Section Editor: Peter S. A. Glass
Psychometric Testing of the Chinese Quality of
Matthew T. V. Chan, MBBS,
Charlotte C. K. Lo, MBChB,
Candy K. W. Lok, MPH, MSc*
Tak Wing Chan, DPhil(Oxon)†
Kai C. Choi, PhD‡
Tony Gin, MD, FRCA, FANZCA*
BACKGROUND: We evaluated a Chinese translation of the quality of recovery (QoR)
score for measuring health status in patients after surgery and anesthesia.
METHODS: The Chinese QoR score was developed by a panel of linguistic experts
using a series of forward and backward translations. We then compared the
psychometric performance of the Chinese QoR score with the original English
version in bilingual Chinese patients undergoing a variety of surgeries. Using a
crossover design, 210 patients were randomly assigned to complete both versions of
the QoR score, 1 h apart, in the morning after surgery according to one of the two
sequences: Chinese followed by the English QoR score or the reverse order. Test-retest
and interrater reliabilities were calculated by comparing scores administered 6–8 h
later and those completed by the patients and duty nurses, respectively.
RESULTS: Patient responses to the Chinese QoR score agreed well with the English
version (weighted kappa statistic, ?w? 0.92). Both QoR scores correlated with
patient satisfaction scores (Chinese version, ? ? 0.82; English version, ? ? 0.79)
confirming convergent validity. There was also significant negative correlation
between the QoR scores and female gender, duration of hospital stay, or magnitude
of surgery (discriminant construct validity). We found the Chinese QoR score has
good internal consistency (Cronbach’s ? ? 0.91), interobserver (?w? 0.77), and
test-retest reliability (?w? 0.83). These values were similar to those of the original
English version (Cronbach’s ? ? 0.89, interobserver ?w? 0.84, test-retest reliability
CONCLUSION: The Chinese QoR score is conceptually, semantically, and operation-
ally equivalent to the English version. Both scales provide valid, reliable, and
responsive assessment of the QoR after surgery and anesthesia.
(Anesth Analg 2008;107:1189–95)
Health-related quality of life (HRQoL) is an impor-
tant attribute of patient care.1,2It reflects a patient’s
experience of the quality of health care received, and it
indicates the impact of adverse events, such as pain or
other organ dysfunction during the period of care. A
number of instruments have been developed to measure
the HRQoL after surgery and anesthesia.3–11All these
instruments were developed in countries with unique
cultures and many were administered in English.3–10
Therefore, it is difficult to apply these instruments to
patients in different cultures, speaking different lan-
guages. In this regard, a validated instrument available
in several languages is important for multicenter studies
involving different cultural groups.
The purpose of the present study was to develop the
Chinese version of the quality of recovery (QoR) score.5
containing nine questions to evaluate postoperative
changes in emotion, well-being, social function, and
physical disability. Each of the nine items is rated on a
scale of 0–2, with a maximum score of 18. The QoR scale
has proven psychometric properties,5and more impor-
tantly, it is the most frequently cited instrument for
measuring HRQoL after anesthesia and surgery.12–14
Using a crossover design, we compared the validity and
reliability of the Chinese QoR score with the original
English version in 210 bilingual Hong Kong Chinese
patients undergoing a variety of surgical procedures.
The translation and validation procedures were
conducted according to the International Quality of
Life Assessment project.15
This article has supplementary material on the Web site:
From the *Department of Anaesthesia and Intensive Care, and
†Centre for Epidemiology and Biostatistics, The Chinese University
of Hong Kong, Shatin, New Territories, Hong Kong; and ‡Depart-
ment of Scoiology, The University of Oxford, Oxford, UK.
Accepted for publication May 7, 2008.
Supported, in part, by a competitive earmarked research grant
CUHK4400/02M from the Research Grant Council, Hong Kong SAR.
Tony Gin is editor of Anesthetic Clinical Pharmacology for the
Journal. This manuscript was handled by Peter S. A. Glass, Section
Editor of Ambulatory Anesthesiology and Tony Gin was not involved
in anyway with the editorial process or decision.
Reprints will not be available from the author.
Address correspondence to Matthew Chan, MBBS, FANZCA,
Department of Anaesthesia and Intensive Care, The Chinese Uni-
versity of Hong Kong, Prince of Wales Hospital, Shatin, New
Territories, Hong Kong. Address e-mail to email@example.com.
Copyright © 2008 International Anesthesia Research Society
Vol. 107, No. 4, October 2008
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Vol. 107, No. 4, October 2008
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