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Validity of the Faces Anxiety Scale for the assessment of state anxiety in intensive care patients not receiving mechanical ventilation

Study typeNo. of patientsPrevalence/incidencePatient characteristicsType of testReference standardSensitivity & specificity, PPV & NPV
Validity & Reliability
ID: 1568

McKinley & Madronio (2008)

Study type: cohort

Level of evidence: (−)
Total no. of patients = 100

Based on 100 patients:
Female = 35%
Male = 65%
Mean age = 59.8 years (range 17–95)
Mean duration of ICU stay = 4.63 days (range 0.7–44.5)

Study period:
Not reported.

29-bed multidisciplinary ICUs (general, cardiothoracic, neurological) of a 600- bed metropolitan tertiary referral hospital in Sydney, Australia.
72% of patients had SAI scores at or below the level originally reported as the norm of 42.38 for medical- surgical inpatients.Patients were eligible to take part in the study if they were aged 18 years or older, conscious and orientated in time and place, able to read and understand English, able to respond verbally to questions about their feelings and emotions and had sufficient corrected vision to see the FAS.

Patients were excluded if they were currently receiving mechanical ventilation or not able to understand and respond to English language questions and instructions.
The Faces Anxiety Scale (FAS) is a single-item scale with 5 possible responses, ranging from a neutral face to a face showing extreme fear, and is scored form 1 to 5. The scale was on an 11 × 24 cm card and patients were asked to point to the face that how the they felt at that time.

Spielberger State Anxiety Inventory (SAI):
20-item, 10 anxiety-present, 10 anxiety-absent, with 4-choice Likert scale from ‘not at all’ to ‘very much’

Note: The FAS was administered first followed by the SAI during ICU stay. No follow-up.
Criterion validity (Spearman’s ρ):

ρ = 0.70 (p < 0.0005)
Additional comments:
Main aim of the study was to decide intervention to reduce anxiety during ICU stay, not to identify rehabilitation needs (no follow-up).
83 patients received sedative and/or opioid therapy in the 24 hours prior to reporting their anxiety, which may have influenced the anxiety ratings.
The appropriateness of reference standard used is questionable.

From: 6.4 Appendix 4, Review protocols and evidence tables

Cover of Rehabilitation After Critical Illness
Rehabilitation After Critical Illness [Internet].
NICE Clinical Guidelines, No. 83.
Centre for Clinical Practice at NICE (UK).
Copyright © 2009, National Institute for Health and Clinical Excellence.

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