Quality of Postoperative Recovery in Children and Young People
Condition: Quality of Recovery
Study type: Observational

Summary: 
      Provision of high-quality anaesthesia is a fundamental goal of all anaesthetic services.
      Establishing whether this is being achieved requires validated measures of anaesthetic
      outcomes but few of these exist, particularly for children.

      QoR-15 (quality of recovery, 15 items) is a questionnaire that has been validated in adults
      and assesses the quality of postoperative recovery from surgery. The investigators have
      developed a modified version, the PaedQoR-15, that the investigators hope is capable of
      performing the same task in children and young people. The principle aim of this study is to
      assess whether PaedQoR-15 is a valid, reliable and clinically acceptable measure of the
      quality of postoperative recovery in children and young people.

      The investigators would also like to consider whether parent/guardian assessments of their
      child's recovery correlate with self-reports. At Great Ormond Street a significant proportion
      of children are unable to answer for themselves. If parent/guardian responses represent a
      good approximation then this questionnaire may have a role in assessing the quality of
      recovery in a population of children who are difficult to care for.
    

Detailed description: 
      In adults a number of instruments have been developed that measure quality of recovery
      following surgery. The best of these, and the most extensively utilised in other studies, is
      the QoR-40 (quality of recovery questionnaire with 40 items) developed by Myles and
      colleagues. QoR-40 is a global measure of recovery incorporating five dimensions; patient
      support, comfort, emotions, physical independence and pain. They developed this questionnaire
      from their database of 10,000 patients who had been contemporaneously interviewed about their
      postoperative experiences. A recent meta-analysis found QoR-40 to be a high-quality
      instrument, sensitive to clinical change and appropriate for purpose.

      The only significant problem with QoR-40 is the time taken to complete it; an average of just
      over 6 minutes. In response to this the same group developed a shorter version, QoR-15
      (quality of recovery questionnaire with 15 items) incorporating elements from all five
      original domains. The QoR-15 has been validated in adults and correlates well with QoR-40 and
      takes only 2.5 minutes to complete. However, the average age of the test population was 56
      years (+/- 16 years) with a range from 18 to 85 years.

      QoR-15 has not been used previously in children, so in preparation for this study the
      investigators trialed it in ten children to assess its basic acceptability. The investigators
      also carried out more extensive cognitive interviews in 5 children to assess whether children
      interpreted the meaning of the questions as intended. As a consequence, minor modifications
      have been made to the wording of some questions. For example, a question about feeling able
      to return to work has been changed to a question about feeling able to return to school/
      college. The investigators also changed a question asking about the presence of moderate pain
      to a question about any pain, as children did not distinguish between moderate and mild pain
      and interpreted the original question as meaning low levels or any pain.

      The visual representation of the scoring scheme has also been modified, as children found the
      original QoR-15 scales confusing. This will not affect the final scoring or the weighting
      given to any question in any way, it simply makes the scoring easier for children to
      understand. This modified questionnaire has been termed the PaedQoR-15 and it is this version
      that will be assessed in our patient population.
    

Intervention name(s): PaedQoR-15 questionnaire
Intervention type(s): Other
Intervention description(s): Children/ young people and one parent/ guardian will complete the questionnaire before and after general anaesthesia for surgery or diagnostic imaging.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children/ young people aged between 10 and 18 years undergoing general anaesthesia for
        surgery or diagnostic imaging
      
Keywords: children; surgery