Assessment of postoperative vigor in patients undergoing elective total joint arthroplasty: a concise patient- and caregiver-based instrument.

Abstract

Assessment of early postoperative recuperative power (i.e., vigor and functional ability) in surgery patients is considered to be important for optimizing patient rehabilitation, discharge planning, and health system resource utilization. However, no broadly accepted method of patient assessment has been available to measure these parameters. Therefore, a panel of experts was assembled to design an instrument to assess recuperative power in the total joint arthroplasty setting. The instrument consists of both subjective, patient-based, preoperative and postoperative, fixed-ended questions and objective, caregiver-based measures of patient function (i.e., muscle strength and hematocrit [HCT]). The prototype instrument employed the vitality subscale of the Short Form-36 (SF-36), the activities of daily living items from the Western Ontario and McMaster University Osteoarthritis Index (WOMAC-ADL), as well as three novel scales: Well-being, Ready to resume activities, and Ready to leave the hospital. The instrument was tested in 65 patients at two medical centers. The reliability and validity of the three novel psychometric scales were tested by measuring internal consistency and validity by comparison with the standard scales. Postoperative patient Well-being and Ready scales correlated strongly with muscle strength (P < .01), while postoperative HCT correlated with muscle strength (r = 0.4) and Ready scale (P < .01). This analysis suggested that patient well-being and readiness to resume normal activities may be the best surrogates of patient vigor and that these parametric assessments correlate well with functional and laboratory measures of vigor (i.e., muscle strength and HCT). Based on these findings, the final instrument (Version 4.2) consists of a patient questionnaire that can be completed within approximately 5 minutes (12 preoperative and 14 postoperative questions), and a caregiver questionnaire that includes two objective functional tests: muscle strength and HCT. In conclusion, postoperative vigor may be able to be assessed with a concise, patient-based instrument and may provide valuable information for rehabilitation and discharge planning. The utility of this instrument is currently being assessed in a prospective clinical study.