Validation of the Multi-INdependence Dimensions (MIND) questionnaire for prolonged mechanically ventilated subjects

Joao C Winck,Hélène Gilet,Fabian Plano,Peter Kalin,Nicolino Ambrosino,Antoine Regnault,Michael Dreher,Javier Murcia,Michele Vitacca

doi:10.1186/s12890-019-0870-2

Abstract

BackgroundEvaluating severity of illness of patients with prolonged mechanical ventilation (PMV) is important to adopt the best appropriate care management for each individual. Yet, no severity-of-illness scoring system has been specifically designed for this type of patients. The aim of this study was to develop and validate a new instrument, the Multi-INdependence Dimensions (MIND) questionnaire designed to comprehensively measure the severity of illness of patients under PMV.MethodsThe validation of the MIND questionnaire was performed during a longitudinal observational study conducted with PMV subjects in weaning facilities in three countries (Argentina, Colombia and Germany). The questionnaire validity was tested in 3 stages: 1) Specification of components, with description of item responses, inter-item and Cronbach alpha correlations; 2) Creation of the composite scores; 3) Measurement properties determination including test-retest reliability after 30 days, clinical validity (Medical Research Council (MRC) muscle strength score, Sepsis-related Organ Failure Assessment (SOFA), Glasgow Coma Scale (GCS), Dependence Nursing Scale and EuroQol-5 Dimension evaluated at inclusion), and ability to detect change.ResultsA total of 128 subjects participated in the validation study. Eleven component scores and four composite scores were created. MIND scores significantly correlated with MRC muscle strength, SOFA, DNS, GCS and EQ-5D, supporting the validity of the new scores. Intraclass Correlation Coefficient greater than 0.82 were observed for all composite scores, indicating good test-retest reliability. MIND scores were able to detect improvement in subject severity of illness.ConclusionThe MIND questionnaire is a valid and reliable instrument for measuring comprehensively the multiple dimensions characterizing the severity of illness of PMV patients.Trial registrationNCT02255058.

Highlights

Evaluating severity of illness of patients with prolonged mechanical ventilation (PMV) is important to adopt the best appropriate care management for each individual
The Multi-INdependence Dimensions (MIND) questionnaire is novel in that it has been developed and validated in a PMV patient population and is more suitable in contrast to other questionnaires that are currently in use in this setting such as Chelsea critical care physical assessment tool (CPAx) [13], Functional Independence Measure (FIM) [7], Physical Function intensive care unit (ICU) Test (PFIT-s) [28], Functional Status Score for the Intensive Care Unit (FSS-ICU) [29] that were designed for other patient populations and include either physical function domains (PFIT, FSS-ICU) or do not focus on all the affected domains of PMV patients (FIM, CPAx)
More specific quality of life questionnaires like the Severe Respiratory Insufficiency Questionnaire-Severe respiratory insufficiency questionnaire (SRI) [41, 42] and the recently developed Quality of Life questionnaire for mechanically ventilated ICU patients-QOL-MV [39] may have allowed gain a better understanding of the perspective of PMV patients and how this complements the healthcare professionals’ perspective captured by the MIND questionnaire

Summary

Introduction

Evaluating severity of illness of patients with prolonged mechanical ventilation (PMV) is important to adopt the best appropriate care management for each individual. Multi-factorial scores have been developed, like the Chelsea Critical Care Physical Assessment Tool (CPAx) that extends evaluation to cough ability and ventilator dependence [13], or the Burns Wean Assessment Program (BWAP) [14] with an extensive respiratory assessment. They were only tested in the ICU setting with non-PMV patients. The development of adequately performing health status, from the severity of illness and dependence angle in particular, measures appropriate to this specific patient population is needed

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