A Human Volunteer Study to Identify Variability in Performance in the Cognitive Domain of the Postoperative Quality of Recovery Scale

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. This study aimed to examine variability in cognitive performance in volunteers. Methods: One hundred forty-three volunteers completed the cognitive domain questions at baseline, after 15 min and 40 min, and on days 1 and 3. Delivery via face-to-face interview was conducted for the first three measurements, and then randomized for day 1 and 3 measurements (faceto-face only, telephone only, telephone then face-to-face, face-to-face then telephone). Permanent repository linkResults: All volunteers answered orientation correctly. Mean change scores for other tests were positive, indicating a modest learning effect. There were no significant differences between methods of delivery (all P > 0.05). Due to variability in volunteers' performances, the authors propose a new scoring system to introduce a tolerance factor in scoring cognitive recovery. The proposed revised change from baseline scores are: orientation 0 or higher, digits forward −2 or higher, digits back −1 or higher, word recall −3 or higher, and word generation −3 or higher. This resulted in approximately 95% volunteers classed as "recovered" for each test item, and recovery for the domains ranged from 82.6 to 89.1%. The initial feasibility study was reanalyzed and cognitive recovery increased at all assessment times. At 3 days, cognitive recovery was found to increase from 33.5 to 86.4%. Conclusion:The authors recommend adoption of the new method for scoring cognitive recovery in the Postoperative Quality of Recovery Scale. Telephone or face-to-face delivery was equivalent and either method can be reliably applied. What We Already Know about This Topic• The Postoperative Quality of Recovery Scale, published in AneSTheSiology in 2010, found lower than anticipated recovery in the cognitive domain.• one hundred forty-three volunteers completed the Postoperative Quality of Recovery Scale cognitive domain questions at baseline, 15 min, 40 min, and 1 and 3 days. Delivery was faceto-face for the first three measurements, and then randomized for day 1 and 3 measurements to combinations of face-toface and telephone interviews. What This Article Tells Us That Is New• The investigators propose a new scoring system that includes performance tolerance such that more than 80% of subjects are considered recovered in the cognitive domain at 3 days. • There were no important differences between methods of delivery; telephone administration of Postoperative Quality of Recovery Scale is, thus, valid.

Recovery after nasal surgery vs. tonsillectomy: discriminant validation of the Postoperative Quality of Recovery Scale

“…These patients were excluded from the cognitive domain and alldomains analysis but were included for other recovery domains. In keeping with the PQRS human volunteer cognitive validation study, 8 a group recovery exceeding 80% in the cognitive domain is considered to represent 'good recovery' for the group.…”

“…7 For the cognitive domain, a tolerance factor is introduced to allow for normal performance variability. 8 This means, that patients are allowed to be 'a little worse' then baseline and still score as recovered. Specifically, recovery is defined for each question in the cognitive domain according to the change scores (post-operative value minus baseline value): orientation ≥ 0, digits forward ≥ −2, digits back ≥ −1, word recall ≥ −3 and word generation ≥ −3.…”

“…Data collection was performed via face-to-face interview during the hospital admission and via telephone interview after hospital discharge by a researcher trained in using the PQRS. 8 Minors were interviewed in the presence of a parent. The patients were all managed by the same anaesthesiologist and surgeon.…”

“…For the cognitive domain, a tolerance factor is included to account for normal variability in performance on cognitive tests. 8 The scale is designed for repeated measurements over time and includes parallel forms for cognitive testing to reduce the effect of learning on performance.…”

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

“…20 Delayed physical recovery is present in up to 60% and 50% of patients at three and six months, respectively. 21,22 Cognitive recovery can be delayed at postoperative day 3 in 14% of the general population 23 and can persist, especially in the elderly population. 24 Cognitive and non-cognitive recovery are also intertwined, with failure of recovery in one being predictive of suboptimal recovery in the other.…”