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Development and validation of a postoperative obstetric 'Quality of Recovery' scoring tool (ObsQoR)
Abstract Number: T-07
Abstract Type: Original Research
Introduction: Few robust scoring systems exist assessing postoperative recovery following cesarean delivery (CD). Quality of Recovery-15 (QoR-15) is a validated general postoperative recovery scoring tool. We present an interim analysis for the development and validation of an obstetric QoR (ObsQoR) for elective CD.
Methods: Items were generated from QoR-40 and the literature. 50 stakeholders were surveyed (13 parturients, 4 partners, 13 anesthesiologists, 11 midwives and 9 obstetricians), with items endorsed by fewer than 66% deleted. Shortlisted items became ObsQoR, each with an 11-point numerical Likert scale (0 = strongly negative; 10= strongly positive). This was tested on 57 women at 3 time points: pre-CD (55/57 respondents), 24 hours (36/57) and at 25 hours (4/57) post-CD. Primary outcome was validity, by correlation analysis of items to 100-mm visual analogue scale (VAS) of general health status. Secondary outcomes included reliability, responsiveness and feasibility. Statistical analysis (Spearman r, Mann-Whitney, Cohen effect size and standardized response mean) was performed using GraphPad Prism (7.0, USA).
Results: 31 items were identified from six dimensions: pain, physical comfort, physical independence, psychological support, emotional state and care of the neonate. Stakeholder survey revealed 23 of these items to include in ObsQoR, and analysis of parturient ObsQoR survey determined ObsQoR-15. Items were analysed against VAS and ObsQoR-15 (Table 1). There was good discriminant validity: VAS of ≥70 or <70 correlated to ObsQoR-15; internal consistency: inter-item and test-re-test correlation; and responsiveness: pre and post-CD scores were 135±12 and 112±18 (mean ± SD), respectively (p<0.0001). Cohen effect size was good at 1.48; standardized response mean 0.99. It is feasible: accepted by 100% of women approached, with a mean ± SD time for completion of 2.16 ± 0.68 minutes.
Discussion: In order to complete ObsQoR-15 validation, we will recruit 100 more women. Interim analysis however shows that ObsQoR-15 appears to be a valid tool to assess elective post-CD recovery, and provides more detailed information than a simple VAS in a reliable and reproducible manner.
1. P.A. Stark. Development and Psychometric Evaluation of a Postoperative Quality of Recovery Score: The QoR-15. Anesthesiology 2013. 118(6):1332-40.
2. P. Myles et al. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaes. 2000. 84; 11-15