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 · 1.50 Impact Factor
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ABSTRACT: Although pelvic floor physical therapy (PFPT) can be beneficial for complaints after vaginal reconstructive surgery, it is not routinely offered to all patients. We sought to evaluate the role of perioperative PFPT in improving quality of life and function after prolapse repairs. This randomized controlled trial compared PFPT to standard care after vaginal reconstructive surgery. The intervention group received PFPT 2 weeks preoperatively and 2, 4, 6, 8, and 12 weeks postoperatively, as well as a physician assessment. Control subjects underwent a physician's assessment alone at the same time points postoperatively. Both groups completed pelvic organ prolapse quantification examinations, intravaginal electromyography (EMG), voiding diaries, and validated questionnaires at baseline and 12 weeks. The primary outcome was change in the World Health Organization Quality of Life-BREF scale after surgery. Forty-nine women completed the study: 24 women in the PFPT group and 25 women in the control group. At 12 weeks, condition-specific questionnaires improved for the entire sample, confirming effectiveness of surgery. Nevertheless, no significant differences were noted between the groups despite therapy with PFPT. However, intravaginal EMG measures were notably affected by the intervention. The PFPT group showed significantly lower averages across all measurements of rest, indicating positive impact on muscle function. Pearson correlations revealed associations with better scores on the World Health Organization Quality of Life-BREF physical domain and greater EMG relaxation, supporting effects from PFPT on quality of life. Pelvic symptoms improved in all subjects after vaginal reconstructive surgery. Whereas PFPT did not result in detectable subjective differences in this short-term study, superior muscular function suggested benefit from the intervention.Journal of Pelvic Medicine and Surgery 01/2013; 19(5):271-7. DOI:10.1097/SPV.0b013e31829c64ea
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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 · 4.45 Impact Factor