The Abdominal Hernia-Q: Psychometric Evaluation and Prospective Testing
Jaclyn T. Mauch, BA, Fabiola A. Enriquez, BA, Judy A. Shea, PhD, Frances K. Barg, PhD, Irfan A. Rhemtulla, MD, MS, Robyn B. Broach, PhD, Sheri L. Thrippleton, PA-C, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.
Background: A standardized method for measuring hernia-related patient reported outcomes (PRO) has not been identified. There remains a need for a broadly applicable, hernia-specific tool that incorporates patient viewpoints and offers pre- and post-operative forms. Our study estimates the psychometric properties of a novel, hernia-specific PRO tool - the Abdominal Hernia-Q (AHQ).
Methods: Concept elicitation interviews (n=15), focus groups (n=6 and n=7), and cognitive debriefing interviews (n=31) were completed to define content. The pre-operative AHQ was administered to patients scheduled to have a ventral hernia repair (VHR). The post-operative AHQ was administered to patients up to 24 months post VHR. The SF-12 and HerQLes were concurrently administered. Patient demographics, pre-operative data, operative details, and post-operative outcomes were collected through a retrospective chart review. Psychometric evaluation, guided by Classical Test Theory, was performed and informed tool refinement. Subsequently, the revised AHQ (pre: 8 items; post: 16 items) underwent prospective testing.
Results: Cross-sectional evaluations of patient responses to the AHQ (pre n=104; post n=261) demonstrated high internal consistency (Cronbach alpha pre = 0.86; post = 0.90) and moderate disattenuated correlations with the HerQLes (pre r=-0.71 and post r=-0.70) and the SF-12 domains (pre and post r=0.5 for 7 of 8 domains). Principal components analyses produced two factors pre-operatively (a physical component and an appearance component) and three factors post-operatively (a physical component, an appearance component, and a surgical team component). In prospective testing (n=67), the AHQ scores replicated the cross-sectional psychometric results. ANOVA results suggested sensitivity to clinical outcomes. The pre-operative scores showed significant differences between groups within previous complications, hernia type, employment status, and CT defect size. The post-operative scores demonstrated significant differences between groups within mesh type, length of stay, and 90-day complications. Effect size demonstrated that pre- to post-operative magnitude of score change was largest for the AHQ (1.38), followed by the HerQLes (0.73) and SF-12 (0.24-0.40), reflecting the sensitivity of AHQ scores to changes in function during the pre- and post-operative time frames.
Conclusions: Through patient involvement and rigorous, iterative psychometric evaluation, we have produced substantial data to suggest the validity and reliability of AHQ scores in measuring hernia-specific PRO. The AHQ is the first broadly applicable, hernia-specific PRO tool to be developed with extensive patient involvement and to offer both pre- and post-operative instruments. The AHQ may advance the clinical management and treatment of patients with abdominal hernias by providing a more complete understanding of patient-defined outcomes.
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