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POSTPARTUM PAIN – Assessment of QoL indicators in the postpartum period
Abstract Number: S-4
Abstract Type: Original Research
Introduction: Although specific maternal morbidity in the postpartum period has been well documented in the literature, this 6 week period has generally been largely ignored by health care systems. QOL tools have not been commonly used in obstetric anesthesia studies and there are currently few instruments available for measuring the mothers' health-related quality of life. The short form of World Health Organization Quality of Life assessment (WHOQOL-Bref) tool has been validated in a sample of postpartum women and shown to be reliable measure of quality of life 1. The Nottingham Health Profile (NHP) was devised to provide information about health services. NHP is shorter and easier to implement and is fairly inexpensive.
Objective: The aim of this study was to assess the usefulness of NHP in postpartum period and to evaluate its psychometric characteristics.
Methods: A random sample of 133 English speaking women was entered into the study prior to discharge and women completed the scale in-hospital between 24-48 hours of delivery. Participants were then mailed/emailed the NHP questionnaire at 7 days postpartum and a sample of women was randomized to complete it by phone. WHOQOL-Bref was sent along with NHP at the 7 day questionnaire point.
Results: We approached 398 women. 181 patients consented to participate in the study and filled out NHP at 24-48 hrs after delivery. 133 patients responded to the follow up postpartum contact, giving a 74% response rate. The mean age of the women was 34 with the median parity of 2. 50% had vaginal delivery. The NHP tool indicated that in the acute setting physical ability, energy level and pain were the most affected. At 1-2 week follow up women were describing greatest difficulties with energy level and pain domains. The scores for physical ability, pain, sleep, energy level improved compared to baseline, whereas the scores for social isolation and emotional reactions remained similar to baseline values. Energy level and Emotional reaction domains of NHP showed moderate correlations with physical and psychological health dimensions of WHOQOL BREF. NHP scores at 1-2 week follow up were lower in physical ability, pain and energy level domains for women who had caesarean compared to vaginal delivery group.
Conclusion: NHP scale was found to be suitable for evaluation of quality of life in the population of postpartum women and showed reasonable feasibility, reliability, and validity of the measures in a clinical obstetric setting. NHP did not demonstrate significant impairment in the domains of emotional reaction and social isolation at 1-2 week follow up, therefore it may not be the best tool to screen for postpartum depression. This is the first study evaluating the usefulness of NHP in postpartum population as well as the first study evaluating quality of life in the postpartum period of Canadian women.
1. Webster J et al. Validation of WHOQOL-BREF among women following childbirth. ANZJOG 2010; 50: 132-3