Sense of coherence remains stable for a year after intensive care in a Norwegian cohort

Follow-up at several points after intensive care

The researchers analysed a prospective cohort drawn from a randomised trial comparing nurse-led follow-up consultations with usual care. The analysis presented focuses on factors associated with sense of coherence, not on demonstrating the effectiveness of these consultations.

Participants had a median age of 57 years and had spent a median of three days in intensive care. Of these, 47% were women and 54% had received mechanical ventilation.

Sense of coherence was measured using the SOC-13 questionnaire on the hospital ward after intensive care, then at 3, 6 and 12 months. Repeated-measures statistical models were used to examine changes over time and associations with demographic, clinical and psychosocial variables.

A stable score, but differences between patients

At the group level, sense of coherence remained stable over the 12 months of follow-up. This stability does not mean that every patient followed the same trajectory or that their physical or psychological symptoms remained unchanged.

Older age, no history of mental health disorders, no prior use of psychotropic medication and fewer post-traumatic stress symptoms at baseline were associated with a higher score.

Conversely, a lower level of education, pain that interfered more with daily life at baseline and less social support measured at three months were associated with a lower score.

Indicators of vulnerability, not a recipe for recovery

These findings describe profiles that might warrant greater attention during rehabilitation. They do not show that increasing social support or reducing pain would necessarily improve sense of coherence.

The association with prior use of psychotropic medication does not demonstrate an adverse effect of the medication either. This analysis cannot separate its role from that of the mental health difficulties that prompted its prescription.

The abstract does not specify losses to follow-up or all the factors accounted for in the analyses. It therefore does not allow a full assessment of the robustness of the reported associations.

What we can take away

After intensive care, this study suggests considering mental health difficulties, pain and social support when supporting patients. It does not establish which intervention would improve their sense of coherence.