| Purpose and significance:Enhanced recovery after surgery(ERAS)needs to evaluate the effect of clinical practice from the perspective of patients’subjective feelings.Quality of life(QOL)assessment scale is the most commonly tool to evaluate subjective feelings.Quality of recovery-40 questionnaire(QoR-40)is one of the most frequently used and validation tool to assess the quality of life after surgery,which suitable to many kinds of clinical and scientific research.The application of QoR-40 to evaluate the effect of clinical practice from the perspective of patients’ subjective feelings will be an important content of ERAS.However,the official Chinese version of the QOR-40(QOR-40C)has not been developed and validated.The aim of the current study was to translate,culturally adapt the QoR-40C and to validate its reliability,validity and responsiveness.Patients and Methods:A systematic translation procedure comprised five stages:forward translation,rating of quality,backward translation,expert committee consultation and pilot test was established and performed to develop the QoR-40C from the original English QoR-40 version.After the pilot study,223 surgical patients were administered the QoR-40C at four time points.The reliability of the QoR-40C was assessed by test-retest reliability,split-half reliability,and Cronbach’s α coefficient.The validity of the QoR-40C was assessed by content validity,construct validity,and criteria validity.Responsiveness to clinical change was measured by paired t-test and standardized response mean(SRM).For criteria validity,the association between the QoR-40C and the SF-36 was determined to evaluate the degree of consistency.Additionally,the QoR-40C total score was compared with the VAS to assess the concurrent validity.Regarding statistics,all data including data entry,descriptive statistical analysis,paired t-test,Spearman’s correlation coefficient(p)and Cronbach’s a were all used SPSS 25.0 software(IBM,Corp)for statistical analysis.The statistical significance of all analyses was set at P<0.05.Results:In the process of translation and cross-cultural adjustment,one item in the physical independence domain of the QoR-40("able to return to work or usual activity")was replaced with another item("able to go to the lavatory by yourself").Reliability:Spearman correlation coefficient(p)for test-retest reliability of the QoR-40C total score in the morning and afternoon of POD3 was 0.917,and the test-retest reliability of each subscale was 0.913,0.927 0.789,0.945,and 0.828,respectively.The split-half reliability for all domains was 0.938 in the morning of the third day after surgery.The median item-to-own dimension and total score of Cronbach’s α for internal consistency of the QoR-40C at different assessment time points were more than 0.70.Validity:All the correlation coefficients between each subscale and the QoR-40 total score showed good correlation and were greater than those for other subscales in the morning of the third day after surgery.Furthermore,the QoR-40C total scores showed moderate positive correlation with the SF-36 in the morning of POD3(p=0.575,P<0.001).The emotional state,physical comfort,and pain subscales of the QoR-40C showed a moderate significant correlation with the mental health,vitality,and bodily pain subscales of the SF-36,respectively.Moreover,the QoR-40C and the visual analogue scale(VAS)scores in the morning of POD3 appeared to have a negative significant correlation(p=-0.299,P<0.001).The factor loadings of each item were within the required range.Responsiveness:A statistically significant difference was observed in the QoR-40C total scores before and after the surgery(P<0.001)with the standardized responsive mean(SRM)of 0.51.Conclusion:The QoR-40C showed good reliability,validity,and responsiveness and was appropriate to be used as a quality of life measurement questionnaire for patients after surgery in China.Purpose and significance:Enhanced recovery after surgery(ERAS)has been proven to be safe and effective with clinical objective indicators in gastric cancer by many studies.At present,the conclusions on the safety and effectiveness of ERAS in gastric cancer are only limited to clinical objective indicators such as average length of stay in hospital,average hospitalization cost,and postoperative complications.Patient reported outcomes(PROs)is currently considered to be an important supplement to evaluate the effects of ERAS clinical practice.QoR-40C is one of the most frequently used and validation tool to assess the subjective feelings of quality of life after surgery,which suitable to many kinds of clinical and scientific research.However,there is no research on QoR-40C in the clinical practice with ERAS in gastric cancer.Thus,the aim of the current study was to use the QoR-40C to investigate the recovery quality of patients with ERAS in gastric cancer from subjective feelings.Patients and Methods:Patients with gastric cancer undergoing radical gastrectomy were selected and divided into the ERAS group and Control group.The ERAS group was given ERAS intervention,the Control group was given conventional intervention.Data collection included time of off-bed activity,time of first flatus,time of diet initiation,time to removal of nasogastric tube,time to remove of urine catheter,visual analogues cale(VAS),hospital stay after surgery,postoperative complication rate,hospitalization cost and 30-day readmission rate.Patients were also asked to answer QoR-40 questionnaires preoperatively,on post operative day(POD)1,3,6 and 30 day.The clinical practice effect of ERAS was evaluated from objective indicators using the average hospital stay after surgery,hospitalization cost,postoperative complications rate,and 30-day readmission rate.The QoR-40C was used to assess the recovery of the quality of life of patients after surgery.The clinical practice effect of ERAS was evaluated from the perspective of patients’subjective feelings through the QoR-40C scale score.By comparing the QoR-40C in the baseline and each time point after the operation in the ERAS group,the current discharge time point was evaluated from the perspective of the patient’s subjective feelings.Regarding statistics,measurement data are expressed as mean ± standard deviation(χ±s),measurement data is compared between two groups using t test,multiple time points are compared using two-factor repeated measures analysis of variance,and count data is using chi-square test.Results:There was no statistically significant difference between the ERAS group and the control group in gender,age,height,weight,body mass index(BMI),education,nutrition,American society of anesthesiologists(ASA)classification(all P>0.05).The ERAS group was better than the control group in time of off-bed activity,time of first flatus,time of diet initiation,time to removal of nasogastric tube,time to remove of urine catheter,visual analogues cale(VAS),hospital stay after surgery,and hospitalization cost.There was no significant difference in the incidence of postoperative complications and the rate of readmission 30 days after surgery(all P>0.05).The QoR-40 scale scores of Baseline time point before surgery in ERAS group and control group were 179.59± 14.58 and 179.79± 17.34,which was not significantly different.The QoR-40 scale scores of both of the groups decreased significantly after sugery,and then gradually increased over time.Compared with the control group,the ERAS group increased faster,which was significantly different(P=0.006).In the ERAS group self-control,the QoR-40C scale scores on the first day after the operation,the third day after the operation,and the sixth day after the operation were compared with the Baseline time point,and the difference were statistically significant(all P<0.001).On POD30,the QoR-40 scores was 182.28± 13.57,which was not statistically different from that of Baseline time point 179.59±14.58(P=0.070).Conclusion:The results of this study show that the QoR-40C scale can be used to evaluate the effectiveness of gastric cancer ERAS clinical practice.It is proved that the postoperative recovery effect of gastric cancer ERAS clinical practice is significantly better than traditional models from the perspective of patients’ subjective feelings.Judging from the patient’s subjective feelings,the patient who discharged from the hospital on the sixth day after surgery were not return to the preoperative level.Purpose and significance:Exercise prehabilitation as an important part of multimodal prerehabilitation plays an important role in postoperative rehabilitation of patients.At present,no studies have been found on the effect of exercise prehabilitation on patients undergoing gastric cancer surgery.This study aimed to explore the effect of exercise prehabilitation on preoperative functional reserve and postoperative recovery of gastric cancer patients undergoing radical gastrectomy.Patients and Methods:Patients who undergoing radical gastrectomy for gastric cancer from November 2020 to March 2021 were recruited and then divided into prehabilitation(Prehab)group and control group.The Prehab group received at least 1 week of preoperative exercise prehabilitation training intervention,including 30 minutes of aerobic exercise and 10 minutes of resistance exercise;the control group used traditional interventions.Data collection included time of off-bed activity,time of first flatus,time of diet initiation,time to removal of nasogastric tube,time to remove of urine catheter,postoperative complication rate,and 30-day readmission rate.The 6 Minute Walking test(6MWT),QOR-40 score,VAS and other changes were recorded on admission(Baseline),pre-operation,postoperative day 1(POD1),postoperative day 3(POD3),and postoperative day 6(POD6)respectively.The 6MWT is used to assess the patient’s functional reserve.The QoR-40C scale is used to assess the recovery of the patient’s quality of life.The VAS score is used to assess the degree of pain in patient.By comparing the 6MWT betweent Baseline and pre-operation,the effect of exercise prehabilitation on preoperative functional reserve was evaluated.The effect of exercise prehabilitation on postoperative recovery was evaluated by comparing the time of off-bed activity,time of first flatus,time of diet initiation,time to removal of nasogastric tube,time to remove of urine catheter,postoperative complication rate,and 30-day readmission rate.The impact of exercise prehabilitation on postoperative recovery was evaluated through repeated measures analysis of variance of 6MWT,QoR-40C scale score,and VAS score.Regarding statistics,measurement data are expressed as mean±standard deviation(χ±s),measurement data is compared between two groups using t test,multiple time points are compared using two-factor repeated measures analysis of variance,and count data is using chi-square test.Results:There was no statistically significant difference between the Prehab group and the control group in gender,age,height,weight,body mass index(BMI),education,nutrition,American society of anesthesiologists(ASA)classification,operation method,and TNM classification(all P>0.05).There was no significant difference in the time of off-bed activity,time of first flatus,time of diet initiation,time to removal of nasogastric tube,time to remove of urine catheter,postoperative complication rate,and 30-day readmission rate.(all P>0.05).The baseline 6MWT of the Prehab group and the control group on the day of admission were(410.00±76.91)meters and(425.96±65.64)meters,respectively,and there was no significant difference between the two groups(P=0.597).The 6MWT of the Prehab group was(516.55±78.25)meters at the time point one day before the operation,compared with(410.00±76.90)meters in the baseline on the day of admission,the difference was statistically significant(P<0.001).There were not statistically significantly differences of postoperative 6MWT,QoR-40,VAS and complications between the Prehab group and the control group(all P>0.05).Conclusion:Exercise prehabilitation significantly improves functional capacity before operation,but it has not significant effect on postoperative rehabilitation and complication. |
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