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Validation of quality-of-recovery scoring tool (ObsQoR-10) in women following vaginal delivery - interim analysis
Abstract Number: F3B-94
Abstract Type: Original Research
Introduction: Few robust scoring tools exist to evaluate postpartum recovery. The ObsQoR-11 tool has been developed and validated following elective and emergency caesarean delivery (1,2). We aimed to validate a modified ObsQoR-10 tool in women following instrumental and spontaneous vaginal deliveries.
Methods: The ObsQoR-10 tool was used in a service evaluation of women following vaginal delivery between October and December 2018. Participants completed a questionnaire at 24 hrs post-delivery and a subset of women at 25 hrs to assess reliability. Primary outcome was validity as assessed by: i) convergent validity [correlation with 100 mm visual analogue scale (VAS) of pain at rest and on mobilising]; ii) discriminant validity [correlation with early and prolonged post-delivery recovery as defined by length of hospital stay (LOS) of ≤36 hrs vs. >36 hrs respectively]; iii) content validity [correlation with LOS, BMI, maternal age, parity, gestational age, estimated blood loss and starting haemoglobin (Hb) concentration]. Secondary outcomes were reliability (assessed using Cronbach’s alpha, inter-item correlation, split-half reliability and test-retest reliability by intra-class correlation) and feasibility of the questionnaire (completion rate and time taken).
Results: All participants completed the ObsQoR-10 at 24 hrs (50/50) and 24% at 25 hrs (12/50). ObsQoR-10 scores at 24 hrs post-delivery: i) had a strong negative correlation to VAS pain scores at rest (Spearman r= -0.61 (95% C.I. -0.76 to -0.39), p<0.01) and on mobilising (Spearman r= -0.67 (95% C.I. -0.80 to -0.47), p<0.0001); ii); were significantly higher in women discharged within 36 hrs (median 82 (77-93) vs. 65 (54-81), p<0.01); iii) negatively correlated with LOS (r= -0.39; CI -0.61 to -0.11; p=0.01) and estimated blood loss (r= -0.31, CI -0.55 to 0.02; p=0.03) but not with any other evaluated clinical indicators (BMI: r= 0.09, p=0.55; maternal age: r= -0.19, p=0.19; parity: r= 0.22, p=0.12; gestational age: r= -0.11, p=0.44; starting Hb concentration: r= -0.23, p=0.11). We demonstrated good test reliability (Cronbach’s alpha=0.79; inter-item correlation >0.15 in 82% items; split-half reliability (0.86) and test-retest reliability (r ≥0.60 for most items)). Acceptability and feasibility were excellent with 100% rate of successful completion and median [IQR] time to completion was 240 [180-300] secs.
Conclusion: Interim analysis demonstrates ObsQoR-10 to be a reliable and valid patient centred outcome measure when used to assess recovery after spontaneous and instrumental vaginal birth. In order to complete our validation of this scoring tool, we aim to evaluate a total of 100 women.
1. Ciechanowicz et al. BJA 2018; 122: 69-78.
2. R. Howle. BJA 2018; 121(2):e19-e20.