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Purpose There is no consensus regarding how best to measure postoperative quality of recovery after anesthesia/surgery (e.g., using 24-hour survey instruments) in veterans or active military. Our goals were to (1) describe health-related quality-of-life (HRQoL) and recovery across time in veterans, (2) examine the commonality between the quality of recovery (QoR-15) and short-form (SF) surveys (including the SF-8, 24-hour version), and (3) examine the responsiveness of these surveys. Materials and Methods This study was approved by the Institutional Review Boards from the University of Pittsburgh, the VA Pittsburgh, and the Human Research Protection Office of the Department of Defense. Secondary analyses of data were executed based on a randomized trial dataset of knee/hip arthroplasty patients, the study having recruited 135 total veterans. QoR-15 and HRQoL SF surveys were completed and self-reported before surgery (pre-op), on postoperative day 2 (PO-D2), and 6 weeks postoperatively. Descriptive statistics were used to examine scores across time. Common content was examined using Pearson’s r. Responsiveness was examined using distribution-based methods. Results Average veteran age was 67 year, 89% were male, 88% white, and average body mass index was 33 kg∙m−2. QoR-15 scores declined from pre-op to PO-D2 but were higher than pre-op at 6 weeks. SF physical component summary (PCS) scores were low both pre-op and PO-D2, but were elevated over baseline at 6 weeks. SF mental component summary (MCS) scores declined from baseline to PO-D2 but were higher than pre-op at 6 weeks. Associations of the QoR-15 total score and PCS/MCS were medium/large and statistically significant at P ≤ .01. Both instruments were responsive to changes. Conclusion QoR-15 and SF-8 have high content commonality and performed similarly in veterans across time. SF-8 has added benefits of (1) brevity, (2) assessment of physical and mental health components, and (3) being normed to the general population. The SF-8, if used without the QoR-15 in tandem in future study of anesthesia-related outcomes, would need to be supplemented by separate questions addressing postoperative nausea/vomiting (a frequent outcome after anesthesia that is relevant to same-day and next-day mobilization after elective joint replacement surgery).

Introduction Valid measures of pain are helpful to adjust treatment plans in real time after total joint replacement (TJR). We enhanced the existing Defense and Veterans Pain Rating Scale (DVPRS) with items related to pain at rest and movement, in specific reference to operative and nonoperative joints, creating the TJR-DVPRS. This manuscript is presented to validate the modified survey instrument. The aims of this psychometric study were to evaluate (1) the latent structure of the TJR-DVPRS, (2) the relationships among the pain dimensions represented on the TJR-DVPRS and the reference-standard Short-Form McGill Pain Questionnaire (version 2, SF-MPQ-2), and (3) the responsiveness of these two measures before and after TJR. Materials and Methods This report involves a secondary analysis of pain surveys from 135 veterans undergoing TJR at one center who participated in a randomized trial. The study was approved by the institutional review boards from participating institutions. The TJR-DVPRS and SF-MPQ-2 were completed preoperatively, during postoperative day 1, and 6 weeks post-surgery. Standard psychometric evaluations included correlations, principal component analysis, and internal consistency of survey items and subscales, using preoperative baseline data as a frame of reference. Responsiveness analysis included assessing both effect size and thresholds of clinically important change for survey subscales using data from all three time points. Results Two reliable subscales were identified for the TJR-DVPRS, one including items about pain intensity and interference related to the operative joint (Cronbach’s α = .809) and the other including two pain items on the nonoperative joint. Combining the subscales indicated a two-factor solution: The first valid factor entailed the four subscales of the SF-MPQ-2 and the TJR-DVPRS operative joint subscales, indicating that these subscales validly represent the same pain dimension. The second valid factor entailed the TJR-DVPRS subscale addressing the nonoperative joint. Responsiveness analysis following accepted psychometric methods demonstrated significant decreases in pain from the preoperative period to 6 weeks postoperatively for all subscales. The TJR-DVPRS and SF-MPQ-2 subscales were similarly responsive, except for the SF-MPQ-2 neuropathic and TJR-DVPRS nonoperative joint subscales, which were minimally responsive during the preoperative to 6-week period. Conclusions The TJR-DVPRS is valid for use among veterans undergoing TJR and poses significantly less respondent burden than does the SF-MPQ-2. The brevity and ease of use of the TJR-DVPRS make it a practical tool for use during surgical recovery to monitor pain intensity at rest and with movement in the operative joint, and to assess pain interference with activity, sleep, and mood. The TJR-DVPRS is at least as responsive as the SF-MPQ-2, but the SF-MPQ-2 neuropathic and TJR-DVPRS nonoperative joint subscales were minimally responsive. Limitations of this study include the small sample size, under-representation of women (which would be expected in the veteran population), and using only veterans. Future validations studies should include civilians and active military TJR patients.

Objective To compare pain outcome reports of patients undergoing hip or knee replacement who received single-injection nerve/plexus blocks with plain bupivacaine (BPV) with those of patients who received injections of buprenorphine-clonidine-dexamethasone (BCD) admixed with BPV. Design Prospective, parallel-arm, randomized, double-blind trial. Setting A single veterans’ hospital. Subjects Ninety-eight veterans scheduled for total hip or knee replacement surgery with spinal as the primary anesthetic. Methods Participants were randomized to BPV-BCD or plain BPV groups. They underwent nerve/plexus blocks in the L2–L4 and L4–S3 distributions in advance of joint replacement surgery. The primary outcome was change in pain from baseline during the postoperative day, as assessed by the total pain score on the short-form McGill Pain Questionnaire-v2 (SF-MPQ-2). Secondary outcomes were pain during movement, pain interference, range of motion, mobility, and quality of recovery. Results On postoperative day one, the SF-MPQ-2 total score for the BPV-BCD group demonstrated greater pain reduction than that of the plain BPV group (mean difference 1.8 points, 95% confidence interval 0.6 to 3.0, P = 0.003). The BPV-BCD group also had larger reductions in pain during movement in the surgical joint and less pain interference, along with increased range of hip and knee flexion, compared with the plain BPV group. Outcomes of mobility and quality of recovery were not different between groups. Conclusions Preoperative BPV-BCD blocks in the L2–L4 and L4–S3 nerve distributions for hip and knee replacements led to less pain on postoperative day one and increased knee and hip range of motion, compared with plain BPV blocks. Trial registration ClinicalTrials.gov ID NCT02891798.

Objective We tested the hypothesis that buprenorphine-clonidine-dexamethasone (BCD) extends perineural analgesia compared with plain bupivacaine (BPV) nerve blocks used for hip and knee replacement surgery. Design Prospective, parallel-arms, randomized, double-blind trial. Setting A single veterans’ hospital. Subjects Seventy-eight veterans scheduled for total hip or knee replacement with plans for spinal as the primary anesthetic. Methods Participants underwent nerve/plexus blocks at L2–L4 and L4–S3 in advance of hip or knee joint replacement surgery. Patients were randomized to receive BPV-BCD or plain BPV in a 4:1 allocation ratio. Patients answered four block duration questions (listed below). Time differences between treatments were analyzed using the t test. Results Significant (P Conclusions BPV-BCD provided 26–39 hours of perineural analgesia in the L2–L4 and L4–S3 nerve distributions after hip/knee replacement surgery, compared with 11–21 hours for plain BPV.

The purpose of this research was to examine the validity of the 55-item Revised Token Test (RTT) and to compare traditional and Rasch-based scores in their ability to detect group differences and change over time. The 55-item RTT was administered to108 left- and right-hemisphere stroke survivors, and the data were submitted to Rasch analysis. Traditional and Rasch-based scores for a subsample of 60 stroke survivors were submitted to analyses of variance with group (left hemisphere with aphasia vs. right hemisphere) and time post onset (3 vs. 6 months post onset) as factors. The 2 scoring methods were compared using an index of relative precision. Forty-eight items demonstrated acceptable model fit. Misfitting items came primarily from Subtest IX. The Rasch model accounted for 71% of the variance in the responses to the remaining items. Intersubtest patterns of item difficulty were well predicted by item content, but unexpected within-subtest differences were found. Both traditional and Rasch person scores demonstrated significant group differences, but only the latter demonstrated statistically significant change over time. Analysis of relative precision, however, failed to confirm a significant difference between the 2 methods. The findings generally support the RTT’s validity, but a minority of items appears to respond to a different construct. Also, within-subtest differences in item difficulty suggest the need for further examination of variability in impaired language performance. Finally, the results suggest an equivocal advantage for Rasch scores in detecting change over time.

Background: Patient‐reported measures of communication difficulty and communication‐related distress may be used to obtain efficient and valid indices of the functional consequences of aphasia and its treatment on the daily lives of many community‐dwelling stroke survivors. However, they have not been employed to evaluate treatment outcomes or to examine hypotheses specifying their relationship to commonly employed measures of speech and language impairment in persons with aphasia. This work was supported by the VHA Department of Rehabilitation Research and Development Merit Review Program (Project # C2386R), and the VA Pittsburgh Healthcare System's Geriatric Research Education and Clinical Center (GRECC). The authors wish to acknowledge the contributions of Burden of Stroke Scale (BOSS) Phase 2 Field Trial collaborators, Katherine Ross PhD, VAMC Phoenix, and Julie Wambaugh PhD, VAMC Salt Lake City, the assistance of their respective study team members, Steve Larson MA, Rosalea Cameron MA, and Christina ...

Purpose: The purposes of this investigation were to examine the construct dimensionality and range of ability effectively measured by 28 assessment items obtained from 3 different patient-reported scales of communicative functioning, and to provide a demonstration of how the Rasch approach to measurement may contribute to the definition of latent constructs and the development of instruments to measure them. Method: Item responses obtained from 421 stroke survivors with and without communication disorders were examined using the Rasch partial credit model. The dimensionality of the item pool was evaluated by (a) examining correlations of Rasch person ability scores obtained separately from each of the 3 scales, (b) iteratively excluding items exceeding mean square model fit criteria, and (c) using principal-components analysis of Rasch model residuals. The range of ability effectively measured by the item pool was examined by comparing item difficulty and category threshold calibrations to the distribution of person ability scores and by plotting the modeled standard error of person ability estimates as a function of person ability level. Results: The results indicate that most assessment items fit a unidimensional measurement model, with the notable exception of items relating to the use of written communication. The results also suggest that the range of ability that could be reliably measured by the current item pool was restricted relative to the range of ability observed in the patient sample. Conclusions: It is concluded that (a) a mature understanding of communicative functioning as a measurement construct will require further research, (b) patients with stroke-related communication disorders will be better served by the development of instruments measuring a wider range of communicative functioning ability, and (c) the theoretical and methodological tools provided by the Rasch family of measurement models may be productively applied to these efforts.

Background: The Burden of Stroke Scale (BOSS) (Doyle et al., 2002) is a health-status assessment instrument designed to measure patient-reported difficulty in multiple domains of functioning, psychological distress associated with specific functional limitations, and,general well-being in stroke survivors. Aims : This study was designed to examine the discriminative and concurrent validity of the BOSS Communication Difficulty (CD) and Communication-Associated Psychological Distress (CAPD) scales. A secondary purpose was to provide a preliminary examination of the relationships between the BOSS CD and CAPD scales and aspects of subjective well-being, including the frequency with which participants reported experiencing general positive and negative emotional states. Methods & Procedures : The BOSS was administered as a face-to-face interviewer-assisted survey to 281 medically stable, community-dwelling stroke survivors selected from five collaborating centres in the USA. Prior to administration of the BOSS...

In two experiments on reactions to persistent annoyance from another person, participants employed a very orderly verbal escalation sequence that fit a cascading Guttman scale. This began with requests and moved on to demands, and then to complaints, angry statements, threats, harassment, and abuse, in that order. The more escalated the tactic, the fewer people used it. People seldom skipped a step on the way to their most escalated tactic. Two possible explanations for this pattern seemed plausible in light of the data, that it is due to either a widely snared try‐try‐again script or a declining hierarchy of thresholds. Verbal escalation was associated with a negative view of the annoyer's character, while physical escalation was associated with blame and feelings of frustration and anger. Escalation was discouraged by membership in the same group as the annoyer. Loud noise did not encourage escalation in general but promoted the use of angry statements.

A variety of strategies were identified in interview‐based chronologies of ordinary interpersonal conflicts. Verbal confrontation with the adversary was the most common strategy and usually preceded other approaches. Efforts to arrange mediation and arbitration were extremely rare, though third parties were approached for other reasons in most of the cases. It was possible to distinguish complainants from respondents in 61 percent of the cases. Respondents employed more problem solving and apology than complainants, while complainants employed marginally more pressure tactics.

To examine the reliability, validity, and responsiveness of the Burden of Stroke Scale (BOSS). A prospective cohort of stroke survivors were assessed at 3 (T1, T2), 6 (T3), and 12 (T4) months post onset (MPO) of stroke. Test-retest reliability was evaluated by calculating intra-class correlation coefficients (ICCs) between T1 and T2 scale scores. Convergent validity was evaluated by calculating Pearson product moment correlation coefficients between T1 BOSS, Stroke Impact Scale and MOS SF-36 scale scores assessing similar health concepts. Responsiveness was evaluated using a repeated measures ANOVA and the linear trend test in the full study sample and by calculating standardized response means (SRM) and a probability of change statistic, $$ \hat{p} $$ between T1, T3, and T4 scale scores in participants demonstrating change on external criteria. ICCs ranged from 0.78 to 0.94. Pearson coefficients ranged from −0.57 to −0.86. Moderate to high responsiveness estimates were obtained for 9 of 12 subscales with SRM ( $$ \hat{p} $$ ) values ranging from .497 (.690) to 1.161 (.877). Composite scale SRM ( $$ \hat{p} $$ ) values ranged from .661 (.746) to 1.192 (.883). The BOSS provided valid and reliable score estimates that were responsive to positive changes in functioning and well-being during the first year of recovery from stroke.

Background and Objective: This study describes the conceptual foundation and psychometric properties of the Burden of Stroke Scale (BOSS), a patient-reported health status assessment designed to quantify the physical, cognitive, and psychological burden of stroke. Methods: Qualitative research methods were used to develop a 112-item pilot version of the instrument. The pilot version was administered to healthy controls (n 251) and stroke survivors with (n 135) and without (n 146) communication disorders on a single occasion for the purposes of reducing the global item pool, describing the resulting scale properties, examining the dimensionality of the burden of stroke construct, and examining the known-groups validity of the instrument. Results: Sixty-four items were retained, comprising 12 internally consistent and unidimensional scales. Principal components analysis revealed three second-order factors (Physical Activity Limitations, Cognitive Activity Limitations, and Psychological Distress) comprising the Burden of Stroke construct. Comparisons between groups revealed that stroke survivors reported greater activity limitations and psychological distress on all scales relative to controls, and that stroke survivors with communication disorders reported greater activity limitations on swallowing, communication, cognition, and social relations scales relative to non–communicatively disordered stroke survivors. Conclusion: These findings support the internal consistency of the BOSS scales, the hypothesized dimensionality of the burden of stroke construct, and the known-groups validity of the instrument. 2004 Elsevier Inc. All rights reserved.