Evaluation of Domains of Patient-Reported Outcome Measures for Recovery After Childbirth

Abstract

IMPORTANCE Despite the global delivery rate being approximately 259 deliveries per minute in 2018, postpartum recovery remains poorly defined. OBJECTIVES To identify validated patient-reported outcome measures (PROMs) used to assess outpatient and inpatient postpartum recovery, evaluate frequency of PROM use, report the proportion of identified PROMs used within each recovery domain, report the number of published studies within each recovery domain, summarize descriptive data (country of origin, year of study, and journal specialty) for published studies using PROMs to evaluate postpartum recovery, and report PROMs used to evaluate global postpartum recovery. EVIDENCE REVIEW This study followed PRISMA-ScR guidelines. A literature search of 4 databases (MEDLINE through PubMed, Embase, Web of Science, and CINAHL) was performed on July 1, 2019, to identify PROMs used to evaluate 12 author-defined domains of postpartum recovery. All psychometrically evaluated PROMs used to evaluate inpatient or outpatient postpartum recovery after all delivery modes were included. FINDINGS From 8008 screened titles and abstracts, 573 studies (515 outpatient and 58 inpatient) were identified in this review. A total of 201 PROMs were used to assess recovery for outpatient studies and 73 PROMs were used to assess recovery for inpatient studies. The top 5 domains (with highest to lowest numbers of PROMs) used to assess outpatient recovery were psychosocial distress (77 PROMs), surgical complications (26 PROMs), psychosocial support (27 PROMs), motherhood experience (16 PROMs), and sexual function (13 PROMs). Among inpatient studies, the top 5 domains were psychosocial distress (32 PROMs), motherhood experience (7 PROMs), psychosocial support (5 PROMs), fatigue (5 PROMs), and cognition (3 PROMs). The 3 most frequently used PROMs were the Edinburgh Postnatal Depression Scale (267 studies), Short-Form 36 Health Questionnaire (global recovery assessment; 40 studies), and Female Sexual Function Index (35 studies). A total of 24 global recovery PROMs were identified among all included studies. Most studies were undertaken in the United States within the last decade and were published in psychiatry and obstetrics and gynecology journals. CONCLUSIONS AND RELEVANCE Most PROMs identified in this review evaluated a single domain of recovery. Future research should focus on determining the psychometric properties of individual and global recovery PROMs identified in this review to provide recommendations regarding optimum measures of postpartum recovery.

Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study

“…Although the ObsQoR-10 seems to be a valid and reliable patient-reported outcome measure to assess inpatient recovery up to 72 hours after delivery, there remains no consensus regarding which patient-reported outcome measure (or measures) should be used to measure global postpartum recovery in the outpatient setting. 5 Future work should focus on defining outpatient postpartum recovery and how best to assess it. The relationship of the ObsQoR-10 scores during the first 72 hours after delivery with longer-term outcomes of patient morbidity, such as requirement for maternal readmission or delayed recovery at the 6-week postpartum follow-up visit, is also unknown and warrants further study.…”

“…Original Research and surgical complications. 5 We elected to test structural validity of the ObsQoR-10 by evaluating the correlation with the EQ-5D-3L and global health VAS scores, which we acknowledge were not developed or designed for use in postpartum patients. However, these patientreported outcome measures are quick and easy to use and have been extensively validated in 170 different languages as a measure of global health state.…”

“…4 A recent scoping and systematic review identified only 3 patient-reported outcome measures, Original Research which have specifically been developed to evaluate aspects of inpatient postpartum recovery. 5 Of these instruments, Obstetric Quality of Recovery-11 (ObsQoR-11) has been recommended as the best performing patient-reported outcome measure available to quantitatively assess functional recovery at day 1 following cesarean delivery. 6 Since the recommendation, ObsQoR-11 (which contains 11 questions scored between 0 and 10) has been amended to a 10item version (ObsQoR-10), in response to patient feedback regarding 2 questions related to moderate and severe pain, which were subsequently combined into a single question.…”

Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery

“… 4 , 5 , 6 Despite this, for most women, the 6-week postpartum appointment remains the only contact with the health care system following childbirth. Although outpatient postpartum recovery domains (aspects or dimensions constituting postpartum recovery) have been proposed (physical function, pain, psychosocial distress, surgical or medical factors, infant health, appearance or cosmetic factors, feeding or breast health, psychosocial support, motherhood experience, sleep, fatigue, cognition, and sexual function), 7 limited guidance is available to clinicians regarding how to best assess postpartum recovery.…”

Deconstructing Current Postpartum Recovery Research—The Need to Contextualize Patient-Reported Outcome Measures

“…domains of inpatient and outpatient postpartum recovery assessed in PROMs have so far included (1) general physical recovery, (2) medical or surgical factors (including complications such as genitourinary or gynecological and fecal incontinence), (3) anesthesia-related adverse events, (4) comfort and satisfaction, (5) pain, (6) psychosocial distress (including depression, anxiety, and other psychological morbidity), (7) psychosocial and patient support, (8) sleep, (9) fatigue, (10) motherhood experience (including adapting to the maternal role and motherhood experience), (11) sexual function, (12) feeding and breast health, (13) cognition, (14) appearance and cosmetic factors, and (15) infant health.…”