Validação da versão brasileira do questionário Quality of Recovery - 40 Items

Effect of anesthetic technique on the quality of anesthesia recovery for abdominal histerectomy: a cross-observational study

Introduction

Spinal anesthesia combined with sedation and general anesthesia combined with epidural are two techniques often used for patients undergoing abdominal hysterectomy. There is no consensus that one of these techniques is superior regarding the perception of patients towards the quality of postoperative recovery. This observational cross-sectional study aimed to assess the quality of postoperative recovery in women undergoing open abdominal hysterectomy by comparing both anesthetic techniques.

Method

We recruited 162 women aged between 30 and 74 years to be submitted to abdominal hysterectomy. The anesthetic technique used followed the preference of the attending anesthesiologist without interference of the investigators. After applying the exclusion criteria, 80 patients underwent spinal anesthesia combined with sedation (Group 1) and 62 women underwent epidural anesthesia combined with general anesthesia (Group 2). The quality of postoperative recovery was evaluated using the questionnaire Quality of Recovery-40 (QoR-40) completed 24 hours after the end of the surgery.

Results

Eighty patients in Group 1 answered the QoR-40 questionnaire with an average rating of 179.4 points, median of 186.5, standard deviation of 17.4 and a confidence interval of 3.8. The 60 patients in Group 2 answered the QoR-40 with an average of 174.9 points, median of 178 points, standard deviation of 16 points and a confidence interval of 4.0 (p = 0.024).

Conclusion

Women who received spinal anesthesia combined with sedation considered quality of postoperative recovery better.

DISABKIDS® in Brazil: advances and future perspectives for the production of scientific knowledge

Objective:

to map the Brazilian scientific production related to the stages of the methodological process for the use of DISABKIDS^® instruments and/or forms adapted to Brazil.

Method:

scoping review, with searches conducted on10 electronic databases, plus Google Scholar and contacts with researchers, without restriction of period or language.

Results:

the mapping identified 90 scientific studies involving 46 instruments. Of these, 11 (23.9%) included the elaboration and/or cultural adaptation of the DISABKIDS^® instruments to measure the Quality of Life of children or adolescents with chronic conditions and 35 (76.1%) used the Generic Measures and/or Specific Modules for the semantic validation of other instruments.

Conclusion:

this scoping review allowed a comprehensive evaluation of the use of the DISABKIDS^® instrument and forms, in relation to the validation of the instrument adapted to Brazil, presenting a positive advance in the scenario with the development of academic/scientific projects in the country, incorporating the method recommended by the literature for the elaboration, cultural adaptation and validation of instruments and for the systematized and standardized recording of the perception and understanding of the target population about the measure of interest, using DISABKIDS^® forms adapted for this purpose.

General anesthesia technique and perception of quality of postoperative recovery in women undergoing cholecystectomy: A randomized, double-blinded clinical trial

Background

The two most common general anesthesia techniques are total intravenous anesthesia (TIVA) and venous/inhalation balanced general anesthesia (BGA). It is unclear whether any of these two techniques affect patient perception of the quality of recovery. The aim of this randomized, double-blinded clinical trial was to assess the quality of postoperative recovery of women undergoing laparoscopic cholecystectomy under general anesthesia. We compared patients who received TIVA with those who received BGA. We also evaluated the factors that may decrease patient-perceived quality of postoperative recovery.

Methods

We prospectively recruited 121 women aged 18–65 years who were scheduled for elective laparoscopic cholecystectomy due to cholelithiasis. These patients were randomized to receive TIVA (target-controlled infusion of propofol and remifentanil) or BGA (continuous remifentanil infusion and sevoflurane inhalation). To measure the quality of postanesthetic and postoperative recovery, we administered the Quality of Recovery-40 (QoR-40) questionnaire 24 hours after the patient awoke from anesthesia.

Results

All 60 patients in the TIVA group responded to QoR-40 (median, 188 points; minimum 128; maximum 200). Sixty-one patients in the BGA group had a mean QoR-40 score of 186 points (median, 188 points; minimum 146; maximum 200). There was no significant difference in the QoR-40 score between the two groups (p = 0.577). The patients who presented postoperative nausea and vomiting (PONV) and pain had worse perception of the quality of postoperative recovery.

Conclusions

Both TIVA and BGA had a similar effect on the perception of the quality of postoperative recovery in women undergoing elective laparoscopic cholecystectomy. PONV and pain may negatively affect patient perception of the quality of postoperative recovery.

PSYCHOMETRIC PROPERTIES OF MEASUREMENT INSTRUMENTS: CONCEPTUAL BASIS AND EVALUATION METHODS - PART II

ABSTRACT Objective: to present and discuss conceptual bases and methods for evaluating the content, construct and criterion validity of self-reported measuring instruments. Method: theoretical study based on the concepts of the Consensus-based Standards for the Selection of Health Measurement Instruments and those evaluated in the Evaluating the Measurement of Patient-Reported Outcomes, which includes concepts of instrument assessment to assess patient-reported outcomes. Results: validity is significant for the methodological quality of an instrument; however, it is a relative criterion, since it depends on the adequacy of the instrument to be measured. There are three different validity measurement properties described in the literature: content, construct and criterion validity. Conclusions: as validity is an important property, it is recommended that it be verified in studies that aimed to develop new scales and in those that adapted and validated for another culture or population.

Validity and reliability of the Korean version of the Quality of Recovery-40 questionnaire

BACKGROUND

The Quality of Recovery-40 (QoR-40) is a widely-used, self-rated, and self-completed questionnaire for postoperative patients. The questionnaire is intended to elicit information from each patient regarding the quality of recovery during the postoperative period. It is noteworthy, however, that an official Korean version of the QoR-40 (QoR-40K) has not been established. The purpose of this study was to develop the QoR-40K by translation and cultural adaptation process and to evaluate the validity and reliability of the QoR-40K.

METHODS

After pre-authorization from the original author of the QoR-40, the translation procedure was established and carried out based upon Beaton's recommendation to create a QoR-40K model comparable to the original English QoR-40. Two hundred surgical patients were enrolled, and each completed the questionnaire during the preoperative period, on the third day, and 1 month after surgery. The QoR-40K was compared with the visual analogue scale (VAS) and another health-related questionnaire, the Short-form Health Survery-36 (SF-36). The method of validation for QoR-40K included test-retest reliability, internal consistency, and level of responsiveness.

RESULTS

Spearman's correlation coefficient for test-retest reliability was 0.895 (P < 0.001), and Cronbach's alpha of the global QoR-40K on the third day after surgery was 0.956. A positive correlation was obtained between the QoR-40K and the mental component summary of SF-36 (ρ = 0.474, P < 0.001), and a negative correlation was observed between QoR-40K and VAS (ρ = -0.341, P < 0.001). The standardized responsive mean of the total QoR-40K was 0.71.

CONCLUSIONS

The QoR-40K was found to be as acceptable and reliable as the original English QoR-40 for Korean patients after surgery, despite the apparent differences in the respective patients' cultural backgrounds.

PROPRIEDADES PSICOMÉTRICAS DE INSTRUMENTOS DE MEDIDAS: BASES CONCEITUAIS E MÉTODOS DE AVALIAÇÃO - PARTE I

RESUMO Objetivo: apresentar e discutir bases conceituais e métodos de avaliações que fundamentam importantes propriedades de instrumentos de medidas. Método: estudo teórico embasado na literatura internacional e nacional e nos instrumentos Consensus-based Standards for the selection of health Measurement Instruments e Evaluating the Measurement of Patient-Reported Outcomes que contemplam conceitos de avaliação de instrumentos para apreciação de resultados relatados pelo paciente. Inicialmente são apresentados e discutidos os conceitos de confiabilidade, responsividade e interpretabilidade, citados exemplos das principais formas de avaliação dessas propriedades. Resultados: pode-se perceber que ainda há divergências em algumas descrições conceituais. Entretanto, os autores ressaltam a importância da confiabilidade para avaliar o instrumento de medida. Destaca-se a importância do conhecimento do Modelo Conceitual, das propriedades de medidas e dos diferentes métodos de avaliação para garantir, principalmente em estudo de validação de instrumentos, resultados confiáveis e válidos. Conclusões: a discussão apresentada sobre a confiabilidade, responsividade e interpretabilidade contribui para os profissionais de saúde no conhecimento teórico e senso crítico na escolha de instrumentos e na condução de análises sobre essas propriedades de medida.

Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study

Objective:

to assess the factors associated with the risk of fall in patients undergoing surgical procedures.

Method:

quantitative and cross-sectional study carried out with 257 adult patients in a hospital in the state of Minas Gerais, Brazil. Data were collected using the sociodemographic and clinical questionnaire, the Morse Fall Scale, and the Quality of Recovery Score. Data were submitted to descriptive statistical analysis and multinomial logistic regression. The level of significance was set at 0.05.

Results:

35.4% of patients had high risk of falls, 38.9% had moderate risk and 25.7% had low risk. The mean value in the surgical recovery scale was 175.37 points and no patient presented poor surgical recovery. Regarding the results of the bivariate analysis, it was found that age (p<0.001), SAH (p<0.001) and diabetes (p=0.017) were positively associated with high risk of fall, whereas cancer (p=0.004) was positively associated with moderate risk of fall. Surgical recovery (p=0,008) was inversely associated with high risk of fall.

Conclusion:

the results of this study allowed the identification of five factors associated with the risk of fall in adults in the postoperative hospital stay. These findings may support the planning of nursing actions aimed at preventing the risk of fall in the postoperative period.