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1Traditional Medicine Research  2019, Vol. 4 Issue (4): 184-194    DOI: 10.12032/TMR20190326112
Special Issue on Integrative Surgery     
Development and validation of the perioperative recovery scale for integrative medicine
Li Zhou1,2, Bi-Ying Su3, Shao-Nan Liu1,2, Xiao-Yan Li1,2, Li-Xing Cao1,4, Li-Ming Lu5, Ze-Huai Wen1,2,6,*(), Zhi-Qiang Chen1,4,*()
1The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
2Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
3Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China.
4Department of Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
5Guangzhou University of Chinese Medicine, Guangzhou, China.
6National Center for Design Measurement and Evaluation in Clinical Research, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Highlights

This study develops and validates a scale for perioperative recovery with integrative medicine. It is acceptable for patients in the perioperative period undergoing treatment by either Chinese or integrative medicine, and has good psychometric properties.

Traditionality

As early as 610 A.D., the ancient book of Chinese medicine named Zhu Bing Yuan Hou Lun, recorded the application of traditional Chinese medicine after surgical operation. It said patients with intestinal rupture caused by trauma could only drink porridge within 20 days after intestinal anastomosis. If the patients ate too much after the surgery, he might suffer from stomachache. Morever, taking Qianxie Powder (a Chinese medicine prescription consisting of iron scraps, Cornu Cervi, etc.) helped to relieve the pain. Wai Ke Zheng Zong published in Ming Dynasty of China (1617 A.D.) also recorded that Hui Xiang Cao powder (a Chinese medicine prescription consisting of Foeniculum vulgare and Alpinia Rhizoma.) was used for the treatment of postoperative analgesia, and Crinis Carbonisatus was used for postoperative hemostasis.

Abstract

Purpose: The aim of this study is to develop and validate a scale for perioperative recovery with integrative medicine. Methods: The procedures for developing the scale included a review of both modern and ancient literature, other perioperative scales or questionnaire references, an expert consultation, and interviews with patients and surgeons following standard procedures. Primary face and content validity were assessed through a small-scale patient survey of 50 patients. A final evaluation based on the patient survey was conducted among 354 patients (age range 16-75) from the same hospital. This included testing the perioperative recovery scale for integrative medicine (PRSIM) for scaling properties, reliability, validity and responsiveness. Results: The PRSIM, a 20-item scale, was modified from an initial version transcript which included 122 items. The 20 items in the PRSIM covered five domains: direct influence, indirect influence, activity, mental function and general health perceptions. Five factors extracted from an exploratory factor analysis demonstrated a desirable model fit. A confirmatory factor analysis further indicated that the PRSIM had a good fit with the same sample. A data analysis of the PRSIM with 349 patients showed that it had good internal consistency (α> 0.7), test-retest reliability (ICC > 0.4) and split half reliability (α= 0.66). Conclusions: The PRSIM can serve as a valuable instrument for assessing patient perioperative recovery in integrative medicine. It is acceptable for patients in the perioperative period undergoing treatment by either Chinese or integrative medicine, and has good psychometric properties.



Key wordsPRSIM instrument      Psychometric test      Reliability      Validity      Responsiveness      Chinese medicine      Integrative medicine     
Published: 05 July 2019
Fund:  Acknowledgments:This study was supported by grants from the Scientific Research and Innovation Fund of Guangzhou University of Chinese Medicine (No. 2009W01), the National Key Technology Research and Development Program during the eleventh Five-year Plan Period (2008BAI53B031), the Project of Guangdong Provincial Department of Science and Technology (No. 2014A020212278), the Science and Technology Program of Guangzhou, China (No. 2014Y2-00048) and the Project of Guangdong Provincial Hospital of Chinese Medicine (No.YK2013BIN13). We thank all investigators for their hard work during the survey. We are grateful for the valuable manuscript suggestions from Dr. Zehui He of the GPCHM Big Data Research Team and Oliver James Dyar from the Department of Public Health Sciences at the Karolinska Institute in Sweden. We would also like to thank the general surgery, gynecology, breast surgery and orthopedics departments, as well as the physical examination center at GPHCM.
Corresponding Authors: Ze-Huai Wen,Zhi-Qiang Chen     E-mail: wenzehuai@139.com;zhi57@163.com
Cite this article:

Li Zhou, Bi-Ying Su, Shao-Nan Liu, Xiao-Yan Li, Li-Xing Cao, Li-Ming Lu, Ze-Huai Wen, Zhi-Qiang Chen. Development and validation of the perioperative recovery scale for integrative medicine. 1Traditional Medicine Research, 2019, 4(4): 184-194. doi: 10.12032/TMR20190326112

URL:

https://www.tmrjournals.com/tmr/EN/10.12032/TMR20190326112     OR     https://www.tmrjournals.com/tmr/EN/Y2019/V4/I4/184

Figure 1 Flow chart of PRISM development
PRSIM, Perioperative recovery scale for integrative medicine.
Characteristics
(n = 349)
Number (%) or Mean ± SD
Sex
Male 100 (28.7)
Female 249 (71.3)
Age 52.95 ± 12.52
Education lever
Primary school and below 86 (24.7)
Middle school 97 (27.8)
High school and junior college 133 (39.1)
University and postgraduate or above 33 (9.5)
Department
General surgery 126 (35.8)
Gynecology 95 (27.0)
Breast surgery 67 (19.0)
Orthopedics 64 (18.2)
Occupation
Teacher or student 13 (3.8)
Business person 11 (3.2)
Manual laboreror farmer 81 (23.2)
Medical staff 6 (1.7)
Retirement 118 (33.8)
Office staff 30 (8.6)
Other 90 (25.8)
Anesthesia
Intravenous anesthesia 15 (4.3)
General anesthesia with endotracheal intubation 252 (72.2)
Epidural orlocal anesthesia 4 (1.2)
Combined spinal epidural anesthesia 78 (22.3)
Table 1 Characteristics of participants
SD: Standard deviation
Domains of the scale Item Component
Factor 1 Factor 2 Factor 3 Factor 4 Factor 5
Direct influence 1 0.74 0.15 0.03 0.05 0.10
2 0.66 0.25 0.30 0.10 0.05
3 0.55 0.20 0.33 -0.02 -0.09
4 0.40 -0.19 -0.03 0.17 0.38
5 0.63 0.03 0.01 0.26 0.06
Indirect influence 6 0.27 0.67 -0.05 -0.01 0.13
7 0.12 0.63 0.15 0.00 -0.05
8 0.04 0.53 0.07 0.04 0.32
9 0.03 0.61 0.07 0.21 -0.13
Activity 10 0.17 0.41 0.07 0.49 0.22
11 0.28 0.23 0.07 0.64 0.22
12 -0.02 -0.02 0.04 0.67 0.18
13 0.23 -0.02 0.16 0.64 -0.25
Mental function 14 0.22 0.10 0.37 -0.05 0.59
15 -0.08 0.08 -0.04 0.16 0.73
General health perceptions 16 0.05 0.21 0.59 0.05 0.34
17 -0.12 0.14 -0.62 0.05 -0.05
18 0.40 0.11 0.53 0.25 -0.17
19 0.42 0.26 0.52 0.32 -0.11
20 -0.06 0.27 0.55 0.32 0.03
Variance explained (%) 24.04 7.62 6.69 6.35 5.73
Table 2 Exploratory factor analysis of the PRSIM
PRSIM: Perioperative recovery scale for integrative medicine; Item 1: Sleep; Item 2: Mental state; Item 3: Appetite; Item 4: Constipation or diarrhea; Item 5: Pain in surgical site; Item 6: Dizzy; Item 7: Nausea and vomiting; Item 8: Cold, with coolness of extremities; Item 9: Pain in other parts except surgical site; Item 10: Lassitude in waist and legs; Item 11: Fatigue when exercise slightly; Item 12: Sweat when exercise slightly; Item 13: Difficulty in daily life, such as washing, dressing; Item 14: Concentration; Item 15: Memory loss; Item 16: Breathe smoothly; Item 17: Fart normally; Item 18: Feeling about recovery of post-operation; Item 19: Feeling of current health condition; Item 20: Energy to return previous post or participant in social activities.
Figure 2 Confirmatory factor analysis model for the PRSIM
PRSIM: Perioperative recovery scale for integrative medicine; Item 1: Sleep; Item 2: Mental state; Item 3: Appetite; Item 4: Constipation or diarrhea; Item 5: Pain in surgical site; Item 6: Dizzy; Item 7: Nausea and vomiting; Item 8: Cold, with coolness of extremities; Item 9: Pain in other parts except surgical site; Item 10: Lassitude in waist and legs; Item 11: Fatigue when exercise slightly; Item 12: Sweat when exercise slightly; Item 13: Difficulty in daily life, such as washing, dressing; Item 14: Concentration; Item 15: Memory loss; Item 16: Breathe smoothly; Item 17: Fart normally; Item 18: Feeling about recovery of post-operation; Item 19: Feeling of current health condition; Item 20: Energy to return previous post or participant in social activities.
Domains Participants No. Mean (SD) t P
Direct influence1 Patients 349 12.95 (2.67) -5.497 < 0.001
Healthy people 51 15.14 (2.41)
Indirect influence2 Patients 349 17.10 (2.46) 2.832 0.005
Healthy people 51 16.06 (2.44)
Activity3 Patients 349 14.50 (3.32) -3.429 0.001
Healthy people 51 15.88 (2.58)
Mental function4 Patients 349 7.91 (1.64) 11.966 < 0.001
Healthy people 51 5.59 (1.24)
General health perceptions5 Patients 349 10.35 (1.59) -1.968 0.050
Healthy people 51 10.82 (1.74)
Table 3 Discriminant validity of the PRSIM between patients and healthy people
PRSIM, Perioperative recovery scale for integrative medicine; SD, Standard deviation;1Scores ranged from 5 to 25; 2Scores ranged from 4 to 20; 3Scores ranged from 4 to 20; 4Scores ranged from 2 to 10; 5Scores ranged from 5 to 25.
Domains Mean (SD) t P
First day Fourth day
Direct influence1 15.52 (3.39) 16.34 (3.57) -1.497 0.141
Indirect influence2 16.84 (2.34) 17.48 (2.42) -1.792 0.090
Activity3 13.76 (3.17) 14.94 (2.81) -3.107 0.003
Mental function4 8.06 (1.74) 7.96 (1.23) 0.393 0.696
Generalhealth perceptions5 17.30 (2.79) 17.52 (2.68) -0.498 0.621
Table 4 Responsiveness of the PRSIM (n = 50)
SD, Standard deviation; 1Scores ranged from 5 to 25; 2Scores ranged from 4 to 20; 3Scores ranged from 4 to 20; 4Scores ranged from 2 to 10; 5Scores ranged from 5 to 25.
Scale domains Corrected item-total correlation (n = 349) Test-retest (n = 49)
ICC 95%CI of ICC
Direct influence 0.51 0.67 0.48~0.80
Indirect influence 0.45 0.78 0.64~0.87
Activity 0.52 0.81 0.68~0.89
Mental function 0.31 0.47 0.22~0.66
General health perceptions 0.54 0.84 0.73~0.91
Table 5 Internal consistency and test-retest reliability of the PRSIM
PRSIM, Perioperative recovery scale for integrative medicine; ICC, Intra-class correlation coefficient.
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