Assessment of Patient Functional Status after Surgery
ABSTRACT Improvement in day-to-day functioning is a valued outcome of surgical intervention. A new functional status assessment instrument, the Activities Assessment Scale (AAS), was designed for a randomized clinical trial evaluating laparoscopic versus open hernia repair procedures.
The study data set included 2,164 patients at baseline and 1,562 patients at 3-month followup. Only male patients were enrolled in the trial. The psychometric characteristics of the AAS were examined in statistical analyses of cross-sectional and longitudinal data from the trial. Correlational analyses, factor analyses, and t-tests were used to evaluate scale performance.
We found that the AAS was a reliable measure (Cronbach's Coefficient Alpha =0.85) in the patient population studied. Factor analyses identified three subscales (sedentary activities; ambulatory activities; work and exercise activities). Construct validity was demonstrated by a correlation of 0.65 between the AAS and the physical functioning (PF) dimension of the SF-36 (p < 0.001); comparisons between clinical subgroups further confirmed its validity (p < 0.001). Patients reporting improvement on the physical functioning dimension after surgery showed an effect size of 1.20 for preoperative-postoperative change in their AAS scores.
The AAS has been demonstrated to be a reliable, valid, and clinically responsive instrument that can be used to evaluate patient functioning after hernia surgery. It is easy to administer and requires less than 5 minutes of patient time to complete. This measurement system may prove useful in assessing surgical outcomes in both research and office practice settings.
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ABSTRACT: Hintergrund Die Erfassung schmerzbedingter Funktionseinschränkungen (FE) spielt im Rahmen der frühen postoperativen Rehabilitation eine herausragende Rolle in der Optimierung der postoperativen Schmerztherapie. Ziel der vorliegenden Studie war die Prüfung der externen Validität von 3 FE-Items (Mobilisierung, Respiration, Schlaf) des Quality-Improvement-in-Postoperative-Pain-Management(QUIPS)-Fragebogens im stationären postoperativen Setting. Material und Methoden Mit dem QUIPS-Outcomefragebogen wurden 380 Patienten aus der Abdominalchirurgie und Traumachirurgie/Orthopädie befragt. Als externe Validitätskriterien für die Messung der schmerzbedingten FE von Mobilisierung, Respiration und Schlaf dienten die Tolerierung der Gelenkmobilisierung durch eine Motorschiene, die anhand des Peak-Flows gemessene Einschränkung der Lungenfunktion und die mithilfe der Aktigraphie erfasste Schlafqualität. Ergebnisse Der QUIPS-Outcomefragebogen erreicht gute Reliabilitätswerte (rtt=0,783–0,954; interne Konsistenz: 0,597–0,941). Die 3 FE-Items erzielten signifikante mittlere Korrelationen (r=0,407–0,469) mit den externen Kriterien. Schlussfolgerungen Der QUIPS-Outcomefragebogen erwies sich als reliables Messinstrument für Akutschmerz. Die externe Validität der FE-Items zu Mobilisierung, Respiration und Schlaf für das stationäre postoperative Setting konnte im Rahmen der verwendeten Validitätskriterien belegt werden.Der Schmerz 08/2012; 26(4). DOI:10.1007/s00482-012-1154-4 · 1.02 Impact Factor
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ABSTRACT: Four visual analog scales were constructed to assess sensory and affective components of operative pain. The Surgical Pain Scales (SPS) measure pain while at rest, pain during normal activities, pain during work or exercise, and pain unpleasantness. Longitudinal data from 2,164 patients in a randomized trial of laparoscopic versus open hernia repair established the reliability, validity, and sensitivity to change of the SPS. Correlations and t-tests were used to determine their psychometric properties compared with the SF-36 health status instrument. Intraclass correlation coefficients of 0.95 for the sensory scales and 0.94 for the unpleasantness rating confirmed that the SPS produced reliable measurements. Correlations ranging from 0.44 to 0.60 between the visual analog scales and the bodily pain dimension on the SF-36 and significant differences between SPS levels for patients requiring more and less time to resume normal activities (p< or =0.015 to p< or =0.002) supported the validity of the scales. Clinical responsiveness was demonstrated by a 33.5-mm reduction (standard error = 1.4 mm) in the mean rating on a 150-mm scale measuring pain during normal activities for patients reporting postoperative improvement on the bodily pain dimension (p< or =0.0001). The Surgical Pain Scales demonstrated excellent psychometric properties in this study population. The SPS can be used to compare pain levels between groups at a single point in time or to track change for individual patients over time or after operations. Individualized pain management interventions can be tailored based on the sensory and effective ratings.Journal of the American College of Surgeons 08/2005; 201(2):245-52. DOI:10.1016/j.jamcollsurg.2005.03.034 · 5.12 Impact Factor
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ABSTRACT: Many men with inguinal hernia have minimal symptoms. Whether deferring surgical repair is a safe and acceptable option has not been assessed. To compare pain and the physical component score (PCS) of the Short Form-36 Version 2 survey at 2 years in men with minimally symptomatic inguinal hernias treated with watchful waiting or surgical repair. Randomized trial conducted January 1, 1999, through December 31, 2004, at 5 North American centers and enrolling 720 men (364 watchful waiting, 356 surgical repair) followed up for 2 to 4.5 years. Watchful-waiting patients were followed up at 6 months and annually and watched for hernia symptoms; repair patients received standard open tension-free repair and were followed up at 3 and 6 months and annually. Pain and discomfort interfering with usual activities at 2 years and change in PCS from baseline to 2 years. Secondary outcomes were complications, patient-reported pain, functional status, activity levels, and satisfaction with care. Primary intention-to-treat outcomes were similar at 2 years for watchful waiting vs surgical repair: pain limiting activities (5.1% vs 2.2%, respectively; P = .06 [corrected]); PCS (improvement over baseline, 0.29 points vs 0.13 points; P = .79). Twenty-three percent of patients assigned to watchful waiting crossed over to receive surgical repair (increase in hernia-related pain was the most common reason offered); 17% assigned to receive repair crossed over to watchful waiting. Self-reported pain in watchful-waiting patients crossing over improved after repair. Occurrence of postoperative hernia-related complications was similar in patients who received repair as assigned and in watchful-waiting patients who crossed over. One watchful-waiting patient (0.3%) experienced acute hernia incarceration without strangulation within 2 years; a second had acute incarceration with bowel obstruction at 4 years, with a frequency of 1.8/1000 patient-years inclusive of patients followed up for as long as 4.5 years. Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely.Clinical Trials Registration ClinicalTrials.gov Identifier: NCT00263250.JAMA The Journal of the American Medical Association 02/2006; 295(3):285-92. DOI:10.1001/jama.295.3.285 · 35.29 Impact Factor