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Postoperative recovery: development of a multi-dimensional questionnaire for assessment of Recovery
Örebro University, School of Health and Medical Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to present a multi-dimensional instrument for self-assessment of progress in postoperative recovery. The author employs different research paradigms and methodologies to achieve this aim.

Walker and Avant’s approach to concept analysis was used to examine the basic elements of postoperative recovery (Study I). The analysis identified different recovery dimensions and developed a theoretical definition showing postoperative recovery to be an energy-requiring process of returning to normality and wholeness, defined by comparative standards.

Fourteen patients and 28 staff members participated in individual and focus group interviews aimed at describing patient and staff experiences of patient recovery (Study II). The essence of the postoperative recovery process was described as a desire to decrease unpleasant physical symptoms, reach a level of emotional wellbeing, regain functions, and re-establish activities.

In Study III, 5 dimensions and 19 items were identified as a part of the operationalization process of the concept postoperative recovery. Fifteen staff members and 16 patients participated in the evaluation of content validity. On average, 85% of the participants considered the items as essential to the recovery process. In a test run of the questionnaire, 14 of 15 patients considered the questionnaire to be easy to understand and easy to complete. Twenty-five patients participated in the evaluation of intra-patient reliability. Percentage agreement (PA), systematic disagreement (RP, RC), and individual variability (RV) between the two assessments were calculated. PA measures ranged from 72% to 100%. The observed disagreement could be explained mainly by systematic disagreement.

In total, 158 patients participated in the evaluation of construct validity, the ability to discriminate between groups, and the investigation of important item variables (Study IV). A rank-based statistical method for evaluation of paired, ordered categorical data from rating scales was used to evaluate consistency between the assessments of the Postoperative Recovery Profile (PRP) questionnaire and a global recovery scale. The number of months needed by participants to be regarded as fully recovered was studied by means of recovery profiles displayed by the cumulative proportion of recovered participants over time. A ranking list based on the participant’s appraisal of the five most important item variables in the PRP questionnaire was compiled to illustrate the rank ordering of the items. In comparing the assessments from the PRP questionnaire and the global recovery scale, 7.6% of all possible pairs were disordered. Twelve months after discharge 73% in the orthopaedic group were regarded as fully recovered, compared to 51% of the participants in the abdominal group (95% CI: 6% to 40%). The pain variable appeared among the top five most important items on eight measurement occasions, of eight possible, in both study groups.

In conclusion, the PRP questionnaire was developed and support was given for validity and reliability. The questionnaire enables one to evaluate progress in postoperative recovery.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2009. , 73 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 32
Keyword [en]
Concept analysis, experiences, postoperative recovery, questionnaire, recovery profile, reliability, validity
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-7731ISBN: 978-91-7668-678-2 (print)OAI: oai:DiVA.org:oru-7731DiVA: diva2:232690
Public defence
2009-09-25, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-08-25 Created: 2009-08-25 Last updated: 2011-05-03Bibliographically approved
List of papers
1. Postoperative recovery: a concept analysis
Open this publication in new window or tab >>Postoperative recovery: a concept analysis
2007 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 57, no 5, 552-558 p.Article in journal (Refereed) Published
Abstract [en]

Aim. This papaer presents a concept analysis of the phenomeneon postoperative recovery.

Background. Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition.

Method. Walker and Avant´s concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for english language papers published from 1982 to 2005 was used for the analysis.

Findings. The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependence in activities of daily living and optimum level of psychological well-being.

Conclusion. The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.

Place, publisher, year, edition, pages
Oxford: Blackwell, 2007
Keyword
concept analysis, definition, postoperative, recovery
National Category
Surgery Nursing
Research subject
Surgery; Nursing Science
Identifiers
urn:nbn:se:oru:diva-8079 (URN)10.1111/j.1365-2648.2006.04156.x (DOI)000244244000010 ()17284272 (PubMedID)2-s2.0-33846991897 (Scopus ID)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2016-08-10Bibliographically approved
2. Experiences of the postoperative recovery process: an interview study
Open this publication in new window or tab >>Experiences of the postoperative recovery process: an interview study
2008 (English)In: The open nursing journal, ISSN 1874-4346, Vol. 2, 1-7 p.Article in journal (Refereed) Published
Abstract [en]

Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.

Place, publisher, year, edition, pages
Bentham Science Publishers Ltd, 2008
Keyword
postoperative, recovery, experience, interview, content analysis
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8080 (URN)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2011-05-03Bibliographically approved
3. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
Open this publication in new window or tab >>Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
Show others...
2009 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 3, 411-419 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability.   The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery.

Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients´ postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment.

Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability.

Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing Ltd, 2009
National Category
Surgery Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8081 (URN)10.1111/j.1365-2753.2008.01027.x (DOI)000266425900002 ()
Note
Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7731Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2015-01-19Bibliographically approved
4. The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
Open this publication in new window or tab >>The Postoperative Recovery Profile (PRP): a multidimensional questionnaire for evaluation of recovery profiles
Show others...
2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 2, 236-243 p.Article in journal (Refereed) Published
Abstract [en]

Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated.

Methods. Postoperative recovery was assessed during the period from discharge to 12 months after lower abdominal- and orthopedic surgery. Construct validity was evaluated by comparing the assessments from the PRP-questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering.

Results. A total of 158 patients were included. The result showed that 7.6 % of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge 51 % participants in the abdominal group were fully recovered, as compared with the 73%, in the orthopedic group (95% CI: 6 % to 40 %). The item variable pain appeared as top five at eight measurement occasions of eight possible in both the abdominal and the orthopedic groups. The importance of the items was emphasized.

Conclusions. The PRP questionnaire allows for evaluation of the progress of postoperative recovery, and can be useful to assess patient-reported recovery after surgical treatment. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-8083 (URN)10.1111/j.1365-2753.2010.01422.x (DOI)000288217700005 ()20846316 (PubMedID)2-s2.0-79952668667 (Scopus ID)
Available from: 2009-10-05 Created: 2009-10-05 Last updated: 2017-02-10

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