Development of a patient-reported outcome measure of recovery after abdominal surgery: A conceptual framework
Bibliographic record
Abstract
Background: The use of patient-reported outcome measures (PROMs) are central for delivering high-quality patient-centered care to postoperative patients. However, the evidence underpinning the measurement properties of PROMs currently in use to measure recovery after abdominal surgery is weak. To bridge this knowledge gap, we initiated a research program to develop a conceptually relevant and psychometrically sound recovery-specific PROM. In compliance with best-practice recommendations for PROM development, this thesis project aimed to develop a conceptual framework representing the health domains relevant to the process of recovery after abdominal surgery. Methods:This study was conducted in two parts: Part 1 (Manuscript 1): A hypothesized conceptual framework of recovery was developed based on literature review and expert opinion. Firstly, a systematic review was undertaken to identify PROMs currently used in the context of recovery after abdominal surgery. All items contained in the PROMs were categorized into health domains covered by the International Classification of Functioning, Disability and Health (ICF). To acquire expert input, 35 perioperative care experts from major surgical societies in North America and Europe were invited to participate in a 2-round Delphi study in which they rated their agreement with each domain. Domains deemed as relevant (>75% agreement) were organized into a diagram comprising a hypothesized conceptual framework of recovery after abdominal surgery. Part 2 (Manuscript 2): A final conceptual framework of recovery was developed based on patient input. Patients from 4 different countries (Canada, Italy, Brazil and Japan) participated in qualitative interviews focusing on their lived experiences of recovery after abdominal surgery. Interviews were guided by the previously developed hypothesized framework. Interviews were analyzed according to a modified grounded theory approach and transcripts were coded according to the ICF. Codes for which thematic saturation was reached were classified into domains of health that are relevant to the process of recovery after abdominal surgery. These domains were organized into a structured diagram. Results:Part 1 (Manuscript 1): The systematic review identified 19 PROMs covering 66 ICF domains. 23 experts (66%) participated in the Delphi process. After Round 2, experts agreed that 22 ICF health domains are potentially relevant to the process of recovery after abdominal surgery. Part 2 (Manuscript 2): 30 patients with diverse demographics and surgical characteristics were interviewed (50% male, age 57±18 years; 66% major or major extended surgery). 39 unique domains of recovery emerged from the interviews, 17 falling under the ICF category of "Body Functions" and 22 under "Activities and Participation". These domains constitute the final conceptual framework of recovery after abdominal surgery.Conclusion:The research reported in this thesis provides comprehensive insight into the health domains that are relevant to the process of recovery after abdominal surgery. This conceptual framework will support content validity and provide the pivotal basis for the development of a novel PROM to inform patient-centered research and quality improvement initiatives in abdominal surgery
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.112 | 0.072 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.002 | 0.009 |
| Scholarly communication | 0.006 | 0.009 |
| Open science | 0.004 | 0.006 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".