Validation of the Japanese version of the quality of recovery score QoR-40
ABSTRACT The quality of recovery score QoR-40 is a recovery-specific and patient-rated questionnaire to assess the early postoperative health status of patients. However, the Japanese version of the QoR40 has not been established. The aim of this study was to validate the quality of recovery 40 Japanese version (the QoR-40J) according to the methods adopted by the International Quality of Life Assessment (IQOLA) project.
After obtaining ethics committee approval and consent, 192 general and otological surgical patients were studied. The QoR-40J was used to measure postoperative health status on day 3 and 1 month after surgery. The level of quality of life was also evaluated using a general, health-related quality of life questionnaire (Short-Form Health Survey-36 sub-scales; SF-36), at 1 month after the surgery. Psychometric analysis including the following properties: test-retest reliability, internal consistency, predictive validity, and measurement of responsiveness, was performed to validate the QoR-40J.
Test-retest reliability (Spearman's correlation coefficient) and internal consistency (Cronbach's α) of the QoR-40J were 0.887 and 0.91, respectively. A significant relationship was observed between the total QoR-40J score and duration of hospitalization (r = -0.291) and between the global QoR-40J score and postoperative scores of the SF-36 sub-scales (physical function, ρ = 0.287; vital score, ρ = 0.349). The standardized mean of the QoR-40J, a measurement of responsiveness, was 0.70.
The results of the psychometric analysis indicated that the QoR-40J has characteristics of acceptable validity, reliability, and responsiveness in clinical practice in Japan. The QoR-40J may aid in evaluating the quality of recovery after surgery or the quality of methods of anesthesia.
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: /st>Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain. METHODS: /st>We undertook a quantitative systematic review of studies evaluating psychometric properties of the QoR-40. Data were combined in meta-analyses using random effects models. This resulted in a total sample of 3459 patients from 17 studies originating in nine countries. RESULTS: /st>We confirmed content, construct, and convergent [pooled r=0.58, 95% confidence interval (CI): 0.51-0.65] validity. Reliability was confirmed by excellent intraclass correlation (pooled α=0.91, 95% CI: 0.88-0.93), test-retest reliability (pooled r=0.90, 95% CI: 0.86-0.92), and inter-rater reliability (intraclass correlation=0.86). The clinical utility of the QoR-40 instrument was supported by high patient recruitment into evaluation studies (97%), and an excellent completion and return rate (97%). The mean time to complete the QoR-40 was 5.1 (95% CI: 4.4-5.7) min. CONCLUSIONS: /st>The QoR-40 is a widely used and extensively validated measure of quality of recovery. The QoR-40 is a suitable measure of postoperative quality of recovery in a range of clinical and research situations.BJA British Journal of Anaesthesia 03/2013; 111(2). DOI:10.1093/bja/aet014 · 4.35 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND In day-case surgery, the effects of the anxiolytic lorazepam as premedication on the quality of postoperative recovery are unknown.OBJECTIVE To evaluate whether lorazepam as a premedication beneficially affects quality of recovery (primary outcome) and psychological manifestations (secondary outcome) after day-case surgery.DESIGNA randomised, double-blind, placebo-controlled clinical trial.SETTINGSingle tertiary centre.PATIENTSInclusion criteria: day-case surgery; age at least 18 years. Exclusion criteria: insufficient knowledge of the Dutch language; intellectual disability; ophthalmology surgery; extracorporeal shock wave lithotripsy; endoscopy; botulinum toxin A treatment; abortion; chronic pain treatment; preceding use of psychopharmaceuticals; contraindication to lorazepam.INTERVENTIONLorazepam (1 to 1.5mg) intravenously vs. NaCl 0.9% as a premedication prior to surgery.MAIN OUTCOME MEASUREQuality of Recovery-40 (QoR-40) score. Secondary outcomes: State-Trait Anxiety Inventory (STAI-State/Trait); State-Trait Anger Scale (STAS-State/Trait); Multidimensional Fatigue Inventory (MFI); Hospital Anxiety and Depression Scale (HADS). Timing of evaluation: T0: preoperatively (all scales); T1: before discharge (STAI-State/Trait); T2: first postoperative working day (QoR-40); T3: 7th day after surgery (all scales). Robust regression analysis was applied. Statistical analyses were adjusted for the corresponding baseline value and sex.RESULTSFour hundred patients were randomised; 398 patients were analysed. Postoperative mean QoR-40 scores were similar in both groups at T2 (174.5 vs. 176.4, P=0.34) and T3 (172.8 vs.176.3, P=0.38). Postoperative mean STAI-State/Trait scores decreased less in the group with lorazepam at T1 (32.3 vs. 29.3, P<0.0001; 32.7 vs. 30.8, P=0.0002). STAI-Trait and HADS-Anxiety decreased less in the group with lorazepam at T3 (31.1 vs. 30.0; P=0.03, 3.3 vs. 2.5, P=0.003). STAS-State increased in the group with lorazepam at T3 (10.8 vs. 10.3, P=0.04).CONCLUSION In day-case surgery, lorazepam as a premedication did not improve quality of recovery. Furthermore, this premedication may delay the decrease in postoperative anxiety and aggression.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT01441843.European Journal of Anaesthesiology 04/2013; 30(12). DOI:10.1097/EJA.0b013e328361d395 · 3.01 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Regional anesthesia improves postoperative analgesia and enhances quality of recovery (QoR) after ambulatory surgery. This randomized, double-blinded, parallel-group, placebo-controlled trial examines the effects of multilevel ultrasound-guided paravertebral blocks (PVBs) and total intravenous anesthesia on QoR after ambulatory breast tumor resection. Sixty-six women were randomized to standardized general anesthesia (control group) or PVBs and propofol-based total intravenous anesthesia (PVB group). The PVB group received T1-T5 PVBs with 5 ml of 0.5% ropivacaine per level, whereas the control group received sham subcutaneous injections. Postoperative QoR was designated as the primary outcome. The 29-item ambulatory QoR tool was administered in the preadmission clinic, before discharge, and on postoperative days 2, 4, and 7. Secondary outcomes included block success, pain scores, intra- and postoperative morphine consumption, time to rescue analgesia, incidence of nausea and vomiting, and hospital discharge time. Data from sixty-four patients were analyzed. The PVB group had higher QoR scores than control group upon discharge (146 vs. 131; P < 0.0001) and on postoperative day 2 (145 vs. 135; P = 0.013); improvements beyond postoperative day 2 lacked statistical significance. None of the PVB group patients required conversion to inhalation gas-based general anesthesia or experienced block-related complications. PVB group patients had improved pain scores on postanesthesia care unit admission and discharge, hospital discharge, and postoperative day 2; their intraoperative morphine consumption, incidence of nausea and vomiting, and discharge time were also reduced. Combining multilevel PVBs with total intravenous anesthesia provides reliable anesthesia, improves postoperative analgesia, enhances QoR, and expedites discharge compared with inhalational gas- and opioid-based general anesthesia for ambulatory breast tumor resection.Anesthesiology 09/2013; 120(3). DOI:10.1097/ALN.0000436117.52143.bc · 6.17 Impact Factor