient-close proxy agreement. Conclusions: Overall, the Sickness Insight in Coping Questionnaire has good psychometric properties. ICU clinicians can use the Sickness Insight in Coping Questionnaire to gain insight in adaptive coping style of patients through ratings of patients or their close family members