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Klassen AF, Pusic AL, Kaur M, Mansouri J, Tsangaris E, Dayan S, Klok J, Armstrong K, Santosa K, Rae C, Poulsen L, Cano SJ. The SKIN-Q: An Innovative Patient-Reported Outcome Measure for Evaluating Minimally Invasive Skin Treatments for the Face and Body. Facial Plast Surg Aesthet Med 2024. [PMID: 38466952 DOI: 10.1089/fpsam.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: As the aesthetics field continues to innovate, it is important that outcomes are carefully evaluated. Objectives: To develop item libraries to measure how skin looks and feels from the patient perspective, that is, SKIN-Q. Methods: Concept elicitation interviews were conducted and data were used to draft the SKIN-Q, which was refined with patient and expert feedback. An online sample (i.e., Prolific) provided field-test data. Results: We conducted 26 qualitative interviews (88% women; 65% ≥ 40 years of age). A draft of the SKIN-Q item libraries were formed and revised with input from 12 experts, 11 patients, and 174 online participants who provided 180 survey responses. The psychometric sample of 657 participants (82% women; 36% aged ≥40 years) provided 713 completed surveys (facial, n = 595; body, n = 118). After removing 14 items, the psychometric analysis provided evidence of reliability (≥0.85) and validity for a 20-item set that measures how skin feels and a 46-item set that measures how skin looks. Short-form scales were tested to provide examples for how to utilize the item sets. Conclusion: The SKIN-Q represents an innovative way to measure satisfaction with skin (face and body) in the context of minimally invasive treatments.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Manraj Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jasmine Mansouri
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Dayan
- Dayan Facial Plastic Surgery, Chicago, Illinois, USA
| | | | | | - Katherine Santosa
- The Center for Plastic Surgery at MetroDerm, Alpharetta, Georgia, USA
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, Løntoft, Nyhøj and Poulsen Plastic Surgery, Odense, Denmark
| | - Stefan J Cano
- Modus Outcomes (a Division of Thread), Cheltenham, United Kingdom
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Barone M, Salzillo R, De Bernardis R, Cogliandro A, Persichetti P. Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss. Aesthetic Plast Surg 2024; 48:652-658. [PMID: 37679561 DOI: 10.1007/s00266-023-03641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss. METHODS Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire. RESULTS We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups. CONCLUSION Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better". LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mauro Barone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Rosa Salzillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Riccardo De Bernardis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Annalisa Cogliandro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Paolo Persichetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
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Makarawung DJS, Dijkhorst PJ, de Vries CEE, Monpellier VM, Wiezer MJ, van Veen RN, Geenen R, Mink van der Molen AB. Body Image and Weight Loss Outcome After Bariatric Metabolic Surgery: a Mixed Model Analysis. Obes Surg 2023; 33:2396-2404. [PMID: 37354307 DOI: 10.1007/s11695-023-06690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE As in nonsurgical weight loss populations, body image may partly explain differences in weight loss outcomes after surgery. The aim of this study was to determine the prospective association between body image and weight loss in a longitudinal cohort of patients up to 3 years after bariatric metabolic surgery. MATERIALS AND METHODS The BODY-Q self-report questionnaire was used to assess body image. Linear mixed models evaluated associations of baseline body image with weight loss in the first year as well as associations of body image at 12 months and first-year change in body image with weight loss 12 to 36 months after surgery. RESULTS Available body image data included 400 (100%), 371 (93%), 306 (77%), 289 (72%), and 218 (55%) patients at baseline and 4, 12, 24, and 36 months, respectively. Body image scores improved significantly until 12 months, followed by a gradual decline. Scores remained improved in comparison to baseline (β = 31.49, 95% CI [27.8, 35.2], p < .001). Higher baseline body image was associated with less weight loss during the first year, and the effect size was trivial (ß = -0.05, 95% CI [-0.09, -0.01], p = .009). Body image and change in body image were not associated with weight loss 12 to 36 months after surgery. CONCLUSION Body image improved after bariatric metabolic surgery. Although no clinically relevant associations of body image with weight loss were demonstrated, the gradual decline in body image scores underlines the importance of long-term follow-up with regular assessment of this aspect of quality of life.
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Affiliation(s)
- Dennis J S Makarawung
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands.
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| | - Phillip J Dijkhorst
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Claire E E de Vries
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Valerie M Monpellier
- Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis ter Heide, the Netherlands
| | - M J Wiezer
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
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Grift A, de Vries C, Monpellier V, Makarawung D, de Raaff C, Nijland L, Mink van der Molen A, Wiezer R, van Wagensveld B, van Veen R, de Castro S, Florisson J, Hoogbergen M. Using the BODY-Q to develop a prospective cohort of patients undergoing bariatric and body contouring surgery: A study protocol. Clin Obes 2023; 13:e12573. [PMID: 36470587 DOI: 10.1111/cob.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
The BODY-Q is a patient-reported outcome measure designed to measure health-related quality of life, satisfaction with appearance and experience with healthcare in patients with obesity who undergo bariatric surgery and/or body contouring surgery after massive weight loss. The aim of this study is to collect long term PRO-data from patients living with obesity undergoing bariatric surgery, comparing patient undergoing or not undergoing body contouring surgery. This study will be a multicentre, prospective longitudinal cohort study with participation of three bariatric medical centres in the Netherlands. The BODY-Q will be used to measure the satisfaction with appearance and HRQL. Patients undergoing bariatric surgery, age >18 years and <65 years and who are able to read and understand Dutch can be included. All bariatric procedures are eligible for inclusion. Administration of the questionnaires will be done preoperatively for bariatric and body contouring surgery as well as at 3, 12, 24, 36, 48 and 60 months post-operatively. Patient-reported outcomes measurements are becoming more important with the shift to patient-centred healthcare. The collected longitudinal data can be helpful in determining the effectiveness and value of bariatric and body contouring surgery from the patient's perspective, and can contribute to patient tailored postoperative care.
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Affiliation(s)
- Annewiek Grift
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Valerie Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Dennis Makarawung
- Department of Plastic, Reconstructive and Hand Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Leontien Nijland
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Aebele Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Rene Wiezer
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Bart van Wagensveld
- Metabolic and Bariatric Department, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | | | | | - Joyce Florisson
- Department of Plastic, Reconstructive and Hand Surgery, OLVG, Amsterdam, The Netherlands
| | - Maarten Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Simone P, Savani L, Marchica P, Persichetti P. Puboplasty as an integral step in massive weight loss abdominal contouring: a retrospective assessment of results, stability, and patients' satisfaction. J Plast Surg Hand Surg 2022; 56:387-395. [PMID: 35400280 DOI: 10.1080/2000656x.2022.2061500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ex-obese patients complain about abdomen and pubis deformities following massive weight loss, due to skin and soft tissue redundancy. Abdominoplasty is often the first corrective procedure performed, but residual mons pubis deformities may impair the final outcome, thus concomitant correction becomes necessary. Sixty patients were treated by the same surgeon between 2008 and 2018, 30 of them receiving only standard umbilical transposition abdominoplasty (A group), and 30 having concurrent monsplasty (AM group), namely skin excess removal, pubic suspension and skin redistribution following superolateral vectors, re-establishment of superficial fascia continuity, with or without liposuction. Retrospective comparison of the two groups included: a subjective evaluation through administration of questionnaires (BODY-QTM, a questionnaire assessing functional and aesthetic improvements after surgery, a questionnaire assessing the overall satisfaction), and an objective evaluation of pre- and post-operative pictures to estimate mons pubis suspension and result stability. Four minor complications were recorded: 1 wound dehiscence in A group, 3 seromas in AM group. All measured outcomes were higher in AM group, with statistically significant difference (p < 0.05) in almost all the questionnaire and BODY-QTM items, and the photographic assessment confirmed higher degree of mons pubis suspension and superior result stability in AM group. We presented a standardized approach to mons pubis reshaping during abdominoplasty, through a straightforward, safe and quick procedure. Our experience supports the significance of the concomitant correction of abdominal and mons pubis deformities, improving the results of the surgery from both a subjective and objective point of view.
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Affiliation(s)
- Pierfranco Simone
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Luca Savani
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
| | - Paolo Marchica
- Clinic of Plastic Surgery, Department of Neuroscience, Padua University Hospital, Padua, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico of Rome University, Rome, Italy
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Lorenzen MM, Poulsen L, Madsen CB, Tsangaris E, Klassen A, Sørensen JA. Danish translation and linguistic validation of new body-Q scales measuring expectations, eating behavior, distress, symptoms and work life. J Plast Surg Hand Surg 2022; 56:376-380. [PMID: 35235477 DOI: 10.1080/2000656x.2022.2044834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this study was to translate and achieve a linguistical and cultural adaption of the newly developed BODY-Q Obesity Module for use in Danish patients. The BODY-Q Eating Module consists of five new modules aiming to measure expectations of weight-loss, eating behavior, eating-related distress, eating-related symptoms and work life. Translation and linguistic validation were performed using a combination of the recommendations developed by the World Health Organization and the International Society for Pharmacoeconomics and Outcomes Research. The translation was performed in five steps consisting of a forward translation, backward translation, expert panel meeting, cognitive debriefing and final proofreading. Each step aimed for a conceptual and cultural equal translation that was easily understood by patients. The discrepancies encountered in the forward translation included the use of layperson versus medical terminology, different tense and sentence structure. The harmonized version was then backwards translated which led to no conceptual differences. The expert panel reviewed the instrument in full and found two items needing correction in the instrument. Cognitive debriefing did not lead to any revisions and the instrument was well received by the participant group. Proofreading of the instrument led to few corrections in grammar and punctuation but no conceptual corrections. The translation of the BODY-Q Eating Module led to a conceptual and cultural equal version of the instrument for use in Danish patients. The instrument can be used in clinical care and research to inform advancements in the field of bariatric and body contouring surgery.
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Affiliation(s)
- Mike Mikkelsen Lorenzen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Christoffer Bing Madsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Elena Tsangaris
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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Fagevik Olsén M, Biörserud C, Nouh MA, Staalesen T, Elander A. Translation and validation of a Swedish version of the BODY-Q: a patient-reported outcome instrument for weight loss and body contouring surgery. J Plast Surg Hand Surg 2022; 56:348-352. [PMID: 34338129 DOI: 10.1080/2000656x.2021.1956503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BODY-Q is self-administered questionnaire that evaluates appearance, function and symptoms related to bariatric- and body contouring surgery. The purpose of this article was to describe the translation process of a Swedish version of BODY-Q and to evaluate its criterion validity to the Swedish questionnaire Sahlgrenska Excess Skin Questionnaire, SESQ. MATERIALS AND METHODS BODY-Q was translated according to International Society for Pharmacoeconomics and Outcome Research's guidelines. The test of validity was made between parts which were comparable to SESQ. Both questionnaires were responded by 30 subjects who were suffering from excess skin after massive weight loss following bariatric surgery or dieting. RESULTS The correlation between the two questionnaires varied. The parts of BODY-Q evaluating excess skin on the whole body and parts of the body had higher correlations (rs 0.328-0.766) than the parts evaluating side effects of excess skin and body-image (rs 0.103-0.574). CONCLUSION The Swedish version of BODY-Q has a good criterion validity and can be recommended in the healthcare for patients with excess skin after massive weight loss and for evaluation of the outcomes from reconstructive surgical procedures.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Christina Biörserud
- Department of Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Micheline Al Nouh
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Trude Staalesen
- Department of Plastic Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Jacobsen AL, DeVries CEE, Poulsen L, Mou D, Klassen AF, Pusic AL, Makarawung DJS, Wiezer MJ, van Veen RN, Sørensen JA. The impact of body mass index (BMI) on satisfaction with work life: An international BODY-Q study. Clin Obes 2022; 12:e12527. [PMID: 35575285 PMCID: PMC9539700 DOI: 10.1111/cob.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 12/05/2022]
Abstract
Obesity is a global health issue known to have a major influence on health-related quality of life (HR-QOL). HR-QOL is a concept evaluating physical and psychological health. Work life can impact HR-QOL in people with obesity. The aim of this study was to measure the association between body mass index (BMI) and satisfaction with work life. This study included participants from an international multicenter field-test study of BODY-Q scales. Recruitment took place at hospitals in Denmark, The Netherlands and USA between June 2019 and January 2020. The BODY-Q Work Life scale was used to measure work life satisfaction. The difference between BMI groups and work life satisfaction was examined using one-way analysis of variance. Multivariable linear regression analysis was used to examine the association between BMI and work life satisfaction, adjusted for significant confounders. Of 4123 participants, 2515 completed the BODY-Q Work Life scale. BMI groups showed significant difference in work life satisfaction (p < .0001). The Work Life scale mean score was 77.6 for the normal BMI group, 78.5 for the overweight group and 75.0, 68.9 and 63.8 for Class 1, 2 and 3 obesity, respectively. Furthermore, BMI was significantly associated with satisfaction with work life (adjusted regression coefficient -.962, p < .0001). Higher BMI was associated with lower work life satisfaction. This finding suggests that a reduction in BMI may have a positive influence on work life satisfaction in people with obesity.
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Affiliation(s)
- Amalie L. Jacobsen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- OPEN, Open Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Claire E. E. DeVries
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of SurgeryOLVG WestAmsterdamThe Netherlands
| | - Lotte Poulsen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- OPEN, Open Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Danny Mou
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Andrea L. Pusic
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | | | | | | | - Jens A. Sørensen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- Department of Plastic SurgeryUniversity of Southern DenmarkOdenseDenmark
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Keramidas E, Rodopoulou S, Gavala MI. A Proposed Classification and Treatment Algorithm for Rectus Diastasis: A Prospective Study. Aesthetic Plast Surg 2022; 46:2323-2332. [PMID: 35043248 PMCID: PMC9592666 DOI: 10.1007/s00266-021-02739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Background This study presents a classification system and treatment method to correct Rectus diastasis (RD) during abdominoplasty. Materials and methods One hundred and sixty seven patients undergoing abdominoplasty were enrolled between April 2014 and January 2018. Forty-three patients did not present with RD and were excluded from the analysis. Mean age was 40.32 years, mean BMI was 23.84, and minimum follow-up was 24 months. A four-type (A: mild 2–3cm, B: moderate 3–5cm, C: severe 5–7cm, and D: very severe 7–9cm) classification system is described. A different treatment method is performed in each category using continuous and interrupted absorbable sutures. Postoperatively patients filled up a questionnaire that involved the level of pain, the postoperative day they performed specific indoor/outdoor activities, and the evaluation of the aesthetic result. Results No statistically significant differences were observed between the four RD types regarding pain, complications, and return to specific activities. All types of RD had the same low rate complication profile. The seroma rate was 0.81%. The infection rate was 0.81%, and the thromboembolism and the pneumonic embolism rate was 0%. After 2–6 years of follow-up no clinical recurrence of rectus diastasis was observed. All reoperations (14.52%) were performed due to scar deformities. Mean pain score levels were very low (<1.5) and within a week most patients returned to specific indoor and outdoor activities. Most patients were extremely satisfied with the results. Conclusions In this article, we present an updated classification system and treatment protocol to provide surgeons a safe and standardized method that produces high-quality aesthetic results. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02739-w.
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Affiliation(s)
- Evangelos Keramidas
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece.
| | - Stavroula Rodopoulou
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
| | - Maria-Ioanna Gavala
- Kosmesis Aesthetic Plastic Surgery Center, Central Clinic of Athens, Ethnikis Antistaseos 9-11, Chalandri, 15232, Athens, Greece
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Reddy RK, Dutt A, Charles WN, Hoyos A, Khajuria A. The 100 Most-Cited Articles in Liposuction: A Bibliometric Analysis. Ann Plast Surg 2021; 87:615-622. [PMID: 34711726 DOI: 10.1097/sap.0000000000003030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Liposuction is one of the most common cosmetic surgical procedures performed worldwide. Despite previous citation analyses in plastic surgery, the most-cited works in liposuction have not yet been qualitatively or quantitatively appraised. We hypothesized that use of validated outcome measures and levels of evidence would be low among these articles. Thus, we performed a bibliometric analysis aiming to comprehensively review the most-cited liposuction literature, evaluating characteristics and quality of the top 100 articles. METHODS The 100 most-cited articles in liposuction were identified on Web of Science, across all available journals and years (1950-2020). Study details, including the citation count, main subject, and outcome measures, were extracted from each article by 2 independent reviewers. The level of evidence of each study was also assessed. RESULTS The 100 most-cited articles in liposuction were cited by a total of 4809 articles. Citations per article ranged from 602 to 45 (mean, 92). Most articles were level of evidence 4 (n = 33) or 5 (n = 35), representative of the large number of case series, expert-opinion articles, and narrative reviews. Ten articles achieved level of evidence 3, 22 articles achieved level of evidence 2, and none reached level 1. The main subject was operative technique in 63 articles, followed by outcomes in 32 articles. Five articles assessed the metabolic effects of liposuction. Only 1 article used a validated objective cosmetic outcome measure, and none used validated patient-reported outcome measures. CONCLUSIONS This analysis provides an overview of the top cited liposuction literature. Overall, level of evidence was low, and no articles achieved the highest level of evidence. Improving the quality of literature requires prioritization of better-designed studies and incorporation of validated outcome measures, which will increase patient satisfaction and ensure provision of excellent, reproducible clinical care.
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Affiliation(s)
- Rohin K Reddy
- From the Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Atul Dutt
- From the Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Walton N Charles
- From the Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Edmondson SJ, Ross DA. The postpartum abdomen: psychology, surgery and quality of life. Hernia 2021; 25:939-950. [PMID: 34309770 DOI: 10.1007/s10029-021-02470-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The postpartum abdomen presents significant challenges to the surgeon. It is anatomically complex, with often substantial symptomatic divarication of the rectus abdominis, affecting all anterior abdominal wall layers. This may lead to profound functional sequelae, and often, of more importance to patients, a significant physical deformity. The complex interplay of functional/physical symptoms can result in reduced quality of life (QoL) as well as negative body image/self-esteem. Postpartum women may seek abdominoplasty to address the whole scope of these concerns. Whilst techniques have evolved achieving such goals operatively, the impact of such surgery on QoL/mental health has yet to be established. METHODS We perform a comprehensive review of potential options of validated patient-reported outcome measures (PROMs) for consideration of use in postpartum women seeking abdominoplasty; in addition to discussing current driving factors for seeking surgery and associated ethics. RESULTS Pressure on postpartum women to return their abdominal wall contour to a pre-pregnant state is high. This poses important ethical considerations for surgeons. There are several well-established/validated PROMs used in body contouring in massive weight loss/bariatric population groups, including Body-Q and Body-QoL scales, but none yet specific to postpartum women. CONCLUSION PROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients' mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial.
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Affiliation(s)
- S-J Edmondson
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England.
| | - D A Ross
- Plastic and Reconstructive Surgery Department, The London Clinic, 20 Devonshire Place, London, W1G 6BW, England
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Dutton GR, Kinsey AW, Howell CR, Pisu M, Dobelstein AE, Allison DB, Xun P, Levitsky DA, Fontaine K. The daily Self-Weighing for Obesity Management in Primary Care Study: Rationale, design and methodology. Contemp Clin Trials 2021; 107:106463. [PMID: 34082075 DOI: 10.1016/j.cct.2021.106463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Abstract
Background Daily self-weighing (DSW) may be an effective harm-reduction intervention to disrupt continued weight gain. Self-Weighing for Obesity Management in Primary Care (SWOP) is a 24-month randomized controlled trial in 400 adults with obesity (BMI: kg/m2 ≥ 30) receiving primary care through a clinical network affiliated with an academic medical center. Objective To test DSW as a potentially scalable way to deter age-related weight gain among primary care patients with obesity. Methods Randomized-controlled trial with two conditions: DSW (instruction to weigh daily and provision of a web-enabled digital scale with graphical weight feedback) or Standard Care (receive a monetary gift card equivalent to value of the scale). Both groups receive standardized weight management educational material. SWOP will test the causal effect of assignment to DSW (Aim 1) and adherence to DSW (Aim 2) on weight (primary outcome) and adoption of weight management practices (secondary outcomes), as well as evaluate the cost-effectiveness of DSW compared to standard care (Aim 3). Findings may inform clinical guidelines for weight management by providing evidence that DSW attenuates continued age-related weight gain among adults with obesity. This trial is registered with ClinicalTrials.gov (NCT04044794).
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Affiliation(s)
- Gareth R Dutton
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Amber W Kinsey
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Maria Pisu
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Amy E Dobelstein
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - David B Allison
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA.
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA
| | - David A Levitsky
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, 244 Garden Ave, Ithaca, NY 14853, USA.
| | - Kevin Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA.
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de Vries CEE, Mou D, Poulsen L, Breitkopf T, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Liem RSL, Nienhuijs SW, Tavakkoli A, Pusic AL, Klassen AF. Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries. Obes Surg 2021; 31:3637-3645. [PMID: 34041700 DOI: 10.1007/s11695-021-05462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The BODY-Q is a rigorously developed patient-reported outcome measure (PROM) for patients seeking treatment for obesity and body contouring surgery. A limitation of the uptake of the BODY-Q in weight management treatments is the absence of scales designed to measure eating-specific concerns. We aimed to develop and validate 5 new BODY-Q scales measuring weight loss expectations, eating behaviors, distress, symptoms, and work life. MATERIAL AND METHODS In phase 1 (qualitative), patient and expert input was used to develop and refine the new BODY-Q scales. In phase 2 (quantitative), the scales were field-tested in bariatric and weight management clinics in the United States (US), The Netherlands, and Denmark between June 2019 and January 2020. Data were also collected in the US and Canada in September 2019 through a crowdworking platform. Rasch measurement theory (RMT) analysis was used for item reduction and to examine reliability and validity. RESULTS The new BODY-Q scales were refined through qualitative input from 17 patients and 20 experts (phase 1) and field-tested in 4004 participants (phase 2). All items showed ordered thresholds and good fit to the Rasch model. The RMT analysis provided evidence of reliability, with PSI values ≥0.72, Cronbach alpha values ≥0.83, and test-retest values ≥0.79. Better scores on 4 scales (exception expectations scale) correlated with lower BMI, with the strongest correlation between the eating-related distress scale scores and BMI (r= -0.249, P < 0.001). CONCLUSION The new BODY-Q scales can be used in research and clinical practice to assess weight loss treatments from the patient perspective.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Department of Surgery, OLVG, Amsterdam, The Netherlands.
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Trisia Breitkopf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.,Dutch Obesity Clinic, The Hague, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Bascarane S, Kuppili PP, Menon V. Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach. Indian J Plast Surg 2021; 54:8-19. [PMID: 33854274 PMCID: PMC8034989 DOI: 10.1055/s-0040-1721868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Psychiatric disorders are more common among people undergoing cosmetic procedures than the general population and evaluating mental health can be cumbersome for plastic surgeons. We aim to summarize the available literature in this regard and propose an integrated approach to psychiatric assessment and management of mental health issues among this group. Methods Electronic search of MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles from inception till April 2020. Generated abstracts were screened for their eligibility. Included articles were grouped according to their thematic focus under the following headings; prevalence of psychiatric morbidity among clients posted for cosmetic surgery, assessment tools, and management of psychiatric morbidity in relation to undergoing cosmetic surgery. Results A total of 120 articles were reviewed. The prevalence of psychiatric disorder in patients undergoing cosmetic surgery was 4 to 57% for body dysmorphic disorder (BDD); the corresponding figures for depression, anxiety, and personality disorder were 4.8 to 25.8, 10.8 to 22, and 0 to 53%, respectively. A range of tools have been used to assess these disorders and specific measures are also available to assess clinical outcomes following surgery. Screening for these disorders is essential to prevent unnecessary surgical procedures, as well as to ensure timely management of the psychiatric comorbidity. Conclusion Psychiatric morbidity is a common concomitant in cosmetic surgery. A structured and integrated approach to evaluation and management of psychiatric morbidity will help to optimize postsurgical outcomes.
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Affiliation(s)
- Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pooja P. Kuppili
- Senior Clinical Fellow, Penn Hospital Black Country Healthcare NHS Foundation Trust United Kingdom
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Smith JR, Sheehan M, Casas LA. Using the BODY-Q to Evaluate Appearance and Quality of Life Following Treatment of Skin Laxity of the Outer Thigh with Microfocused Ultrasound and Calcium Hydroxylapatite. Aesthet Surg J 2020; 40:1219-1231. [PMID: 31875882 DOI: 10.1093/asj/sjz372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two procedures that have demonstrated collagen-stimulating properties and improvements in skin laxity in a variety of aesthetic indications are microfocused ultrasound with visualization (MFU-V) and injection with calcium hydroxylapatite (CaHA). OBJECTIVES By treating skin laxity with a combination of these therapies, it was hypothesized that our patients would experience improved appearance and quality of life as measured by the BODY-Q. METHODS A total of 60 consecutive female patients aged 30 to 60 years with body mass index less than 28 kg/m2 who expressed interest in treatment for skin laxity affecting the outer thighs completed selected scales (Body Image, Appraisal of Excess Skin, Satisfaction with Hips and Outer Thighs, and Appearance-Related Psychosocial Distress) from the BODY-Q within 1 week of treatment. At the time of treatment, MFU-V was directed to the outer thighs (150 lines at focal depths of 3.0 and 4.5 mm per outer thigh). Immediately following MFU-V, patients received treatment with CaHA injected into the subdermis (1.5 mL diluted 1:1 with 1.5 mL of 2% lidocaine solution per outer thigh). At 90 days posttreatment, these patients repeated the BODY-Q. RESULTS At 90 days posttreatment, with 100% follow-up among the 60 consecutive female patients treated, scores from the BODY-Q scales showed statistically significant improvement (P < 0.01). CONCLUSIONS Following treatment of skin laxity on the outer thighs with a combination of MFU-V and CaHA, our patients reported a statistically significant improvement in appearance and quality of life at 90 days posttreatment. This protocol may be applicable to other areas of the body. LEVEL OF EVIDENCE: 4
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de Vries CE, Klassen AF, Hoogbergen MM, Alderman AK, Pusic AL. Measuring Outcomes in Cosmetic Abdominoplasty. Clin Plast Surg 2020; 47:429-436. [DOI: 10.1016/j.cps.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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17
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Poulsen L, Simonsen N, Klassen AF, Cano S, Rose M, Juhl CB, Stoving RK, Andries A, Sorensen JA. Comparison of the Moorehead-Ardelt quality of life questionnaire and the BODY-Q in Danish patients undergoing weight loss and body contouring surgery. Clin Obes 2020; 10:e12351. [PMID: 31898419 DOI: 10.1111/cob.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
This study compared the measurement properties of the Moorehead-Ardelt quality of life questionnaire-II (MAQOL-II) and the BODY-Q, to determine which was more suitable for measuring patient-reported outcome (PRO) in Danish bariatric surgery (BS) and body contouring surgery (BC) patients. We examined content validity against the COSMIN guidelines and compared psychometric performance using Rasch measurement theory methods and criteria. MAQOL-II data were obtained from the Danish Bariatric Surgery Database from September 2010 to November 2017, and BODY-Q data were collected from June 2015 to March 2018. The MAQOL-II failed to meet recommended standards for content validity, while all criteria were met for the BODY-Q. A total of 16 965 MAQOL-II and 2259 BODY-Q assessments were obtained. A random sample was selected from the MAQOL-II dataset to match the BODY-Q sample. Psychometrically, the BODY-Q performed better than the MAQOL-II. For example, Cronbach's α was 0.82 for the MAQOL-II vs ≥0.90 for all BODY-Q scales. Fifty percent (3/6) of MAQOL-II items had disordered thresholds, while all BODY-Q items had ordered thresholds (123/123). Poor item fit was revealed for 17% (1/6) of MAQOL-II and 8% (10/123) of BODY-Q items. For scale reliability, person separation index was 0.79 for the MAQOL-II and 0.88 (0.81-0.93) for the BODY-Q. In conclusion, the MAQOL-II does not meet today's standards for a rigorously developed PRO measure. The BODY-Q, on the other hand, gives substantial, accurate and interpretable measurement and should be recommended for use in PRO in BS and BC patients.
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Affiliation(s)
- Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Simonsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael Rose
- Department of Plastic Surgery, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Claus B Juhl
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Rene K Stoving
- Department of Endocrinology and The Psychiatric Services of Southern Denmark, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Alin Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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The long-term effect of body contouring procedures on the quality of life in morbidly obese patients after bariatric surgery. PLoS One 2020; 15:e0229138. [PMID: 32084189 PMCID: PMC7034793 DOI: 10.1371/journal.pone.0229138] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction There has been a significant increase in the number of body contouring procedures performed worldwide. This study aimed to evaluate the long-term psychosocial effects of these procedures among patients who undergone weight loss surgery and maintained their body mass for a minimum of one year. Material and methods Post-bariatric patients undergoing body contouring procedures were recruited for the study consecutively. Inclusion criteria: BMI < 30 following bariatric surgery, weight maintenance for a minimum of 12 months, and completion of all follow up questionnaires (6 and 12 months). Patients were surveyed 24 hours before, 6-months, and 12-months post-procedure using a Polish validated version of BODY-Q. Results 30 consecutive patients with a mean age of 38 years (SD 5,91) were included in this study. The BODY-Q questionnaire revealed statistically significant improvements in the acceptance of body appearance after 12 months of follow up. In the abdominal area, the rise in scores achieved 90 from the starting level of 13, and the overall body image increased from 24 to 67. Moreover, in patients with postoperative complications (one hematoma and four minor wound dehiscence), the overall score did not differ from uncomplicated patients. Conclusions Body contouring procedures after massive weight loss significantly improve the general perception of personal appearance as well as both the psychological and social aspects of life in patients, already significantly stigmatized by their appearance. Body contouring procedures have essential value and should be widely offered as a step in the treatment of morbidly obese patients.
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Geerards D, Klassen AF, Hoogbergen MM, van der Hulst RRWJ, van den Berg L, Pusic AL, Gibbons CJ. Streamlining the Assessment of Patient-Reported Outcomes in Weight Loss and Body Contouring Patients: Applying Computerized Adaptive Testing to the BODY-Q. Plast Reconstr Surg 2019; 143:946e-955e. [PMID: 31033817 DOI: 10.1097/prs.0000000000005587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The BODY-Q is a widely used patient-reported outcome measure of surgical outcomes in weight loss and body contouring patients. Reducing the length of the BODY-Q assessment could overcome implementation barriers in busy clinics. A shorter BODY-Q could be achieved by using computerized adaptive testing, a method to shorten and tailor assessments while maintaining reliability and accuracy. In this study, the authors apply computerized adaptive testing to the BODY-Q and assess computerized adaptive testing performance in terms of item reduction and accuracy. METHODS Parameters describing the psychometric properties of 138 BODY-Q items (i.e., questions) were derived from the original validation sample (n = 734). The 138 items are arranged into 18 scales reflecting Appearance, Quality of Life, and Experience of Care domains. The authors simulated 1000 administrations of the computerized adaptive testing until a stopping rule, reflecting assessment accuracy of standard error less than 0.55, was met. The authors describe the reduction of assessment length in terms of the mean and range of items administered. The authors assessed accuracy by determining correlation between full test and computerized adaptive testing scores. RESULTS The authors ran 54 simulations. Mean item reduction was 36.9 percent (51 items; range, 48 to 138 items). Highest item reduction was achieved for the Experience of Care domain (56.2 percent, 22.5 items). Correlation between full test scores and the BODY-Q computerized adaptive test scores averaged 0.99. CONCLUSIONS Substantial item reduction is possible by using BODY-Q computerized adaptive testing. Reduced assessment length using BODY-Q computerized adaptive testing could reduce patient burden while preserving the accuracy of clinical patient-reported outcomes for patients undergoing weight loss and body contouring operations.
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Affiliation(s)
- Daan Geerards
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Anne F Klassen
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Maarten M Hoogbergen
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - René R W J van der Hulst
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Lisa van den Berg
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Andrea L Pusic
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Chris J Gibbons
- From the Patient-Reported Outcomes, Value & Experience Center, Department of Surgery, Brigham and Women's Hospital; the Department of Surgery, Harvard Medical School; the Department of Pediatrics, McMaster University; the Department of Plastic and Reconstructive Surgery, Catharina Hospital; and the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
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Rosenfield LK, Davis CR. Evidence-Based Abdominoplasty Review With Body Contouring Algorithm. Aesthet Surg J 2019; 39:643-661. [PMID: 30649214 DOI: 10.1093/asj/sjz013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.
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Affiliation(s)
- Lorne K Rosenfield
- University of California, San Francisco, CA
- Stanford University, Stanford, CA
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21
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Development of the BODY-Q Chest Module Evaluating Outcomes following Chest Contouring Surgery. Plast Reconstr Surg 2019; 142:1600-1608. [PMID: 30204682 DOI: 10.1097/prs.0000000000004978] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome instrument designed for weight loss and/or body contouring. In this article, the authors describe the development of a new module for masculinizing chest contouring surgery. METHODS Qualitative methods were used to develop the BODY-Q Chest Module, which was subsequently field-tested in Canada, the United States, The Netherlands, and Denmark between June of 2016 and June of 2017. Participants were aged 16 years or older and seen for gynecomastia, weight loss, or transman chest surgery. Data were collected using either a Web-based application or paper questionnaire. Rasch measurement theory analysis was performed. RESULTS The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, and 341 gender-affirming). Rasch measurement theory analysis refined a 10-item chest scale and a five-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability [i.e., person separation index and Cronbach alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale), respectively]. Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean scores for the chest and nipple scales were significantly higher (p < 0.001 on independent samples t tests) in participants who were postoperative compared with preoperative. CONCLUSION This new BODY-Q Chest Module is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes for masculinizing chest contouring surgery.
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Barone M, Cogliandro A, Tsangaris E, Salzillo R, Morelli Coppola M, Ciarrocchi S, Brunetti B, Tenna S, Tambone V, Persichetti P. Treatment of Severe Gynecomastia After Massive Weight Loss: Analysis of Long-Term Outcomes Measured with the Italian Version of the BODY-Q. Aesthetic Plast Surg 2018; 42:1506-1518. [PMID: 30259165 DOI: 10.1007/s00266-018-1232-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/09/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia. MATERIALS AND METHODS Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q postoperative module. All patients had experienced substantial weight loss (> 30 kg), presented with bilateral severe tissue ptosis of the breast, follow-up of almost 2 years and had a good understanding of the Italian language, and signed consents were included in the study. The sample was studied about age, BMI, comorbidity, bariatric surgical procedure, follow-up, type of post-bariatric surgical procedure, complications and secondary procedures. RESULTS We performed 487 severe gynecomastia corrections from 2008 to 2016; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts: 52 access using a circumareolar scar, 18 with an inframammary fold scar, 10 with an inframammary fold scar using intercostal perforator flaps. There were 16 secondary procedures in group one, 2 in group two and 1 in group three. We compared the secondary procedures of group 1 with the other groups, and we obtained a significant difference with a P = 0.04. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m2 at the time of surgical correction of gynecomastia. From the BODY-Q analysis, the group of patients undergoing adenomammectomy with inframammary fold scar using intercostal perforator flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image. CONCLUSIONS This is the first study that used the BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- M Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy.
| | - A Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
| | - E Tsangaris
- Department of Surgery, Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - R Salzillo
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - M Morelli Coppola
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - S Ciarrocchi
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - B Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - S Tenna
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - V Tambone
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
- Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy
| | - P Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research Group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
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de Vries CEE, Kalff MC, Prinsen CAC, Coulman KD, den Haan C, Welbourn R, Blazeby JM, Morton JM, van Wagensveld BA. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev 2018; 19:1395-1411. [PMID: 29883059 DOI: 10.1111/obr.12710] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS). METHODS We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D). RESULTS Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D). CONCLUSION The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials.
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Affiliation(s)
- C E E de Vries
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - M C Kalff
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C den Haan
- Medical Library, OLVG, Amsterdam, The Netherlands
| | - R Welbourn
- Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - J M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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Suijker J, Troncoso E, Pizarro F, Montecinos S, Villarroel G, Erazo C, Cisternas JP, Andrades P, Benítez S, Sepúlveda S, Danilla S. Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort. Aesthet Surg J 2018; 38:279-288. [PMID: 29117298 DOI: 10.1093/asj/sjx090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Body contouring surgery (BCS) is becoming increasing popular for aesthetic and reconstructive purposes, particularly among patients with massive weight loss (MWL). However, data on quality of life (QoL) following the surgery are limited, especially long-term QoL. OBJECTIVES The authors evaluated the effect of BCS on QoL and the durability of this effect over time. METHODS QoL was measured with the Body-QoL® instrument at 3 time points among consecutively treated patients: the day before BCS, 1 to 9 months postoperatively (short term), and 1 to 2.7 years postoperatively (long term). Total Body-QoL scores were compiled, as were scores for the instrument's main domains: body satisfaction, sex life, self-esteem and social performance, and physical symptoms. Scores were examined for the entire study population and separately for the cosmetic and MWL cohorts. RESULTS Fifty-seven of the 112 patients participated in the short-term assessment and 84 in the long-term assessment. Total Body-QoL scores increased significantly (P < 0.0001), from 44.0 ± 14.1 preoperatively to 85.5 ± 17.5 short-term postoperatively and to 84.4 ± 12.7 long-term postoperatively. Scores for the 2 postoperative assessments did not differ significantly. Similar results were observed for scores on each separate domain. Although preoperative scores were lower for the MWL cohort than the cosmetic cohort (33.9 ± 15.6 vs 46.1 ± 12.8; P = 0.0002), they improved substantially after BCS, approaching scores for the cosmetic cohort. CONCLUSIONS QoL increases significantly after BCS. This favorable outcome remained stable throughout long-term follow-up and was true for the cosmetic and MWL cohorts. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Jaco Suijker
- Resident, Department of General Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Francisca Pizarro
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Sofia Montecinos
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Galia Villarroel
- Medical Students, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Cristian Erazo
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Juan Pablo Cisternas
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Patricio Andrades
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Susana Benítez
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Sergio Sepúlveda
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Stefan Danilla
- Plastic and Reconstructive Surgeons, Department of Plastic and Reconstructive Surgery, Hospital Clínico de la Universidad de Chile, Santiago, Chile
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Psychometric Validation of the BODY-Q in Danish Patients Undergoing Weight Loss and Body Contouring Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1529. [PMID: 29184741 PMCID: PMC5682177 DOI: 10.1097/gox.0000000000001529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
Abstract
Background A well-developed patient-reported outcome instrument is needed for use in Danish bariatric and body contouring patients. The BODY-Q is designed to measure changes in important patient outcomes over the entire patient journey, from obesity to post-body contouring surgery. The current study aims to psychometrically validate the BODY-Q for use in Danish patients. Methods The process consisted of 3 stages: translation and linguistic validation, field-test, and data analysis. The translation was performed in accordance with the International Society for Pharmacoeconomics and Outcomes Research and World Health Organization guidelines, and field-test data were collected in 4 departments in 2 different hospitals. Field-test data were analyzed using Rasch Measurement Theory. Results A total of 495 patients completed the Danish BODY-Q field-test 1-4 times, leading to a total of 681 assessments with an overall response rate at 76%. Cronbach α values were ≥ 0.90, and person separation index values were in general high. The Rasch Measurement Theory analysis provided broad support for the reliability and validity of the Danish version of the BODY-Q scales. Item fit was outside the criteria for 34 of 138 items, and of these, 21 had a significant chi-square P value after Bonferroni adjustment. Most items (128 of 138) had ordered thresholds, indicating that response options worked as intended. Conclusion The Danish version of the BODY-Q is a reliable and valid patient-reported outcome instrument for use in Danish bariatric and body contouring patients.
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Klassen AF, Cano SJ, Kaur M, Breitkopf T, Pusic AL. Further psychometric validation of the BODY-Q: ability to detect change following bariatric surgery weight gain and loss. Health Qual Life Outcomes 2017; 15:227. [PMID: 29178962 PMCID: PMC5702178 DOI: 10.1186/s12955-017-0802-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/16/2017] [Indexed: 11/15/2022] Open
Abstract
Background Recent systematic reviews have identified that current patient-reported outcome instruments have content limitations when used to measure change following bariatric surgery. The aim of this study was to measure change after bariatric surgery using the BODY-Q, a PRO instrument designed for weight loss and body contouring. Methods The BODY-Q is composed of 18 independently functioning scales and an obesity-specific symptom checklist that measure appearance, health-related quality of life (HR-QOL) and experience of health-care. The sample for this study included patients who were exploring or seeking bariatric surgery in Hamilton (Canada) at the time of the BODY-Q field-test study and who agreed to further contact from the research team. These patients were invited to complete 12 BODY-Q scales and the symptom checklist between 7 June 2016 and 29 November 2016. Data were collected online (REDCap) and via postal surveys. Clinical change was measured using paired t-tests with effect sizes and standardized response means. Results The survey was completed by 58 of 89 (65%) pre-bariatric participants from the original BODY-Q field-test sample. The non-participants did not differ from participants in terms of age, gender, ethnicity, BMI or initial BODY-Q scale scores. Participants who had undergone bariatric surgery had a mean BMI of 49 (SD = 7) at time 1 and 35 (SD = 7) at time 2. Time since bariatric surgery was on average 2 years (SD = 0.5) (range 0.4 to 3 years). Percentage total weight loss ranged from 12 to 51 (mean 31, SD = 9). The difference in the proportion of patients to report an obesity-specific symptom on the BODY-Q checklist was significantly lower at follow-up for 5 of 10 symptoms. Participants improved on BODY-Q scales measuring appearance (of abdomen, back, body, buttocks, hips/outer thighs, inner thigh), body image and physical function (p < 0.001 on paired t-tests) and social function (p = 0.002 on paired t-test). These changes were associated with moderate to large effect sizes (0.60 to 2.29) and standardized response means (0.47 to 1.35). Conclusions The BODY-Q provides a set of independently functioning scales that measure issues important to patients who undergo weight loss. BODY-Q scales were responsive to measuring clinical change associated with weight loss 2 years after bariatric surgery.
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Affiliation(s)
- Anne F Klassen
- McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada.
| | - Stefan J Cano
- Modus Outcomes, Letchworth Garden City, Letchworth, UK
| | - Manraj Kaur
- School of Rehabilitation Sciences, Institute of Applied Health Sciences, Room 308, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Trisia Breitkopf
- McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, L8N 3Z5, Canada
| | - Andrea L Pusic
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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Patient-Reported Outcomes in Weight Loss and Body Contouring Surgery: A Cross-Sectional Analysis Using the BODY-Q. Plast Reconstr Surg 2017; 140:491-500. [DOI: 10.1097/prs.0000000000003605] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Development and Evaluation of the Quality of Life for Obesity Surgery (QOLOS) Questionnaire. Obes Surg 2017; 28:451-463. [DOI: 10.1007/s11695-017-2864-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Klassen AF, Cano SJ, Grotting JC, Baker SB, Carruthers J, Carruthers A, Van Laeken N, Sykes JM, Schwitzer JA, Pusic AL. FACE-Q Eye Module for Measuring Patient-Reported Outcomes Following Cosmetic Eye Treatments. JAMA FACIAL PLAST SU 2017; 19:7-14. [PMID: 27631534 DOI: 10.1001/jamafacial.2016.1018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aesthetic eye treatments can dramatically change a person's appearance, but outcomes are rarely measured from the patient perspective. The patient perspective could be measured using an eye-specific patient-reported outcome measure. Objective To describe the development and psychometric evaluation of FACE-Q scales and an adverse effect checklist designed to measure outcomes following cosmetic eye treatments. Design, Setting, and Participants Pretreatment and posttreatment patients 18 years and older who had undergone facial aesthetic procedures were recruited from plastic surgery clinics in United States and Canada and completed FACE-Q scales between June 6, 2010, and July 14, 2014. We used Rasch Measurement Theory, a modern psychometric approach, to refine the scales and to examine psychometric properties. Main Outcomes and Measures The FACE-Q Eye Module, which has 4 scales that measure appearance of the eyes, upper and lower eyelids, and eyelashes. Scale scores range from 0 (worst) to 100 (best). The module also includes a checklist measuring postblepharoplasty adverse effects. Results Overall, 233 patients (81% response rate) 18 years and older participated. Adverse effects included being bothered by eyelid scars, dry eyes, and eye irritation. In Rasch Measurement Theory analysis, each scale's items had ordered thresholds and good item fit. Person Separation Index and Cronbach α were greater than or equal to 0.83. Higher scores on the eye scales correlated with fewer adverse effects (range, -0.26 to -0.36). In the pretreatment group, older age correlated with lower scores (range, -0.42 to -0.51) on the scales measure appearance of the eyes and upper and lower eyelids. Compared with the pretreatment group, posttreatment participants reported significantly better scores on the scales measuring appearance of eyes overall, as well as upper and lower eyelids. Conclusions and Relevance The FACE-Q Eye Module can be used in clinical practice, research and quality improvement to collect evidence-based outcomes data. Level of Evidence NA.
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Affiliation(s)
| | - Stefan J Cano
- Can to Modus Outcomes, Letchworth Garden City, England
| | | | | | - Jean Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada
| | - Alastair Carruthers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Nancy Van Laeken
- Division of Plastic Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Andrea L Pusic
- Memorial Sloan Kettering Cancer Center, New York, New York
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Gilmartin J, Bath-Hextall F, Maclean J, Stanton W, Soldin M. Quality of life among adults following bariatric and body contouring surgery. ACTA ACUST UNITED AC 2016; 14:240-270. [DOI: 10.11124/jbisrir-2016-003182] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Poulsen L, Rose M, Klassen A, Roessler KK, Sørensen JA. Danish translation and linguistic validation of the BODY-Q: a description of the process. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016; 40:29-38. [PMID: 28179749 PMCID: PMC5258793 DOI: 10.1007/s00238-016-1247-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/20/2016] [Indexed: 11/28/2022]
Abstract
Background Patient-reported outcome (PRO) instruments are increasingly being included in research and clinical practice to assess the patient point of view. Bariatric and body contouring surgery has the potential to improve or restore a patient’s body image and health-related quality of life (HR-QOL). A new PRO instrument, called the BODY-Q, has recently been developed specifically for this patient group. The aim of the current study was to translate and perform a linguistic validation of the BODY-Q for use in Danish bariatric and body contouring patients. Methods The translation was performed in accordance with the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) and the World Health Organization (WHO) recommendations. Main steps taken included forward and backward translations, an expert panel meeting, and cognitive patient interviews. All translators aimed to conduct a conceptual translation rather than a literal translation and used a simple and clear formulation to create a translation understandable for all patients. Results The linguistic translation process led to a conceptually equivalent Danish version of the BODY-Q. The comparison between the back translation of the first Danish version and the original English version of the BODY-Q identified 18 items or instructions requiring re-translation. The expert panel helped to identify and resolve inadequate expressions and concepts of the translation. The panel identified 31 items or instructions that needed to be changed, while the cognitive interviews led to seven major revisions. Conclusions The impact of weight loss methods such as bariatric surgery and body contouring surgery on patients’ HR-QOL would benefit from input from the patient perspective. A thorough translation and linguistic validation must be considered an essential step when implementing a PRO instrument to another language and/or culture. A combination of the ISPOR and WHO guidelines contributed to a straightforward and thorough translation methodology well suited for a Danish translation of the BODY-Q. The described method of translation and linguistic validation can be recommended for future translations of PRO instruments in the field of plastic surgery. Level of Evidence: Not ratable.
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Affiliation(s)
- Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Michael Rose
- Department of Plastic Surgery, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | | | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self-Report Scales to Measure Expectations and Appearance-Related Psychosocial Distress in Patients Seeking Cosmetic Treatments. Aesthet Surg J 2016; 36:1068-78. [PMID: 27222106 PMCID: PMC5029370 DOI: 10.1093/asj/sjw078] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The use of screening scales in cosmetic practices may help to identify patients who require education to modify inappropriate expectations and/or psychological support. OBJECTIVES To describe the development and validation of scales that measure expectations (about how one's appearance and quality of life might change with cosmetic treatments) and appearance-related psychosocial distress. METHODS The scales were field-tested in patients 18 years and older seeking facial aesthetic or body contouring treatments. Recruitment took place in clinics in the United States, United Kingdom, and Canada between February 2010 and January 2015. Rasch Measurement Theory (RMT) analysis was used for psychometric evaluation. Scale scores range from 0 to 100; higher scores indicate more inappropriate expectations and higher psychosocial distress. RESULTS Facial aesthetic (n = 279) and body contouring (n = 90) patients participated (97% response). In the RMT analysis, all items had ordered thresholds and acceptable item fit. Person Separation Index and Cronbach alpha values were 0.88 and 0.92 for the Expectation scale, and 0.81 and 0.89 for the Psychosocial Distress scale respectively. Higher expectation correlated with higher psychosocial distress (R = 0.40, P < .001). In the facial aesthetic group, lower scores on the FACE-Q Satisfaction with Appearance scale correlated with higher expectations (R = -0.27, P = .001) and psychosocial distress (R = -0.52, P < .001). In the body contouring group, lower scores on the BODY-Q Satisfaction with Body scale correlated with higher psychosocial distress (R = -0.31, P = .003). Type of treatment and marital status were associated with scale scores in multivariate models. CONCLUSIONS Future research could examine convergent and predictive validity. As research data are accumulated, norms and interpretation guidelines will be established. LEVEL OF EVIDENCE 2 Risk.
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Affiliation(s)
- Anne F Klassen
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Stefan J Cano
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Amy Alderman
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Charles East
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lydia Badia
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Stephen B Baker
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Sam Robson
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andrea L Pusic
- Dr Klassen is an Associate Professor, Department of Pediatrics, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Dr Cano is the Chief Scientific Officer of Modus Outcomes, Boston, MA. Dr Alderman is a plastic surgeon in private practice in Alpharetta, GA. Mr East is a Facial Plastic Surgeon in the Craniofacial Service, University College London Hospitals, and an Honorary Senior Lecturer, University College London Hospitals, London, UK. Ms Badia is a facial plastic surgeon in private practice in London, UK. Dr Baker is a Professor and Program Director, Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC. Dr Robson is a physician in private practice in Aberdeen, Scotland. Dr Pusic is a Plastic Surgeon and Associate Professor, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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FACE-Q Satisfaction with Appearance Scores from Close to 1000 Facial Aesthetic Patients. Plast Reconstr Surg 2016; 137:651e-652e. [PMID: 26910721 DOI: 10.1097/01.prs.0000480007.03293.ed] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patient Expectations of Bariatric and Body Contouring Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e694. [PMID: 27200256 PMCID: PMC4859253 DOI: 10.1097/gox.0000000000000677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/23/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patient expectations are important in bariatric and body contouring surgery because the goals include improvements in health-related quality of life, appearance, and body image. The aim of this study was to identify patient expectations along the weight loss journey and/or body contouring surgery. METHODS This qualitative study took an interpretive description approach. Between September 2009 and February 2012, 49 patients were interviewed postbody contouring surgery. Data were analyzed using a line-by-line approach whereby expectations were identified and labeled as expected, unexpected, or neutral. Constant comparison was used to ensure coding was done consistently. Interviews continued until no new themes emerged. RESULTS Participants described expectations according to appearance, health-related quality of life, and patient experience of care. Two areas stood out in terms of unmet expectations and included appearance and physical health, ie, recovery from body contouring surgery. Most participants, who underwent bariatric surgery, expected neither the extent of excess skin after weight loss nor how the excess skin would make them look and feel. For recovery, participants did not expect that it would be as long or as hard as it was in reality. CONCLUSIONS A full understanding of outcomes and expectations for this patient population is needed to enhance patient education and improve shared medical decision making. Education materials should be informed by the collection of evidence-based patient-reported outcome information using measures such as the BODY-Q. A patient-reported outcome scale measuring patient expectations is needed for obese and bariatric patients.
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The BODY-Q: A Patient-Reported Outcome Instrument for Weight Loss and Body Contouring Treatments. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e679. [PMID: 27200241 PMCID: PMC4859238 DOI: 10.1097/gox.0000000000000665] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/16/2016] [Indexed: 01/28/2023]
Abstract
Background: Body contouring performed for cosmetic purposes, or after weight loss, has the potential to improve body image and health-related quality of life (HRQL). The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the psychometric properties of the BODY-Q scales after an international field-test. Methods: Weight loss and body contouring patients from Canada, United States, and United Kingdom were recruited between November 2013 and February 2015. Data were collected using an iPad directly into a web-based application or a questionnaire booklet. Rasch measurement theory analysis was used for item reduction and to examine reliability, validity, and ability to detect change. Results: The sample included 403 weight loss and 331 body contouring patients. Most BODY-Q items had ordered thresholds (134/138) and good item fit. Scale reliability was acceptable, ie, Person separation index >0.70 for 16 scales, Cronbach α ≥0.90 for 18 of 18 scales, and Test–retest ≥0.87 for 17 of 18 scales. Appearance and HRQL scores were lower in participants with more obesity-related symptoms, higher body mass index, and more excess skin and in those pre- versus postoperative body contouring. The 134 weight loss patients who completed the BODY-Q twice, either 6 weeks (weight loss/nonsurgical body contouring program) or 6 months (bariatric program) later, improved significantly on 7 appearance and 4 HRQL scales. Conclusion: The BODY-Q is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes in patients who undergo weight loss and/or body contouring.
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Guerra S. C, Yáñez M. R. ACTUALIZACIÓN EN CONTORNO CORPORAL POSBARIÁTRICO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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