Insights From the Child's Perspective-Validation of the English Version of the Pictorial Version of the Quality of Recovery-15 Questionnaire

IntroductionPatient-reported outcome measures play a key role in efforts to improve the quality and safety of perioperative care. There are no English-language tools to allow children to directly contribute to these efforts. The primary aim of this study was to examine the validity, reliability, acceptability, and feasibility of the use of an English version of the pictorial Quality of Recovery-15 (QoR-15) questionnaire in the context of routine pediatric care.MethodsA prospective observational study was performed including children aged 5-17 years presenting for care at Stony Brook University Hospital. Participants completed the adapted pictorial QoR-15, a VAS pain scoring, and a satisfaction survey before surgery and on Postoperative Day 1. Statistical methods were similar to prior studies that assessed the properties of the QoR-15. Tests were employed to confirm the validity, reliability, and responsiveness of the questionnaire.ResultsA total of 253 children conormpleted testing. Mean (SD) preoperative and postoperative QOR-15 scores were 131.9 (+/- 15.4) and 125.7 (+/- 26.4), respectively. Of note, QoR-15 scores could range from a total of 0 to 150. Each question was internally consistent and correlated well with the total QoR-15 score. Construct validity tests demonstrated that the tool was able to differentiate between known determinants of poor recovery, including the duration of surgery (Spearman's Rho = -0.35 [CI = -0.45, -0.23]) and length of recovery unit admission (Spearman's Rho = -0.37 [CI = -0.47, -0.25]). Lower average postoperative QoR-15 scores were recorded in the context of higher levels of postoperative pain, defined by a VAS >= 7, confirming discriminative validity. The instrument demonstrated excellent internal consistency, with a Cronbach's raw alpha of 0.92, and a split-half coefficient of 0.85. These results were consistent across a variety of ages.ResultsA total of 253 children conormpleted testing. Mean (SD) preoperative and postoperative QOR-15 scores were 131.9 (+/- 15.4) and 125.7 (+/- 26.4), respectively. Of note, QoR-15 scores could range from a total of 0 to 150. Each question was internally consistent and correlated well with the total QoR-15 score. Construct validity tests demonstrated that the tool was able to differentiate between known determinants of poor recovery, including the duration of surgery (Spearman's Rho = -0.35 [CI = -0.45, -0.23]) and length of recovery unit admission (Spearman's Rho = -0.37 [CI = -0.47, -0.25]). Lower average postoperative QoR-15 scores were recorded in the context of higher levels of postoperative pain, defined by a VAS >= 7, confirming discriminative validity. The instrument demonstrated excellent internal consistency, with a Cronbach's raw alpha of 0.92, and a split-half coefficient of 0.85. These results were consistent across a variety of ages.SummaryOur data suggest that the English-language pictorial QoR-15 has good reliability, acceptability, and responsiveness. This suggests that the tool may allow children to contribute to efforts to both improve and better understand pediatric perioperative care.Clinical ImplicationsThere is no existing English-language tool to allow children to describe the quality of their perioperative experience. This is a key gap in efforts to both understand and improve pediatric care.New Information Added by This StudyThis study demonstrates the validity, reliability, acceptability, and feasibility for the use of an English pictorial Quality of Recovery questionnaire.