Behavioural changes after anaesthesia: Validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population

Abstract

Aim: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. Methods: The PHBQ was translated using a back-translation method. The subjects were 340 children, ages 2 Á/13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p /0.09 for all factors). Results: Five factors emerged as being most consistent: general anxiety-withdrawal, eating disturbances, separation anxiety, regressionaggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75 Á/0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.0469/0.018 vs (/0.00899/0.014, p B/0.001). There were no gender differences. Conclusion:The results support a conclusion that a five-factor model better fits data from Swedish children than the original six-factor model.

Are postoperative behavioural changes after adenotonsillectomy in children influenced by the type of anaesthesia?

“…Other studies have found higher rates of NPOBC after anaesthesia with sevoflurane than with other agents. 15,21 These results are also consistent with our study results, although, to our knowledge, no other study compared the number of NPOBCs between propofol and sevoflurane/nitrous oxide anaesthesia.…”

“…The possible answers were provided on a scale from 1 to 5 ('much less', 'less', 'unchanged', 'more' or 'much more' than before hospitalisation). 15 A score of 0 was awarded if no negative behaviour was reported either before or after surgery. Before data analysis, the original scores were grouped into two categories: negative change (scores of 4 or 5), or no change/positive change (scores of 0 to 3).…”

“…14 This consists of 27 items describing six subscales: general anxiety, separation anxiety, sleep anxiety, eating disturbances, aggression against authority and apathy/withdrawal. 15 The questionnaire is intended for measuring intraindividual changes of children's behaviour according to the subjective evaluation of their parents. For each subscale, the parents were asked to compare the child's current behaviour (at any time point after surgery) with his/her behaviour in the week before hospitalisation.…”

“…The general anxiety subscale consists of eight items (items 4, 5, 6, 8, 12, 13, 21 and 27), the separation anxiety subscale five items (items 9, 16, 17, 18 and 20), the anxiety about sleep subscale three items (items 1,19 and 22), the eating disturbance subscale three items (items 2, 3 and 24), aggression towards authority subscale two items (items 14 and 25) and the apathy/ withdrawal subscale six items (items 7, 10, 11, 15, 23 and 26). 15,17 Subscale scores were calculated by adding values of NPOBC on each of the items of a specific subscale. The internal consistency (Cronbach alpha) for the total score was 0.83.…”

“…20,30,34 We have not found consensus in the literature about the scoring system. 15,25 Different authors use different NPOBC cut-off points and the resulting NPOBC incidences vary. 25,34,41 Probably, additional validation and improvement of the original PHBQ is needed.…”