The Development Of The Theoretical Framework And Item Pool Of The Perioperative Recovery Scale For The Integrated Traditional And Western Medicine

BackgroundWestern medicine seems to be often useless or have only a limited role to solve the problems of decreased quality of life (QOL), i.e., discomfort, gastrointestinal disorders, fatigue, dizziness, coldness, score waist and so on following the surgical injury. Conversely, the Traditional Chinese Medicine (TCM) shows its advantages to solve the problems. Therefore, the treatment of the integrated traditional and western medicine may better improve the postoperative outcomes. However, the efficacy of TCM has been questioned because of the lack of tools which can achieve the accreditation from both TCM and western medicine. The efficacy of TCM is often measured by the objective criteria which is applied in the western medicine and is too much focused on microscopic index. As a result, it may lead to a bias of conclusions. Based on the patient-reported outcomes, developing a scale which is characterized by clinical recovery in the combination with traditional and western medicine is important to appropriately evaluate the effect of the integrated medicine in the postoperative populations and provide support for the therapeutic efficacy assessment in the integrated traditional and western medicine.ObjectiveTo establish the theoretical framework and item pool of the perioperative recovery scale with the clinical characteristics of integrative traditional and western medicine, and to prepare for the development of this scale and the psychometric testing. An objective, comprehensive and generic instrument used to measure the patient-reported outcome (PRO) in perioperative recovery will be developed subsequently.MethodsAccording to the international guidance for developing scale, literature review and expert consultation were adopted.1. Literatures reviews(1) The extensive literatures on TCM library stacks in Guangzhou University of Chinese Medicine and Chinese Medical Classics CD-ROM were searched to identify theories of TCM that could be the guidance for theoretical framework(2) The literatures which related to quality of life (QOL) for TCM or integrated traditional and western medicine, the QOL or PRO studies of surgery and the postoperative recovery on VIP Information system V 6.33 and Wanfang database were searched. The established scales were viewed to provide relevant dimensions, items and the developing procedure.(3)A systematic literature searching on PubMed, EBSCOhost, Web of patient-reported outcome and quality of life (http://www.proqolid.org) and Google Scholar online was performed to identify the articles about the generic or specific instruments which can assess the postoperative rehabilitation and the developing methods of scales accepted by international society. The established instruments were viewed to provide relevant dimensions, items and the developing procedure.2. Expert consensusThe surgical and gynecological specialists, experts in clinical epidemiologist and statistician were invited to join discussion. The expert consultation at the first round concerning the feasibility of the study and the aspects we should pay attention to was held before the study. In the second round of expert consultation following the literature search, the experts were encouraged to discuss the content and the range of the scale available as well as to advice the frequency of using the scale and how many items should it consist of, etc. The initial theoretical framework for the perioperative recovery scale of the integrated traditional and western medicine was developed by literature and expert review. Thereby the item pool was generated from the theoretical framework.ResultSeven foreign instruments and a domestic instrument which were directly related with surgery and anesthesia from 1976 to 2010 were useed by the literature review. In the light of the purpose of developing the scale, the initial theoretical framework for the perioperative recovery scale of integrative traditional and western medicine was developed in terms of the comprehensive analysis of the eight scales'theoretical framework, items and the expert opinions. The scale should incorporate the domains of physical function, mental function, activity function, general health perceptions and pain. Besides these domains, a social function is involved before the surgery and after discharge in a longer perspective. We consider that the facets of the scale should encompass the five organs'function of TCM, qi-blood, meridian, yin-yang and the patient-reported outcomes according to the theories of TCM. The pathogenesis of surgical diseases in TCM is mainly related to the disorders of the organs, qi-blood and yin-yang, the original prognosis of surgical illness is also related to the five organs in the ancient Chinese medicine. According to above-mentioned TCM theory, the facets of the domains were included. With threr was considered reviews and discuss, totally 122 items were embodied in the item pool of the scale, which 49 items were grouped under the dimensions of physical function,24 under the mental function,25 under the activity,12 under the pain,5 under the general health perceptions and 7 under the social function. The combination of domains, facets with items is the embodiment of the integrated traditional and western medicine.ConclusionThe initial theoretical framework for the perioperative recovery scale of the integrated medicine is of characteristics with TCM for it contains the view of western medicine in the domains and the theories of TCM in the facets. As a result, the instrument shall be used as a postoperative recovery outcome measure for comprehensive evaluation of the treatment of the integrated traditional and western medicine.