Revisiting a measure of child postoperative recovery: development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery

Abstract

Background The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children’s post-hospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method This study used principal components analysis, a panel of experts, Cronbach’s alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ-AS. The PHBQ-AS demonstrated good internal consistency reliability and concurrent validity with another measure of children’s psychosocial and physical functioning. Conclusion Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ-AS may provide a means for reducing the burden of post-operative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes.

An evaluation of preoperative anxiety in Spanish‐speaking and Latino children in the United States

“…The mYPAS‐SF consists of 18 items in 4 domains of behavior (activity, emotional expressivity, state of arousal, and vocalization). All mYPAS domains have good to excellent inter and intraobserver reliability using Kappa statistics (.73‐.91) and has good face validity . Total scores range from 23.3 to 100 with higher scores indicating a higher level of anxiety.…”

“…Total scores range from 23.3 to 100 with higher scores indicating a higher level of anxiety. Moreover, the mYPAS demonstrated strong criterion validity . The measure has been used extensively in studies in various fields including psychology, surgery, anesthesia, and dentistry, and has been used in over 12 different languages including Spanish, Danish, and Swedish and in 14 different countries including Spain, Israel, and Portugal.…”

Measuring behavioral and emotional changes in children following hospitalization: Limitations and future directions

“…It was advised that researchers score the measure by taking an average of the individual items. Notably, this version of the PHBQ still lacks meaningful clinical cutoff scores and is specifically designed for ambulatory surgeries …”

Intraoperative music application in children and adolescents – a pilot study

“…1,[5][6][7]10,13,22 Furthermore, previous overviews of behavioural changes in children after hospitalization have concluded that anaesthesia-related techniques, medication and events are not the only contributors to the overall experience of hospitalization. 1,[5][6][7]10,13,22 Furthermore, previous overviews of behavioural changes in children after hospitalization have concluded that anaesthesia-related techniques, medication and events are not the only contributors to the overall experience of hospitalization.…”

“…1,2 Maladaptive behaviour like night-time crying, separation anxiety, temper tantrums, enuresis, general anxiety or poor appetite have been described in up to 50% of paediatric patients after general anaesthesia. 1,2 Maladaptive behaviour like night-time crying, separation anxiety, temper tantrums, enuresis, general anxiety or poor appetite have been described in up to 50% of paediatric patients after general anaesthesia.…”