A systematic review finds limited data on measurement properties of instruments measuring outcomes in adult intensive care unit survivors

Abstract

Background and Objective There is a growing number of studies evaluating the physical, cognitive, mental health and health-related quality of life (QOL) outcomes of adults surviving critical illness. However, there is little consensus on the most appropriate instruments to measure these outcomes. To inform the development of such consensus, we conducted a systematic review of the performance characteristics of instruments measuring physical, cognitive, mental health and HRQOL outcomes in adult intensive care unit (ICU) survivors. Methods We searched PubMed, Embase, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and The Cochrane Library in March 2015. We also conducted manual searches of reference lists of eligible studies and relevant review articles. Two people independently selected studies, completed data abstraction, and assessed the quality of eligible studies using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist. Results We identified 20 studies which explicitly evaluated measurement properties for 21 different instruments assessing outcomes in ICU survivors. Eleven of the instruments assessed QOL, with few instruments assessing other domains. Of the 9 measurement properties evaluated on the COSMIN checklist, 6 were assessed in <10% of the evaluations. Overall quality of eligible studies was poor to fair based on the COSMIN checklist. Conclusions While an increasing number of studies measure physical, cognitive, mental health and HRQOL outcomes in adult ICU survivors, data on the measurement properties of such instruments are sparse and generally of poor to fair quality. Empirical analyses evaluating the performance of instruments in adult ICU survivors are needed to advance research in this field.

Core Outcome Measures for Clinical Research in Acute Respiratory Failure Survivors. An International Modified Delphi Consensus Study

“…For the "Mental Health" core outcome, two measures reached consensus: Hospital Anxiety and Depression Scale (with separate subscales for anxiety and depression symptoms) and Impact of Events Scale-Revised (evaluating posttraumatic stress disorder symptoms). These instruments have commonly been used in critical care clinical research, with some evaluation of their measurement properties (8,19,(24)(25)(26)(27)(28) and recent recommendations for their use in clinical practice (29). For the "Pain" core outcome, panel members suggested eight existing instruments.…”

“…Measure cards included information such as number of survey items, estimated time needed to complete, administration mode (e.g., patient or proxy or both), scoring information, need for specialized training for administration or scoring, licensing or purchasing information, cost, required equipment, number of times used in prior ICU survivorship research (8), and published measurement properties (e.g., validity, reliability) in ICU survivors. The Consensus-based Standards for the selection of health Measurement Instruments checklist was used to rate a study's evaluation of measurement properties (19). Panel members were also provided with easy-to-understand descriptions of the measurement properties described on the measure cards.…”

Core Domains for Clinical Research in Acute Respiratory Failure Survivors: An International Modified Delphi Consensus Study

“…Additionally, the psychometric properties of many of the instruments used in these studies have not been well-evaluated among ICU survivors. (15)…”

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“…However EQ-5D is characterized by being brief, easy-to-use and flexible in different settings and has been recommended for use in ICU settings. 26,27 Furthermore, applying a simple short generic instrument like EQ-5D is suitable for participants that might be challenged with cognitive impairment. In spite of its brevity, EQ-5D still encompasses a global description of HRQoL which includes a medical interpretation and an interpretation of the social, emotional and physical function.…”