MMPI Scale Scores Research Articles

Comparability of MMPI-3 scores from remote and in-person administrations and the impact of the COVID-19 pandemic on MMPI-3 scores.

The COVID-19 pandemic onset necessitated remote administration of psychological instruments, including the Minnesota Multiphasic Personality Inventory-3 (MMPI-3). Although previous evidence has demonstrated that MMPI scale scores are robust across administration modalities, the specific effects of remote administration on the psychometric properties of MMPI-3 scale scores must be investigated. Distinguishing psychometric differences due to administration modality from substantive changes in psychological symptoms due to the COVID-19 pandemic is also important. Thus, goals of the present study include evaluating the psychometric comparability of MMPI-3 scores derived from in-person and remote administration modalities and examining substantive scale scores changes associated with the COVID-19 pandemic. Using a large sample of college students (n = 2,503), rates of protocol invalidity, mean scale scores, reliability, and criterion validity were compared across participants completing the MMPI-3 in-person (both prior to and after the onset of COVID-19) and via remote administration. Results demonstrate comparably low rates of protocol invalidity, negligible differences in reliability, and similar patterns of criterion validity for MMPI-3 scale scores across administration modalities. Results also indicate that mean MMPI-3 scale scores pre- and post-COVID-19 onset substantially differ on select scales, but that scores on remote and in-person protocols administered post-COVID-19 have negligible differences. Remote MMPI-3 scale scores also demonstrated expected patterns of correlations with external criteria, supporting the validity of remote scores. Overall, the present study demonstrates that MMPI-3 protocols administered remotely and in-person are extremely psychometrically similar, although scores have generally increased post-COVID-19 onset for reasons independent of administration modality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Role of Depression and Anxiety As Mediators Between Insomnia Symptoms and Suicide Ideation in Patients With Adjustment Disorder

Objective: The aim of this study was to evaluate whether insomnia can independently affect suicide ideation or whether insomnia affect suicide ideation by mediating depression or anxiety in adjustment disorder (AD). Methods: Electronic medical records were retrospectively reviewed for 65 patients with diagnosed AD visited an outpatient clinic between January 2018 and December 2020. Measurements include the Insomnia Severity Index (ISI), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Statistical analyses were performed to assess relationship between insomnia and suicide ideation in AD and the mediating role of depression or anxiety in this association. Results: During 3 years of study period, of the AD patients, 37 (57%) were male and 28 (43%) were female. Among them, 45 (69.2%) and 23 (35.4%) had clinically significant symptoms of insomnia (ISI ≥15) and suicide ideation (MMPI scale score ≥70), respectively. In a mediation model using depression and anxiety as mediating variable, there were significant effects of insomnia on depression (t=5.55, p<0.001) and anxiety (t=6.21, p<0.001) and of depression (t=5.70, p<0.001) and anxiety (t=3.54, p<0.001) on suicide ideation. Total effect of insomnia on suicide ideation was statistically insignificant, suggesting complete mediation. Conclusion: A significant association with suicide ideation was observed in the case of insomnia accompanied by depression and anxiety. Therefore, in patients with AD who complain of insomnia, symptoms of depression and anxiety should be evaluated by clinicians with active intervention for suicide ideation.

CORRELATION BETWEEN EMOTIONAL INTELLIGENCE INDICES AND WORKPLACE AMBULATORY BLOOD PRESSURE LEVEL IN PATIENTS WITH HYPERTENSION

Objective: The aim of our study was to determine correlation relationship between ambulatory blood pressure level in workplace and emotional intelligence (EI) in untreated patient with arterial hypertension (AH). Design and method: We analyzed 200 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00, nighttime – 0.00–6.00, and work period as 11.00–19.00 (BPw). After ABPM session patients completed the PS and EI questionnaire: “Minnesota Multiphase Personality Inventory”(MMPI) and “EmIn Questionnaire” (only for 70 patients), by Lyusin D, 2006. We analyzed following EmIn scale scores: I - emotion self-awareness; II - management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V - management of others’ emotions. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean workplace systolic BP level (SBP) was 141.5 ± 15.5 and diastolic (DBP) - 89.4 ± 11.2 mm Hg (M ± SD). We have found the following correlations (p > 0.05): V scale scores (management of others’ emotions) and II (management of one's own emotions) of EmIn Questionnaire positively correlated with workplace SBP level (r = 0,36 and 0,31 respectively), and V scale scores related with DBP workplace level (r = 0,38). MMPI scale scores (psychological questionnaire) did not correlate with SBP and DBP workplace levels. Thus, V and II scale scores of “EmIn Questionnaire” (management of others’ and one's own emotions) was related with workplace BP level. Conclusions: Management of others’ and one's own emotions (V and II scale scores of “EmIn Questionnaire) was related with workplace SBP and DBP levels.

PP.26.14] CORRELATIONS BETWEEN PSYCHOLOGICAL STATUS, QUALITY OF LIFE SCORES AND LEFT VENTRICULAR MASS INDEX, AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH HYPERTENSION

Objective The aim of our study was to determine correlations between psychological status and quality of life with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM device (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the questionnaires. Left ventricular mass index (LVMI) (L. Teichholtz et al., 1976) was measured using echocardiography. We assessed the following QL scale scores (General Well-Being Questionnaire by J.Siegrist et al.): I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. We analyzed the following MMPI scale scores (Minnesota Multiphasis Personality Inventory): L – lie scale, F – aggravation scale, K – correction scale, 1 – hypochondria, 2 – depression, 3 – hysteria, 4 – psychopathy, 6 – rigidity of affect, 7 – psychasthenia, 8 – schrizothemia, 9 – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) −89.1 ± 9.0 mm Hg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = −0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = −0.23, r = −0.24 respectively, p < 0.05) and with SBP load variables (r = −0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices.Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation not only with LVMI, but also to SBP indices. Conclusions It was identified inverse correlation between psychological status (energy, optimism, good mood) and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no significant links between QL scales scores and LVMI, ambulatory BP indices.

PP.01.30] PSYCHOLOGICAL STATUS SCORES RELATED WITH LEFT VENTRICULAR MASS INDEX AND MEAN AMBULATORY BLOOD PRESSURE VARIABLES IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Objective: The aim of our study was to determine correlations between psychological status and quality of life scores with left ventricular mass index and mean ambulatory blood pressure variables in patients with arterial hypertension (AH). Design and method: We analyzed 76 ambulatory blood pressure monitoring (ABPM) data of AH patients. ABPM monitor (Spacelabs 90207) was applied after the washout period. After ABPM session patients completed the QL questionnaire “General Well-Being Questionnaire” (J.Siegrist et al.). Left ventricular mass index (LVMI) (L. Teichholtz et all., 1976) was measured using echocardiography (Acuson 128XP). We assessed the following QL scale scores: I - physical well-being, II - physical performance, III - positive psychological well-being, IV - negative psychological well-being, V - psychological performance, VI - social well-being, VII - social performance. Also, patients completed the psychological questionnaire “Minnesota Multiphasis Personality Inventory” (MMPI). We analyzed the following MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The mean ambulatory systolic BP (SBP) was 136.1 ± 11.2; diastolic (DBP) - 89.1 ± 9.0 mmHg (M ± SD). LVMI – 122,1 ± 24,9 g/m2. We found the following correlations: 1) 9 MMPI scale scores (energy, optimism, good mood) were negatively correlated with LVMI (r = -0.33, p < 0.05); 2) 9 MMPI scale scores had the negative relationships with clinical and ambulatory SBP levels (r = -0.23, r = -0.24 respectively, p < 0.05) and with SBP load variables (r = -0.25, p < 0.05). There were no significant links between QL scales scores and LVMI, ambulatory BP indices. Thus, energy, optimism, good mood (9 MMPI scale scores) had a negative correlation with LVMI, also to SBP indices. Conclusions: It was identified inverse correlation between energy, optimism, good mood and LVMI indices, and also with clinical and ambulatory SBP variables of AH patients. There were no links between QL scores and LVMI, ambulatory BP indices.

OP.1A.09] THE RELATIONSHIP BETWEEN THE AGGRESSION LEVEL OF PATIENTS WITH ARTERIAL HYPERTENSION AND THE ANTIHYPERTENSIVE DRUG EFFECTIVENESS

Objective: The aim of study was to define relationships between psychological traits of patients with arterial hypertension (AH) and the antihypertensive drug effectiveness.Design and method: We analyzed ambulatory blood pressure monitoring (ABPM) data of 275 patients with AH without serious concomitant diseases We used data base of several studies with the same design: 1) the washout period duration - 1–2 weeks; 2) initial ABPM session (SpaceLabs 90207) before treatment; 3) treatment with standard therapeutic doses (amlodipin, diltiazem, metoprolol, betaxolol, enalapril, moxonidin, lisinopril) with the addition of diuretic if needed; 4) psychological status assessment was performed by the psychological questionnaire “Minnesota Multiphase Personality Inventory”(MMPI) before and at the end of the treatment. The antihypertensive therapy effectiveness (ATE) was assessed as the difference between mean ABPM levels before and after treatment. We used Spearman Partial Coefficient for correlation analysis adjusted for age, sex and duration of AH. Results: The initial mean daytime BP level was (M ± SD): systolic (SBP) - 140.1 ± 11.2, diastolic (DBP) - 90.2 ± 9.1 mmHg. We found following correlations (r) (p < 0.05): 1) negative – between ATE and leadership traits, aggression level (6 MMPI scale score) (r = −0,21) 2) positive - between ATE and optimism, cheerfulness (9 MMPI scale score) (0,20) (see table). Conclusions: Conclusion: Thus leadership traits, aggression had a negative correlation with the effect of antihypertensive treatment. While high optimism, cheerfulness level predict significantly better results of antihypertensive therapy.

3C.06

Objective: The aim of our study was to determine relationship between emotional intelligence (EI), psychological status (PS) and mean ambulatory blood pressure monitoring (ABPM) level, white coat effect (WCE) in untreated patients with arterial hypertension (AH). Design and method: We analyzed 150 ambulatory blood pressure monitoring (ABPM) data of AH patients without serious concomitant diseases. ABPM monitor (Spacelabs 90207) was applied after the washout period. We defined daytime period as 8.00–22.00 (BPd), nighttime – 0.00–6.00 (BPn). After ABPM session patients completed the PS and EI questionnaire: “Minnesota Multiphase Personality Inventory” (MMPI) and “EmIn Questionnaire” (by Lyusin D.). We assessed following EmIn scale scores: I - emotion self-awareness; II- management of one's own emotions; III - control of emotional expression; IV - understanding others’ emotions; V - management of others’ emotions. We used Spearman Partial Coefficient for correlation (r) analysis adjusted for age, sex and duration of AH. Results: The mean daytime systolic BP (SBP) was 139.1 ± 12.7, diastolic (DBP) - 83.1 ± 9.9 mm Hg (M ± SD). We found the following correlations (p > 0.05): 1) 9 MMPI scale scores (energy, optimism, good mood) with WCE for SBP (r = -0.28) and mean clinical SBP (r = -0.25); 2) III scale scores (control of emotional expression) with WCE for DBP (r = -0.24); 3) I scale scores (emotion self-awareness) with mean clinical SBP (r = 0.27); 4) IV scale scores (understanding others’ emotions) with mean clinical DBP and SBP (r = 0.34, r = 0.31) and with mean ambulatory DBP and SBP. For mean 24 hours SBP, SBPd r = 0.25 and r = 0.25, for 24 hours DBP, DBPd, DBPn r = 0.30, r = 0.29, r = 0.24 respectively. Energy, optimism, good mood (9 MMPI scale scores) and good emotion self-control levels (I scale scores) had a negative correlation with WCE levels and mean clinical SBP. Perception of own or other people's emotions (II and IV scale scores) positively correlated with levels of clinical and ambulatory BP. Conclusions: Energy, optimism, good mood and good emotion self-control in AH patients at the clinic may reduce WCE and mean clinical SBP levels. Excessive perception of their own or other people's emotions (II and IV scale scores) can lead to increased clinical and ambulatory BP levels.

VARIABILITY OF COLOR CHOICE IN THE LUSCHER COLOR TEST—SEX DIFFERENCES

In this preliminary investigation of variability of responses on the Lüscher Color Test, subjects were 567 volunteers administered the test twice with a 10-min. interval between them. Two hypotheses were tested: (a) that variability of responses attests to the personality of the respondent (tested by the relations of variability and MMPI scale scores), and (b) variability of responses is based on learning the test's content. As such, men's scores should be more variable than women's. Analysis showed that variability was not correlated with scores for personality on the MMPI scales. Men's scores are more variable than women's, but only until age 45.

Conditional standard error of measurement and personality scale scores: an investigation of classical test theory estimates with four MMPI scales

Abstract This study is a preliminary examination of the fit of three classical test theory models of standard error of measurement to selected personality scale (MMPI) score retest data. The three models compared are the conventional standard error of measurement formula, Lord’s (1955: Lord, F. M. (1955). Estimating test reliability. Educational and Psychological Measurement, 15, 325–336) conditional standard error of measurement formula, and Keats’ (1957: Keats, J. A. (1957). Estimation of error variances of test scores. Psychometrika, 22, 29–41) conditional standard error of measurement formula. Absolute mean error differences between test and retest MMPI scale scores were calculated from boot-strapping (with replacement) a sample of MMPI scale retest scores for 271 psychiatric patients. It was found that, on average across 5000 samplings, Keats’ conditional standard error of measurement formula produced less average absolute difference between estimated and actual MMPI absolute test–retest scale score differences than did the conventionally-employed standard error of measurement formula, and less average absolute error difference than Lord’s conditional standard error of measurement. Potential implications for practitioners in establishing cut-scores for patient classification are raised.

入学時のMMPI尺度得点とそれによる留年予測の困難性

We tested students with MMPI tests on their entrance into medical school, and tried to find the current features of scale scores of the tests as compared with the Japanese reference values obtained more than 25 years before. Since the data consisted of responses for two Japanese language translation versions of the tests we stratified the data by version, sex and calendar year, respectively and calculated means and standard deviations of 14 scale scores in each stratum. By comparing with the mean values of standard population, we found lower Si and higher K scores in both male and female, and significant differences in Mf scores between male and female students. On the other hand, we found neither differences due to temporal trends nor differences between versions of the test. More importantly, we were unable to find differences between successful students and those who had had to repeat a year. Indeed, correct predictions, using a linear discriminant function based upon seven of the scales, were only 60% in male and 64% in female students, respectively. Now, when we used a simple assumption as the diagnostic rule-that no students repeated-then 64% of male and 83% of female students were correctly classified; a result superior to the discriminant function rule. However, by using a different linear discriminant function, with variables selected directly from 550 unit items of MMPI test battery, we were able to attain marginally better separation than the simple rule, but for male students only. In conclusion, it is difficult to obtain a practical prediction rule using MMPI scale scores, even though use of the unit items of MMPI might improve accuracy of predictions.

Attention deficits disorder and drug abuse.

Recent research studies have attempted to explore various aspects of attention deficit disorder and substance abuser subtypes. The purpose of the present study is to evaluate the effect of drug abuse on MMPI scale score profiles of alcoholics with or without attention deficit disorder symptoms. For the alcoholic group with ADDRT versus the alcoholic group with ADDRT and drug abuse there were no significant differences between the groups. The hypothesis that the factor of drug abuse would account for MMPI score differences between alcoholics with or without ADDRT failed to be supported. Regardless of whether or not the subject groups contained drug abusers or not, the ADDRT-diagnosed groups demonstrated clinically significant levels of psychopathology on the MMPI profiles. These results would suggest that the variable of ADDRT diagnosis is probably an important factor to consider in substance abuser populations.

An empirical demonstration of the problem of cluster dissimilarity from different clustering methods in a single sample

This study utilized the four most commonly employed clustering techniques (CLINK, SLINK, UPGMA, and Ward's) to illustrate the dissimilarity of cluster group membership (based upon short-form MMPI scale scores and a measure of alcohol dependency) between partitions in a sample of 113 impaired driving offenders. Results, examined with the Rand index of cluster comparison, demonstrated that cluster group membership can be so different between alternative clustering methods as to equal chance assignment. Cautions are given with regard to the use of cluster analysis for other than exploratory work. In particular, psychologists are cautioned against attempting to use cluster analysis based upon personality inventory scores (which can never be wholly reliable or discrete) for patient classification.

Stability of MMPI Scale Scores Within Four Codetypes Across Forty Years

Stability of MMPI Scale Scores Within Four Codetypes Across Forty Years

Neurotic traits and disease duration in headache patients.

The purpose of this study was to test the hypothesis that duration of illness is correlated with neurotic personality traits. Four hundred and eighteen patients with migraine, tension, and mixed headaches were studied. The MMPI was used to evaluate the patients' personality characteristics. Scales employed were: scale 1--hypochondriasis, scale 2--depression, scale 3--hysteria, and scale 7--psychasthenia. The MMPI scale scores were analysed with regard to sex, diagnosis, and duration of illness. Patients with mixed headaches showed significantly more elevated scores on the MMPI scales than those suffering from migraine and tension headaches. No correlation was found between any of the MMPI scale scores and the duration of illness. No interaction was found between duration of illness and the diagnostic categories of headache in determining the MMPI neurotic scale scores. It is hypothesized that the higher MMPI scores found in patients with mixed headache is characteristic of these patients.

Life stress and clinically elevated MMPI scales: Gender differences in the moderating influence of coping

Coping styles were evaluated as moderators of life stress-psychopathology relationships. Five hundred twenty-one undergraduates (271 females and 250 males) completed the Life Experiences Survey, the Coping Strategies Inventory, and the MMPI. To assess maladaptive coping styles, groups were constructed for each of 8 clinical scales (Hs, D, Hy, Pd, Pa, Pt, Sc, and Ma) composed of all subjects with a clinically significant elevation on that scale. The coping styles of these "clinical" groups were compared to the coping styles of "normal" groups, made up of subjects whose life stress scores were approximately the same but whose corresponding MMPI scale scores were within normal limits. To assess adaptive coping styles, a group of effective copers (with high life stress but normal MMPI profiles) was compared to a group of less effective copers (with high life stress but with at least one scale outside of normal limits). All groups were constructed separately for gender. The predicted gender differences and specific coping style-psychopathology relationships were, by and large, found. Coping style differences between the effective and less effective copers were also found. These findings suggest that several coping styles are important moderators of life event stress-psychopathology relationships.

Traumatogenicity: Effects of self-reported noncombat trauma on MMPIs of male Vietnam combat and noncombat veterans treated for substance abuse

A recent review of the literature on Post-Traumatic Stress Disorder (PTSD) and the MMPI has shown that all previously published studies have been limited to clinical groups whose trauma occurred in Vietnam combat. The purpose of this study was to test hypotheses that predict higher MMPI and PTSD scale scores among combat veterans who differ in degrees of noncombat traumas. Results support predictions. Those who reported more noncombat traumas attain significantly higher MMPI scores for scales F, Hypochondriasis, Hysteria, Psychopathic Deviate, Psychasthenia, Schizophrenia, Mania, Social Introversion, and an MMPI PTSD score (Keane, Malloy, & Fairbank, 1984). Moreover, noncombat effects are manifested differentially: Combat veterans with higher noncombat trauma evidence greater social withdrawal, whereas noncombat veterans who report higher noncombat trauma are characterized by higher anxiety. MMPI elevations were progressively higher as groups increased in degrees of combat and noncombat trauma: noncombat and low combat trauma veterans were the better adjusted, and combat veterans with higher noncombat trauma were the worst adjusted. Results provide descriptive validity for PTSD as a construct and underscore the importance of assessing frequency and intensity, as well as types of traumas and stresses, in the background histories of substance abusers and other clinical groups as well.

Depression associated with chronic pain: incidence, characteristics, and long-term outcome.

Of 98 consecutive patients admitted to a pain management program for patients with nonmalignant chronic pain, 34 were definitely depressed, 20 were probably depressed, and 44 were not depressed by research diagnostic criteria (RDC). At the time of admission, no characteristic differences were observed among the three study groups except for, by definition, the presence of a RDC diagnosis of major depression (definite or probable) and an associated increase in Hamilton depression scale score and a group of MMPI scale scores. There was a 98% improvement rate for depression by participation of the patients in a nonpharmacologic program for nonmalignant chronic pain; there were no differences in frequency of depression among the three study groups at the time of dismissal. This progress was maintained at long-term follow-up (average, 11.6 months): 87 of 98 patients (88.8%) remained nondepressed.

Birth order effects in second-generation alcoholics.

The effects of birth-order position (first-, middle- and last-born) in intact families with three children on the psychopathology scores of second-generation alcoholics were examined by administering the MMPI to 90 alcoholic sons of alcoholic parents. Analyses of variance (ANOVAs) applied to the individual MMPI scale scores revealed a consistent pattern of results: first borns evidenced significantly less exaggerated psychopathology scores than both groups of later borns. Most of the extreme scale scores obtained within this population of alcoholics were obtained from the later borns. Implications for previous generalizations about the alcoholic children of alcoholic parents are discussed.

Predicting the outcome of contingency contracting for drug abuse

Contingency contracting was used in an attempt to reduce the illicit drug use of 21 methadone maintenance outpatients. Eleven subjects (compliers) showed a significant reduction in illicit drug use whereas 10 subjects (violators) showed no significant change. Subject variables differentiating the two groups were examined. The variables were divided into three categories: personality (MMPI scale scores); demographic (age, education, race, marital status, and employment status); and treatment history (methadone dosage level, years of narcotic addiction, attempts at detoxification, duration of current methadone treatment, total duration of methadone treatment, frequency of drug use during baseline, and types of drugs during baseline). Treatment history variables were most useful for differentiating the two groups.

Utility of the MMPI Pain Assessment Index in predicting outcome after lumbar surgery.

A Pain Assessment Index (PAI), computed from a weighted combination of MMPI scales scores, has been developed to assess a pain patient's tendency toward continued pain complaints after surgery (Smith & Duerksen, 1979). This study examined the ability of the PAI, determined from presurgery MMPIs, to predict outcome subsequent to lumbar laminectomy and discectomy. One hundred and six chronic low back pain patients (61 males, 45 females) were categorized as having good, fair, or poor outcome 1 year or more postsurgery. Using the cutting score proposed by Smith and Duerksen (1979), the PAI correctly classified 79% of the subjects as having good or fair/poor outcome, and 87% as to whether they were working at follow-up. However, the MMPI Hypochondriasis (HS) scale alone correctly predicted the overall outcome of 83% and the work status of 81% of the subjects. The PAI (and, to a lesser extent, the HS and Hysteria [HY] scales of the MMPI) were found to have good ability to identify patients who were doing well after surgery, but low power in predicting which patients would have a fair or poor surgical result.