Clinimetric properties of 3 instruments measuring postoperative recovery in a gynecologic surgical population Kirsten B. Kluivers, MD, a Jan C. M. Hendriks, PhD, b Ben W. J. Mol, MD, PhD, c,d Marlies Y. Bongers, MD, PhD, c Mark E. Vierhout, MD, PhD, a Hans A. M. Bro ¨lmann, MD, PhD, e and Henrica C. W. de Vet, PhD, f Veldhoven, Nijmegen, and Amsterdam, the Netherlands Background. General, health-related quality-of-life questionnaires and recovery-specific questionnaires have been used to measure recovery in surgical patients. The aim of this study was to evaluate the clinimetric properties of 3 recovery instruments and to examine whether recovery-specific instruments are useful. Methods. The Quality of Recovery-40 (QoR-40), Recovery Index-10 (RI-10), and RAND-36 health survey were used to measure recovery in women undergoing different types of hysterectomy in the first 12 weeks after operation. Construct validity was assessed by testing predefined hypotheses. The changes observed during the postoperative period were used as indicators for responsiveness. Results. One hundred and sixty-one women were included. Response rate and internal consistency were found satisfactory. The highest number of hypotheses used for assessment of construct validity was confirmed in the RI-10. The RI-10 was more responsive compared with the QoR-40 and the RAND-36. Conclusions. Because construct validity and responsiveness were greatest in the RI-10, we conclude that this short recovery-specific instrument is useful in studies evaluating postoperative recovery. We recommend the use of the RI-10, unless the immediate postoperative days are of interest in which the QoR-40 was valid. (Surgery 2008;144:12-21.) From the Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, the Netherlands, a Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, b Department of Obstetrics and Gynecology, Ma ´xima Medical Centre, Veldhoven, the Netherlands, c Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands, d Department of Obstetrics & Gynecology, VU University Medical Centre, Amsterdam, the Netherlands, e and the EMGO Institute, VU University Medical Centre, Amsterdam, the Netherlands f TRADITIONAL EVALUATION OF MEDICAL INTERVENTIONS considers clinical endpoints such as efficacy, effec- tiveness, mortality, and occurrence of complica- tions. 1,2 In the last decade, there has been a shift from disease-orientated outcomes to patient-orien- tated outcomes, such as patient preference and perceived health-related quality of life. This issue is of eminent importance in the evaluation of min- imally invasive surgery. Noninvasive operations compared with conventional open procedures is expected to obtain a cure of the underlying disease at an equal effectiveness, however possibly with less burden to the patient, and therefore quicker re- covery after the operation and earlier resumption of daily activities and work. The evaluation of re- covery from operation requires instruments that focus specifically on recovery during the short- term period postoperatively. Although many researchers have developed ad hoc questionnaires for the postoperative period and even performed validation studies, none have given an answer to the question of whether it is a necessity to use these recovery-specific instru- ments. A wide range of well-validated, generic, health-related quality-of-life instruments are avail- able, like the SF-36 and RAND-36 health surveys, Nottingham Health Profile, Sickness Impact Pro- file, and Euroqol 5D. 3 A recovery-specific quality- of-life instrument needs to show advantages over these widely known instruments before being recommended for use in clinical trials. Korijla et al 4 advised use of the SF-36 health survey in the follow up of women undergoing hysterectomy; however, they did not review studies that used this Accepted for publication March 30, 2008. Reprint requests: Kirsten B. Kluivers, MD, Department of Ob- stetrics and Gynecology, Radboud University Nijmegen Medical Centre, 791, Postbus 9101, 6500 HB Nijmegen; the Netherlands. E-mail: K.Kluivers@obgyn.umcn.nl. 0039-6060/$ - see front matter Ó 2008 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2008.03.027 12 SURGERY