Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework (original) (raw)
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How well are we measuring postoperative “recovery” after abdominal surgery?
Quality of Life Research, 2015
Purpose The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after abdominal surgery and to analyze the content of PRO instruments against this conceptual framework. Methods Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were interviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework. Results A total of 17 patients and 15 healthcare professionals were interviewed. A total of 22 important recoveryrelated concepts were identified and linked to the ICF. The four most important concepts were ''Energy level,'' ''Sensation of pain,'' ''General physical endurance,'' and ''Carrying out daily routine.'' The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recovery concepts. No instrument covered all of the important concepts. Conclusions The comparison of the contents of PRO instruments commonly used to measure postoperative recovery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals.
Development and Validation of the Surgical Recovery Scale (SRS)
Journal of Surgical Research, 2011
Presently no fully validated instrument is available for the assessment of general postoperative recovery. Such an instrument would form a useful patient-centered outcome measure in studies evaluating surgical and peri-operative interventions. The aim of our study is to develop and validate a summary score based on the Identity Consequence Fatigue Scale (ICFS), for the specific purpose of reliably measuring functional patient recovery following surgery.
Factors associated with recovery among patients after abdominal surgery
2016
Purpose: To examine the level of postoperative recovery and identify relationships among age, postoperative pain, co-morbidity, intra surgical condition, length of incision, and recovery in patients after abdominal surgery. Design: Descriptive correlational design. Method: Sample was 190 patients aged 18 years and older after abdominal surgery at Bach Mai Hospital, Hanoi, Vietnam. Data were collected by interviewing with questionnaires and obtaining demographic and medical data from patient's chart review. Patient's recovery was measured by the quality of recovery scale (QoR-15). Spearman's Rho correlation was employed for data analysis. Main Findings: The average age of subjects was 54.14 years. The length of hospital stay ranged from 3 to 20 days. Main cause of surgery was gastrointestinal disease found in 114 subjects (59.7%), and 54 subjects with urological disease (28.3%). The surgical approach included laparotomy and laparoscopic surgery. There were 38.2% of subjects with one or more co-morbid diseases. The overall QoR scores were good with the mean of 128.91. Age, pain, co-morbidity, and length of incision were negatively correlated with recovery (rs =-.350, rs =-.411, rs =-.428, rs =-.231, p < .05 respectively). Surgical Apgar score was positively correlated with recovery (rs = .289, p < .05). Conclusion and recommendations: To enhance the patient's postoperative recovery and their optimum health outcomes, pain control has to be taken into action. Patients with long wounds have co-morbid diseases and show instability in their hemodynamic status during operation has to be closely monitored.
Perioperative medicine (London, England), 2013
Measurement of outcomes after major abdominal surgery has traditionally focused on mortality, however the low incidence in elective surgery makes this measure a poor comparator. The Postoperative Morbidity Survey (POMS) prospectively assesses short-term morbidity, and may have clinical utility both as a core outcome measure in clinical trials and quality of care. The POMS has been shown to be a valid outcome measure in a mixed surgical population, however it has not been studied in patients undergoing major abdominal surgery. This study assessed the inter-rater reliability and validity of the POMS in patients undergoing major abdominal surgery. Patients undergoing elective major abdominal surgery were visited on postoperative day 1 until discharge by two novice observers who administered the POMS in order to assess inter-rater reliability. Subjects who had previously had the POMS performed prospectively on postoperative days 3 and 5 were identified from a database. The pattern and p...
Development and Feasibility of a Scale to Assess Postoperative Recovery
Anesthesiology, 2010
Background: Good postoperative recovery is increasingly recognized as an important outcome after surgery. The authors created a new Post-operative Quality Recovery Scale (PQRS) that tracks multiple domains of recovery from immediate to long-term time periods in patients of varying ages, languages, and cultures. Methods: The parameters of importance to both clinicians and patients were identified. After an initial pilot study of 133 patients, the PQRS was refined. It consists of six domains (physiologic, nociceptive, emotive, activities of daily living, cognitive, and overall patient perspective). An observational study of 701 patients was performed with the refined PQRS to assess its capacity to evaluate and track recovery and to discriminate between patients. It was conducted in eight countries and in five languages, involving patients more than or equal to 6 yr undergoing elective surgery with general anesthesia. Recovery was assessed before surgery and at multiple time periods postoperatively. Recovery was defined as return to baseline values or better. Results: Seven hundred one patients completed the PQRS. Mean completion time was 4.8 (SD 2.8) min. Recovery scores improved with time. Physiologic recovery was complete in 34% of subjects by 40 min. By the third postoperative day, complete recovery was obtained in 11% of cases (all domains): 48.7% nociceptive, 81.8% emotive, 68.8% activities of daily living, and only 33.5% cognitive. Overall, 95.8% of the patients reported that they were "satisfied or totally satisfied" with their anesthetic care.
A measure of quality of life after abdominal surgery
Quality of Life Research, 2006
Objective: To develop a reliable and valid measure of short-term quality of life after abdominal surgery. Summary background data: A major limitation of clinical trials evaluating laparoscopic surgical procedures has been the lack of a measure of short-term quality of life after abdominal surgery. Methods: We used existing health status measures, focus groups, and semi-structured patient interviews to generate a prototype questionnaire of 51 items, which was administered to patients within 2 weeks after an abdominal surgical procedure. We used structural equations modeling to reduce the number of items, retaining the three items with the highest factor loadings on each of the factors that accounted for one or more eigenvalue. Results: We administered the prototype questionnaire to 500 patients (mean age [SD] 53.4 [16.0], 51.4% male, 73.0% inpatient) at a mean 4.1 days after an abdominal surgical procedure. Item reduction yielded an 18-item measure with 6 sub-scales. The final instrument demonstrated good model fit in relation to our hypothesized factors (root mean square error of approximation 0.085, goodness-of-fit index 0.89). Conclusions: We developed a reliable and valid 18-item, 6-subscale measure of health-related quality of life after abdominal surgery, for use as an outcome measure in studies comparing laparoscopic and conventional abdominal surgery.
Journal of Evaluation in Clinical Practice, 2011
Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.
Reliability of The Post-Operative Recovery Index for Measuring Quality of Recovery after Surgery
The Egyptian Journal of Hospital Medicine, 2023
Background: Postoperative recovery is a crucial component of the patient experience, regardless of the kind of treatment. There has been a lot of research done in this field, including studies using post-operative recovery as an end measure. Objectives: This study aimed to evaluate the consistency of the Quality of Recovery (QoR-40) index among post-operative patients in the hospitals of Erbil city. Subjects and methods: A descriptive study was designed among 166 participants of patients, physicians, nurses, and medical assistants in four surgical wards of Hawler, Rizgary, Maternity, and Raparin (Pediatric) Teaching Hospitals in Erbil City in the Kurdistan Region of Iraq. The data were collected through self-report and direct interview face-to-face techniques from January to July 2022. A questionnaire was designed, and It is divided into two main sections: the sociodemographic information about the participants is presented in the first section, and the second section contains a ready-made scale question about the QoR-40 index, which consists of 40 items concerning five different items and is used to assess the quality of recovery following surgery dimensions. RESULTS: The study results showed that all the participants believed that the items of all dimensions were applicable and can be used in measuring the level of recovery for post-operative patients and the correlation coefficient was 0.746 which considered that this index has a Good Agreement among the participants. Conclusion: This study concluded that the QoR-40 index is reliable among the different peoples of patients, nurses, physicians, and medical assistants, and it's considered that this index has a positive agreement among people with very highly applicable for post-operative patients in measuring the quality of the recovery after surgery.