Validation of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Abstract

Background: Preoperative anxiety is an unpleasant state of tension that may impact patients' post-operative pain and satisfaction. The level of preoperative anxiety should be routinely identified. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-reported questionnaire that is used to quickly assess preoperative anxiety and information needs with good psychometric properties. Objectives: To validate the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to explore coping strategies used by patients in dealing with surgery and anesthetic. Methods: The cross-cultural validation of APAIS involved the translation of a Chinese version of APAIS and an investigation of its psychometric properties and clinical applicability. Forward-back translation and a pilot study were performed to produce a Chinese adaptation of APAIS. The inpatients of the orthopedic, otolaryngology, and general surgery department scheduled for general anesthesia surgery were enrolled to complete psychometric testing. The reliability was assessed using Cronbach's alpha. Exploratory factor analysis and confirmatory factor analysis were calculated to assess construct validity. The criteria validity was analyzed using the correlation between APAIS and State-trait anxiety inventory-state (STAI-S) and Visual analogue scale-anxiety (VAS-A). Coping styles were evaluated using the Medical Coping Modes Questionnaire (MCMQ) score that covered three domains: confrontation, avoidance, and resignation. The impact of different coping styles on patients' anxiety was explored. Results: A total of 204 valid questionnaires were collected the day before surgery. Cronbach's alpha coefficients were 0.862 for the anxiety scale and 0.830 for the information scale. Exploratory factor analysis with oblique rotation revealed two factors that explained 76.45% of the total variances. A confirmatory factor analysis showed a twofactor model with an adequate model fit (root mean square error of approximation: 0.073, goodness-of-fit: 0.966). The APAIS anxiety score significantly correlated with STAI-S (r = 0.717, P < 0.01) and VAS-A (r = 0.720, P < 0.01). For the three coping strategies, preoperative anxiety had a low correlation with confrontation (r = 0.33, P < 0.01) and resignation (r = 0.22, P < 0.05). Conclusions: The Chinese version of APAIS is a valid and reliable instrument for assessing preoperative anxiety. Use of this measurement tool for Chinese patients is feasible and shows promising results.

The Czech version of the Surgical Fear Questionnaire: measuring validity and reliability

“…All items are rated on a scale from 1 (not at all) to 5 (extremely). The APAIS has been translated into various languages -Chinese (Wu et al, 2020), Czech (Zeleníková et al, 2017), French (Maurice-Szamburski et al, 2013, German (Berth et al, 2007), Italian (Buonanno et al, 2017), Japanese (Nishimori et al, 2002), Malay (Mohd Fahmi et al, 2015), Spanish (Vergara-Romero et al, 2017), Turkish (Çetinkaya et al, 2019) and others. The Surgical Fear Questionnaire (SFQ) was published in 2014 (Theunissen et al, 2014).…”

Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) in Serbia

“…For example, this might be attributable to some cultural aspects regarding anxiety and fear in the Serbian population and ways of coping with those feelings. This is supported by the fact that the Serbian version is not only different from the original, but it also differs from the Malay (Mohd et al., 2015), Chinese (Wu et al., 2020), French (Maurice‐Szamburski et al., 2013), Japanese (Nishimori et al., 2002), and Italian (Buonanno et al., 2017) version as well. To the best of our knowledge, Greek validation study is the only study that showed an identical two‐factor structure of the translated and validated APAIS, with clearly separated anesthesia and procedure‐related subscales (Bakalaki et al., 2017).…”

“…The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was developed in 1996 by Moerman et al. (1996) and the original Dutch version has been translated and validated into many reliable versions in several languages (Maurice‐Szamburski et al., 2013; Mohd et al., 2015; Vergara‐Romero et al., 2017; Wu et al., 2020). Nowadays, APAIS has gained widespread use, since contemporary literature offers strong evidence of its validity and reliability (Aust et al., 2018).…”

Flexible cystoscopy can improve anxiety and subjective feelings of bladder cancer patients during follow-up.

“…Compared with the HADS, APAIS places more attention on anesthesia and the examination itself, which can better reflect the subjective feelings of patients [ 14 ]. The Chinese version of APAIS has been proved as an effective tool for assessing patients’ preoperative anxiety [ 8 ]. There is no research focusing on the change of LUTS caused by cystoscopy.…”

“…The order of bladder examination remained consistent between the two groups. The day before the cystoscopy, patients were informed about the type of cystoscope, and then filled out the Amsterdam Preoperative Anxiety and Information Scale (APAIS), which has been proved as a reliable method for assessing preoperative anxiety [ 8 ]. Patients were asked to select the pain level and score immediately according to the visual analogue scale (VAS) after the cystoscopy.…”