Top Banner
Psychometric Properties of Psychometric Properties of the Ambulatory Surgery- the Ambulatory Surgery- Inventory of Nausea, Vomiting Inventory of Nausea, Vomiting and Retching and Retching (AS-INVR) (AS-INVR)
23

Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall, DrPH , RN 2 Susan Fetzer , PhD, RN 3

Jan 28, 2016

Download

Documents

royce

Psychometric Properties of the Ambulatory Surgery-Inventory of Nausea, Vomiting and Retching ( AS-INVR). Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall, DrPH , RN 2 Susan Fetzer , PhD, RN 3 Christian Apfel , PhD, MD 4 1 College of Nursing, University of Kentucky, Lexington, KY - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Psychometric Properties of the Psychometric Properties of the Ambulatory Surgery-Inventory of Ambulatory Surgery-Inventory of Nausea, Vomiting and Retching Nausea, Vomiting and Retching

(AS-INVR)(AS-INVR)

Page 2: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Jan Odom-Forren, PhD, RN, CPAN, FAAN1

Lynne Hall, DrPH, RN2

Susan Fetzer, PhD, RN3

Christian Apfel, PhD, MD4

1College of Nursing, University of Kentucky, Lexington, KY

2School of Nursing, University of Louisville, Louisville, KY

3School of Nursing, University of New Hampshire, Durham, NH

4Anesthesia and Perioperative Care, University of California, San Francisco, CA

•Funded by an unrestricted grant from Merck and Co., Inc., North Wales (PA) awarded to University of California, San Francisco and from Dr. Apfel’s Discretionary Fund for the Perioperative Clinical Research Core

22

Page 3: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Purpose Purpose

To evaluate the psychometric properties of To evaluate the psychometric properties of the AS-INVR in adults who required the AS-INVR in adults who required ambulatory surgery and experienced post ambulatory surgery and experienced post discharge nausea and vomiting (PDNV).discharge nausea and vomiting (PDNV).

33

Page 4: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Background Background

Over 34 million patients in the U.S. undergo ambulatory surgery each year and PDNV affects 35-55% of outpatients.

Reliable and valid measures of the incidence and severity of PDNV are lacking.

The Ambulatory Surgery-Inventory of Nausea, Vomiting and Retching (AS-INVR) is a short measure of PDNV adapted from the Rhodes Index of Nausea and Vomiting for the ambulatory surgery population.

The psychometric properties of the AS-INVR were evaluated in only one prior study with ambulatory surgery patients.

44

Page 5: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Specific AimsSpecific Aims

1.1. Explore the dimensionality of the Explore the dimensionality of the

AS-INVR. AS-INVR.

2. Examine the internal consistency 2. Examine the internal consistency reliability of the AS-INVR.reliability of the AS-INVR.

3. Evaluate the construct validity of the 3. Evaluate the construct validity of the

AS-INVR.AS-INVR.

55

Page 6: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Hypothesis Testing for Construct Hypothesis Testing for Construct ValidityValidity

H1: Persons with PDNV will have a higher H1: Persons with PDNV will have a higher mean AS-INVR score than those `mean AS-INVR score than those `without.without.

H2: Higher AS-INVR scores will be H2: Higher AS-INVR scores will be associated with lower quality of life associated with lower quality of life scores scores related to nausea.related to nausea.

H3: Higher AS-INVR scores will be H3: Higher AS-INVR scores will be associated with lower quality of life associated with lower quality of life scores scores related to vomiting.related to vomiting.

66

Page 7: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

MethodsMethods

Design and SampleDesign and Sample– Multi-site prospective study of a convenience Multi-site prospective study of a convenience

sample of 203 adults after ambulatory surgery sample of 203 adults after ambulatory surgery from Day of Surgery through Day 5 post-op.from Day of Surgery through Day 5 post-op.

– The purpose of the larger study was to The purpose of the larger study was to identify the incidence and management identify the incidence and management strategies of adult patients after ambulatory strategies of adult patients after ambulatory surgery.surgery.

– Eligible participants were recruited Eligible participants were recruited consecutively either in preadmission testing or consecutively either in preadmission testing or in the preoperative area on the day of surgery.in the preoperative area on the day of surgery.

77

Page 8: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Inclusion/Exclusion Inclusion/Exclusion CriteriaCriteria

Inclusion Criteria– At least 18 years of age or older and undergoing

outpatient surgery– Received general anesthesia requiring an endotracheal

tube or laryngeal mask anesthesia

Exclusion Criteria– Unable to communicate in English– Transferred to inpatient stay– Current pregnancy– Persistent or recurrent nausea and/or vomiting before

anesthesia

88

Page 9: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

MeasuresMeasures

Post Discharge Nausea (PDN) Severity Post Discharge Nausea (PDN) Severity Quality of Life (QOL)Quality of Life (QOL)Ambulatory Surgery-Inventory of Nausea, Ambulatory Surgery-Inventory of Nausea, Vomiting and RetchingVomiting and RetchingSociodemographic characteristicsSociodemographic characteristicsClinical characteristicsClinical characteristics

99

Page 10: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

ProcedureProcedure

Protocol approved by Institutional Review Protocol approved by Institutional Review BoardBoard

Written informed consent obtainedWritten informed consent obtained

Data collected via phone interview and Data collected via phone interview and mailed patient diarymailed patient diary

1010

Page 11: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Data Analysis Data Analysis

Principal components analysis followed by Principal components analysis followed by exploratory factor analysis with Varimax rotation exploratory factor analysis with Varimax rotation to determine the instrument’s dimensionalityto determine the instrument’s dimensionality

Cronbach’s alpha to assess internal consistency Cronbach’s alpha to assess internal consistency reliability. Coefficients greater than .70 were reliability. Coefficients greater than .70 were considered to represent good internal considered to represent good internal consistency.consistency.

Independent samples t-test and correlational Independent samples t-test and correlational analysis for hypothesis testing to evaluate analysis for hypothesis testing to evaluate construct validity.construct validity.

1111

Page 12: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

RESULTSRESULTS

1212

Page 13: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Sample DescriptionSample Description

Mean age 55 Mean age 55 ++ SD 15.4; range 23-87 SD 15.4; range 23-87 yearsyears

Female 72%; Caucasian 93%Female 72%; Caucasian 93%

Presence of PDNV 56%Presence of PDNV 56%

Conventional surgery 36%; laparoscopic Conventional surgery 36%; laparoscopic surgery 35%surgery 35%

American Society of Anesthesiologists’ American Society of Anesthesiologists’ Physical Status II—70%Physical Status II—70%

1313

Page 14: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Exploratory Factor Analysis withVarimax Rotation of Two Factorsa

  Day 1 (n = 202) Day 2 (n = 203) Day 3 (n = 201) Day 4 (n = 200) Day 5 (n = 197)

Item Factor 1 Factor 2 Factor 1 Factor 2 Factor 1 Factor 2 Factor 1 Factor 2 Factor 1 Factor 2

4. In the last 24 hours, I have felt nauseated or sick at my stomach.

.89 .16 .91 .25 .91 .21 .92 .26 .97 .02

7. In the last 24 hours, I have felt nauseated or sick at my stomach _ times.

.86 .24 .91 .19 .91 .18 .99 .10 .96 .04

5. In the last 24 hours, I have felt nauseated or sick at my stomach ____hours.

.83 .27 .90 .20 .96 .16 .90 .25 .98 .05

2. In the last 24 hours, from retching or dry heaves I have felt ___distress.

.44 .38 .40 .45 .33 .02 .26 .35 .47 .19

3. In the last 24 hours, from vomiting or throwing up, I have felt ___distress

.23 .91 .19 .63 .18 .83 .15 .68 .10 .995

6. In the last 24 hours, each time I threw up I produced a ____amount.

.19 .78 .16 .87 .09 .90 .17 .86 .10 .995

1. In the last 24 hours, I threw up _____times.

.23 .74 .17 .88 .15 .88 .12 .84 .10 .995

a Sample size varies from 197-203.Note: Factor 1 = Nausea; Factor 2 = Vomiting. 1414

Page 15: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Internal Consistency Internal Consistency ReliabilityReliability

Cronbach’s alphas were > .80 for the 7-item AS-Cronbach’s alphas were > .80 for the 7-item AS-INVR and the shortened 6-item AS-INV, INVR and the shortened 6-item AS-INV, indicating strong internal consistency of both indicating strong internal consistency of both measures in this sample of ambulatory surgery measures in this sample of ambulatory surgery patients. patients.

1515

Page 16: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Factor Structure and Cronbach’s Alphas for Factor Structure and Cronbach’s Alphas for the 7-Item AS-INVR by Day the 7-Item AS-INVR by Day Post-surgery a,b

Postoperative

Day

Items

Composing

Factor 1

Nauseac

Items

Composing

Factor 2

Vomitingc

Mean Inter-

Item

Correlations

Range of

Corrected Item-

Total

Correlations

Range of

Alphas if One

Item Deleted

Cronbach’s

Alpha

1 2,4,5,7 1,3,6 .49 .54-.78 .82-.86 .87

2 4,5,7 1,2,3,6 .48 .44-.85 .78-.85 .87

3 4,5,7, 1,3,6 .41 .30-.91 .69-.81 .83

4 4,5,7 1,3,6 .44 .37-.89 .74-.83 .85

5 2,4,5,7 1,3,6 .43 .25-.89 .71-.83 .84

aAS-INVR = Ambulatory Surgery-Inventory of Nausea, Vomiting, RetchingbSample size varies from 197-203.cResults based on exploratory factor analysis with Varimax rotation; all factor loadings were .40 or greater. 1616

Page 17: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Internal Consistency Internal Consistency

of the AS-INV of the AS-INV a,b

Cronbach’s Alphas for 6-item Version AS-INV by Dimension and Postoperative Daya,b 

Day Factor 1 Factor 2

1 .92 .88

2 .95 .95

3 .96 .96

4 .97 .97

5 .98 .98

1717

a Ambulatory Surgery-Inventory of Nausea and Vomitinga Ambulatory Surgery-Inventory of Nausea and Vomitingb Sample size varies from 197-203.b Sample size varies from 197-203.

Page 18: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

CONSTRUCT VALIDITYCONSTRUCT VALIDITY

1818

Page 19: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Differences in Mean AS-INVR and Differences in Mean AS-INVR and

AS-INV Scores by Presence AS-INV Scores by Presence

of PDNV and Post-Op Day of PDNV and Post-Op Day a, b

 

Post-op Day 

Measure 1 2 3 4 5

AS-INVR          

PDNV 5.62 + 4.44 5.34 + 4.07 4.53 + 3.13 4.74 + 3.59 4.00 + 2.38

No PDNV .19 + .81 .51 + 1.64 .23 + 1.15 .20 + .90 .15 + 1.11

AS-INV          

PDNV 5.17 + 3.88 5.04 + 3.59 4.44 + 2.91 4.52 + 3.40 3.94 +2.24

No PDNV .19 + .81 .49 + 1.52 .21 + 1.11 .20 + .90 .11 + .85

a Sample size varies from 197-203.b All comparisons significant at p < .001.

1919

Page 20: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

Correlations of the 6-Item AS-INV Scores with QOL-N, QOL-V, and Mean PDN Scores

by Post-Operative Daya

Post-Operative Day Measure  QOL-N QOL-V PDN

Day 1 .38* .23* .43*

Day 2 .46* .18* .49*

Day 3 .51* .32* .55*

Day 4 .56* .07 .45*

Day 5 .58* -- .56*

a Sample size varies from 195-203.*p < .01Note: --Unable to compute because of lack of vomiting

2020

Page 21: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

DiscussionDiscussion

The results of dimensionality assessment support shortening the 7-item AS-INVR to form the 6- item AS-INV.

Both versions demonstrated strong internal consistency.

Construct validity was supported via hypothesis testing: – Patients with PDNV had higher AS-INVR and AS-INV mean

scores than those without PDNV.– Higher AS-INVR and AS-INV scores were associated with

lower quality of life scores related to nausea. – Higher AS-INVR and AS-INV scores were associated with

lower quality of life scores related to vomiting.

2121

Page 22: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3

ConclusionsConclusions

The AS-INV is an inexpensive, easy to administer measure of nausea and vomiting in adults after ambulatory surgery.

The 6-item AS-INV is recommended based on this psychometric evaluation of the 7-item AS-INVR.

This shortened scale provides a reliable and valid measure of the amount and distress of nausea and vomiting in adult patients after ambulatory surgery.

The 6-item version should be considered for use in future studies.

2222

Page 23: Jan Odom- Forren , PhD, RN, CPAN, FAAN 1 Lynne Hall,  DrPH , RN 2 Susan  Fetzer , PhD, RN 3