Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

Hollenbeck, Brent K.; Dunn, Rodney L.; Wolf, J. Stuart; Sanda, Martin G.; Wood, David P.; Gilbert, Scott M.; Weizer, Alon Z.; Montie, James E.; Wei, John T.

doi:10.1007/s11136-008-9366-x

Cited by 39 publications

(51 citation statements)

References 27 publications

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“…In laparoscopic arm, 10 unique AE were reported (4 Dindo II, 6 Dindo III) with 6 AE in robotic arm (1 Dindo I, 2 Dindo II, 2 Dindo III, 1 Dindo IV). Based on an indexed value of severity and number of AE (14), there was no significant group difference (p = 0.868). AE’s consisted of one left iliac venotomy in each arm (closed intraoperatively without changing route of access), and one small bowel obstruction in each arm (one in the robotic arm requiring surgical exploration).…”

Section: Resultsmentioning

confidence: 94%

“…Quality-of-life instruments specific to pelvic floor disorders included the Patient Global Impression of Improvement (PGI-I), the Hunskaar Severity Index, the Pelvic Floor Distress Inventory (PFDI), the Pelvic Floor Impact Questionnaire (PFIQ) (10, 11), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) (12). Patient convalescence was measured using the Activities Assessment Scale (AAS) (13), as well as the Convalescence and Recovery Evaluation (CARE) (14). Pain levels were measured with validated Surgical Pain Scales (SPS) scores (15).…”

Section: Methodsmentioning

confidence: 99%

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Robotic Compared With Laparoscopic Sacrocolpopexy

Anger

Mueller

Tarnay

et al. 2014

Obstetrics &Amp; Gynecology

237

133

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Objective: Laparoscopic and robotic sacrocolpopexy are widely used for pelvic organ prolapse (POP) treatment. Evidence comparing outcomes and costs is lacking. We compared costs and clinically relevant outcomes in women randomized to laparoscopic sacrocolpopexy compared with robotic sacrocolpopexy. Methods: Participants with symptomatic stage POP II or greater, including significant apical support loss, were randomized to either laparoscopic or robotic sacrocolpopexy. We compared surgical costs (including costs for robot, initial hospitalization) and re-hospitalization within 6 weeks. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events. Results: We randomized 78 women [mean age 59 years]: laparoscopic (n=38), robotic (n=40). The robotic sacrocolpopexy group had higher initial hospital costs ($19,616 vs. $11,573, p < 0.001) and over 6 weeks, hospital costs remained higher for robotic sacrocolpopexy ($20,898 vs. $12,170, p < 0.001). When we excluded costs of robot purchase and maintenance, we did not detect a statistical difference in initial day of surgery costs of robotic vs. laparoscopic ($12,586 vs. $11,573; p = 0.160) or hospital costs over 6 weeks ($13,867 vs. $12,170; p = 0.060). The robotic group had longer operating room times (202.8 min vs. 178.4 min, p = 0.030) and higher pain scores 1-week after surgery (3.5 ± 2.1 vs. 2.6 ± 2.2; p = 0.044). There were no group differences in symptom bother by Pelvic Floor Distress Inventory, POP stage, or rate of adverse events. Conclusion: Costs of robotic sacrocolpopexy are higher than laparoscopic, while short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs.

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Section: Resultsmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Robotic Compared With Laparoscopic Sacrocolpopexy

Anger

Mueller

Tarnay

et al. 2014

Obstetrics &Amp; Gynecology

237

133

View full text Add to dashboard Cite

show abstract

“…5,8 Domain scores for CARE range from 0 to 100, with higher scores corresponding to a better health state and domain scores are combined to generate a composite score. 8 SF-12 is an abbreviated version of the SF-36 and consists of 12 items and measures two domains including mental and physical component summaries (MCS, PCS), respectively.…”

Section: Methodsmentioning

confidence: 99%

“…One such instrument is the Convalescence and Recovery Evaluation (CARE). 5 The CARE is a 27-item validated short term health instrument that was designed specifically to measure changes common to all patients after abdominal and pelvic surgery and has four domains (Pain, Gastrointestinal, Cognitive, and Activity). Prior studies have been limited to measures of general HRQOL (e.g.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patient-reported Quality-of-life Outcomes After Renal Surgery

Kim

Williams

Cheng

et al. 2012

Urology

Self Cite

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Objectives To assess the feasibility of two patient-reported health related quality of life (HRQOL) instruments, CARE and SF-12, as tools for evaluating HRQOL outcome consequences following renal surgery, and to determine which domains of these HRQOL instruments are most sensitive to HRQOL outcome effects of renal surgery. Methods Patients completed CARE and SF-12 preoperatively (baseline) and at 2, 4, 12 and 24 weeks after surgery. Clinical data, patient response rate, HRQOL changes over time, and likelihood of patient return to baseline HRQOL were evaluated. Results Seventy-one patients were enrolled. Sixty patients completed the baseline and at least one follow-up set of questionnaires. The CARE pain, gastrointestinal (GI) and activity domain scores and the SF-12 physical composite score (PCS) were sensitive to changes in HRQOL (all p<0.05), whereas other domain subscores of these instruments did not change from pre-surgical baseline to post-surgical follow-up. Postsurgical HRQOL effects detected by the CARE pain, GI, and activity domains, and SF-12 PCS were most evident at 2 weeks (all p<0.001). The CARE composite score demonstrated 74% and 50% of patients returned to within 90% of baseline 4 weeks after radical and partial nephrectomy respectively. Conclusion Evaluation of patient-reported HRQOL outcomes after renal surgery is feasible, our findings suggest that the activity, pain, and GI domains of CARE and PCS subscore of the SF-12 are sensitive measures of HRQOL outcome consequences of renal surgery and represent appropriate measures of either care quality or comparative effectiveness analyses of robotic, laparoscopic, and open renal surgery.

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“…The Convalescence and Recovery Evaluation (CARE), a validated generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery, will be used to measure baseline activity levels and activity levels after surgery, such that return to baseline activity can be compared [22,23]. Photographs of the abdomen will be obtained at baseline and at different time points postoperatively and will be evaluated using a Scar Evaluation Scale (SES) [24].…”

Section: Methodsmentioning

confidence: 99%

Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)

Kenton

Tarnay

Brubaker

et al. 2012

Contemporary Clinical Trials

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Introduction Robotic assistance during laparoscopic surgery for pelvic organ prolapse rapidly disseminated across the United States without level I data to support its benefit over traditional open and laparoscopic approaches. This manuscript describes design and methodology of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS) Trial [1]. Methods ACCESS is a randomized comparative effectiveness trial enrolling patients at two academic teaching facilities, UCLA (Los Angeles, CA) and Loyola University (Chicago, IL). The primary aim is to compare costs of robotic assisted versus pure laparoscopic abdominal sacrocolpopexy (RASC vs LASC). Following a clinical decision for minimally-invasive abdominal sacrocolpopexy (ASC) and research consent, participants with symptomatic stage≥II pelvic organ prolapse are randomized to LASC or RASC on the day of surgery. Costs of care are based on each patient’s billing record and equipment costs at each hospital. All costs associated with surgical procedure including costs for robot and initial hospitalization and any re-hospitalization in the first 6 weeks are compared between groups. Secondary outcomes include post-operative pain, anatomic outcomes, symptom severity and quality of life, and adverse events. Power calculation determined that 32 women in each arm would provide 95% power to detect a $2500 difference in total charges, using a two-sided two sample t-test with a significance level of 0.05. Results Enrollment was completed in May 2011. The 12-month follow-up will end in May 2012. Conclusions This is a multi-center study to assess cost as a primary outcome in a comparative effectiveness trial of LASC versus RASC.

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Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

Cited by 39 publications

References 27 publications

Robotic Compared With Laparoscopic Sacrocolpopexy

Robotic Compared With Laparoscopic Sacrocolpopexy

Evaluation of Patient-reported Quality-of-life Outcomes After Renal Surgery

Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)

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