RESUMEN
BACKGROUND: Little is known about the disturbance in bodily experience (BE) following ventricular assist device (VAD) implantation. The level of disturbance in BE serves as an indicator of the status of the patients' adaptation process to the device. This process encompasses coping with both the more affective, psychological conflicts and the more cognitive, practical challenges of living with the VAD. To provide an economical screening tool for everyday clinical practice, we refined and validated a questionnaire on BE in VAD patients. METHODS: Seven specific items were derived from clinical experience and presented to 365 VAD patients (85% male; time since implantation: 3-36 months). The item structure was examined using factor analyses and probabilistic test theory. Discriminant validity and change sensitivity were determined in relation to associated psychometric instruments. RESULTS: Four items were found to constitute the unidimensional bodily experience scale (BE-S). Besides a high internal consistency of the scale (ω = 0.86), the RMSEA of >0.01 indicates a very good model fit. The BE-S has high convergent validity with related constructs (Hospital Anxiety and Depression Scale, Kansas City Cardiomyopathy Questionnaire). Change sensitivity analyses proved the BE-S alone to be significantly sensitive to the temporal dynamics of psychological adaptation processes following VAD implantation. CONCLUSION: The BE-S constitutes a valid and economical tool for clinical practice to assess patients' disturbance in BE after VAD implantation. It is a valuable tool for identifying patients with difficulties in adapting to the VAD. Subsequently, it enables early and focused therapeutic support for these patients at risk.
RESUMEN
BACKGROUND: Disturbance in bodily experience (BE) is a potential adverse consequence of ventricular assist device (VAD) implantation. The concept BE encompasses all cognitive and affective processes related to the subjective experience of one's own body. METHODS: A cross-sectional, multicenter study was performed, involving 365 VAD patients (85% male; time postimplant: 3-36 months). Patients completed a BE questionnaire (BE-S, 5-point Likert scale), and the disturbance in BE was analyzed based on sex, time since implantation (in the first, second, or third years postimplant), and patient acuity (elective vs emergent implantation). Subsidiary, patients' gratitude was surveyed. RESULTS: Disturbance in BE was not particularly pronounced (mean = 2.69, standard deviation = 1.17). Eighty-five percent of patients expressed high levels of gratitude. Disturbance in BE decreased (p = 0.04), while gratitude increased (p = 0.02) with time since implantation. Female patients showed more disturbance in BE (p = 0.01) and less gratitude (p = 0.01) compared to male patients. Among patients who underwent emergency implantation, the decrease in disturbance occurred predominantly in the third year, exceeding the level observed in elective implanted patients (p = 0.03). CONCLUSIONS: Disturbance in BE following VAD implantation does generally not reach excessive levels and tends to decrease over time. Our data indicate more disturbance and less gratitude in female patients. In emergently implanted patients, disturbance in BE is prolonged. Screening for disturbance in BE is recommended during follow-up, especially for these at-risk groups, to ensure early and focused psychological support.