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Postoperative recovery in daysurgery: Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2010 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.

Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.

Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.

Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.

Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 40 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 112
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-59515ISBN: 978-91-7393-359-9 (print)OAI: oai:DiVA.org:liu-59515DiVA: diva2:351980
Presentation
2010-09-28, Linden, ingång 65, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Supervisors
Available from: 2010-09-17 Created: 2010-09-17 Last updated: 2010-09-17Bibliographically approved
List of papers
1. Psychometric evaluation of the post-discharge surgical recovery scale
Open this publication in new window or tab >>Psychometric evaluation of the post-discharge surgical recovery scale
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2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 4, 794-801 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objectives Day surgery patients are discharged after a short period of postoperative surveillance, and reliable and valid instruments for assessment at home are needed. The aim of this study was to evaluate the psychometric properties of a Swedish version of the post-discharge surgical recovery (PSR) scale, an instrument to monitor the patients recovery after day surgery, in terms of data quality, internal consistency, dimensionality and responsiveness. Methods Data were collected on postoperative days 1 and 14 and included 525 patients. Data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbachs alpha. The dimensionality of the scale was determined through an exploratory factor analysis. Responsiveness was evaluated using the standardized response mean and the area under the receiver operating characteristics curve (AUC). The correlation between change score in PSR and change score in self-rated health was assessed using Pearsons correlation coefficient. Patients ability to work and their self-rated health on postoperative day 14 were used as external indicators of change. Results Six items showed floor or ceiling effects. Cronbachs coefficient alpha was 0.90 and the average inter-item correlation coefficient was 0.44 after the deletion of two items. The items were closely related to each other, and a one-factor solution was decided on. A robust ability to detect changes in recovery (standardized response mean = 1.14) was shown. The AUC for the entire scale was 0.60. When initial PSR scores were categorized into three intervals, the ability to detect improved and non-improved patients varied (AUC 0.58-0.81). There was a strong correlation between change scores in PSR and health (0.63). Conclusions The Swedish version of the PSR scale demonstrates acceptable psychometric properties of data quality, internal consistency, dimensionality and responsiveness. In addition to previous findings, these results strengthen the PSR scale as a potential instrument of recovery at home.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2010
Keyword
day surgery; postoperative period; psychometrics; questionnaire; recovery; validation study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-58188 (URN)10.1111/j.1365-2753.2009.01197.x (DOI)000279901700019 ()
Note

This is the authors’ version of the following article: Katarina Berg, Ewa Idvall, Ulrica Nilsson, Kristofer Franzén Årestedt and Mitra Unosson, Psychometric evaluation of the post-discharge surgical recovery scale, 2010, Journal of Evaluation In Clinical Practice, (16), 4, 794-801. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2753.2009.01197.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html

Available from: 2010-08-11 Created: 2010-08-09 Last updated: 2017-12-12Bibliographically approved
2. Postoperativerecovery after different orthopaedic day surgical procedures
Open this publication in new window or tab >>Postoperativerecovery after different orthopaedic day surgical procedures
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Orthopaedic day surgery is common. Postoperative recovery may differ according to surgical procedures and personal factors. We studied postoperative recovery up to two weeks after different orthopaedic day surgical procedures, and tried to identify possible predictors associated with recovery. Three-hundred and fifty-eight patients who had undergone knee arthroscopy or surgery on the hand/arm, foot/leg or shoulder were included. Data were collected preoperatively and on postoperative days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale, the emotional state, physical comfort and physical independence dimensions in the Quality of Recovery-23, and a general health question. A multiple linear regression was used to explore predictors of recovery. The shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery compared to the other patient groups (p<0.001). Significant predictors of recovery were age, perceived health and emotional status on the first postoperative day, and type of surgery. Postoperative recovery after common orthopaedic day surgical procedures differs, and factors influencing it need to be further explored. The impact of a patient’s emotional state on recovery after day surgery can be of particular interest in this work. Post-discharge planning needs to be tailored to the surgical procedure.

Keyword
Day surgery, postoperative recovery, orthopaedic nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-59513 (URN)
Available from: 2010-09-17 Created: 2010-09-17 Last updated: 2010-09-17Bibliographically approved

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