Elsevier

Medicina Intensiva (English Edition)

Volume 44, Issue 6, August–September 2020, Pages 344-350
Medicina Intensiva (English Edition)

Original
Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patientsEvaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico

https://doi.org/10.1016/j.medine.2019.04.009Get rights and content

Abstract

Aim

A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients.

Design

A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test–retest analysis.

Setting

The Department of Intensive Care Medicine of a reference hospital.

Participants

Patients admitted between 23 February 2016 and 20 December 2017.

Interventions

Questionnaire administration.

Variables

Items of the modified Freedman questionnaire.

Results

Item relevance and definition yielded scores >3 (Likert scale maximum = 4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors.

Conclusions

The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.

Resumen

Objetivo

Evaluar las características psicométricas del cuestionario Freedman modificado para la valoración del sueño en el paciente crítico.

Diseño

Estudio psicométrico. Se exploró la validez de contenido mediante un grupo de expertos y la consistencia interna fue evaluada mediante el coeficiente alfa de Cronbach. Se realizó un análisis factorial para evaluar la validez de constructo; la estabilidad fue medida con análisis test-retest mediante el índice de correlación intraclases.

Ámbito

Servicio de Medicina Intensiva de un hospital de referencia.

Participantes

Pacientes ingresados entre el 23 de febrero de 2016 y el 20 de diciembre de 2017.

Intervenciones

Administración de un cuestionario.

Variables

Ítems del cuestionario Freedman modificado.

Resultados

La pertinencia de los ítems y su definición obtuvieron valores superiores a 3, en una escala tipo Likert con valor máximo de 4 puntos. El alfa de Cronbach indicó un valor global de 0,933. El índice de correlación intraclases obtuvo valores superiores a 0,75 en la mayoría de los ítems del cuestionario. El análisis factorial obtuvo asociación entre las variables analizadas y los 4 factores.

Conclusiones

El cuestionario Freedman modificado presentó unas buenas características psicométricas. Puede resultar un instrumento fiable para evaluar la calidad del sueño en el paciente crítico, así como los factores ambientales relacionados.

Introduction

Sleep is a basic necessity that modulates the immune system, regulates homeostasis, and improves some cognitive functions; moreover, it contributes to the adjustment of physiological functions through hormonal secretion and anabolic stimulation.1, 2

At intensive care units (ICU), due to their characteristics and the high severity of their patients’ conditions, there are more sleep alterations, and patients suffer from both qualitative and quantitative deprivations.3 Studies conducted on the incidence of sleep alteration in the critically ill patient report a prevalence of 22% to 61%. Sleep pattern alterations are observed in the critically ill patient and they consist in a predominance of the stage N1 – light sleep and stage N2 – muscle tone reduction of the sleep cycle with a decrease or absence of stages N3-deep, restorative sleep, and REM sleep. The patients often experience awakenings, a high index of arousal, and periods of daytime sleep (40%–50% of the sleep can occur during the day)4, 5, 6; patients rarely complete a full sleep cycle.7, 8

Assessing the sleep of patients admitted at the ICU is a complex process,9, 10, 11 and this situation requires tools to evaluate it objectively; but these tools like polysomnography and actigraphy are not available in all ICUs. They also require trained researchers for their interpretation. That is why, in order to assess sleep and the factors that interrupt it, there is the alternative of assessment through subjective methods based on questionnaires. This process is less expensive. In contrast, questionnaires, even when they have been validated through comparison with objective evaluation methods, they have not been submitted for psychometric studies.12, 13, 14

These psychometric studies assess the characteristics that every measuring tool should have, which necessarily includes controlling its precision by studying its reliability and validity. Validity refers to the degree to which the tool measures what it intends to measure; reliability refers to the trustworthiness conferred to the data obtained from it and it is associated with the internal coherence or consistency and precision of the measures collected.15 The objective of the present study is to assess whether the modified Freedman questionnaire is suitable, due to its psychometric characteristics, for sleep assessment in critically ill patients.

Section snippets

Design of the study

Psychometric study conducted at the Intensive Medicine Service (IMS) of the Hospital General Universitario de Castellón, Spain. It is a multipurpose ICU including 15 beds and 1 intermediate care unit with 6 beds. The reliability, stability, and validity of the construct and content were assessed.

Participants

Patients admitted to the IMS during the study period from February 23, 2016 through December 20, 2017. Work was conducted with a convenience sample that included the patients that met the inclusion

Results

A sample of n = 129 patients was analyzed. The mean age was 60.61 ± 13.88 years, range (25-85); 62% were males. The mean stay of the period were 10.31 ± 14.41 days, range (3–117). Regarding the reason for ICU admission, 46.5% was for medical reasons, 23.3% for postoperative reasons, 18.6% due to coronary disease, and 11.6% for traumatic reasons.

The results of exploring the validity of the content of the questionnaire from the answers given by members of the expert group to the questions of variable

Discussion

The Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) proposes a series of recommendations to improve safety and quality of clinical practice in critically ill patients. We should mention here that, regarding the issue at hand, the Sedation, Analgesia, and Delirium Working Group at SEMICYUC gives great importance to facilitating sleep and controlling environmental stimuli during the night. Sleep control and evaluation, together with other recommendations, are

Conclusions

The results of this study indicate that the Freedman questionnaire modified by Gómez Sanz shows good psychometric characteristics, which leads us to think that it can turn out to be a reliable tool to evaluate the quality of sleep in the ICU patient with a RASS between −1 and +1, as well as the environmental and human factors that can interfere with sleep.

Funding

This study has received no public or private funding whatsoever.

Conflicts of interest

None reported.

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  • Cited by (0)

    Please cite this article as: Bernat Adell MD, Bisbal Andrés E, Galarza Barrachina L, Cebrián Graullera G, Pages Aznar G, Melgarejo Urendez A, et al. Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico. Med Intensiva. 2020;44:344–350.

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