Ulrica Nilsson

Measurement of quality of recovery using the QoR-40: a quantitative systematic review

BACKGROUND Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain. METHODS We undertook a quantitative systematic review of studies evaluating psychometric properties of the QoR-40. Data were combined in meta-analyses using random effects models. This resulted in a total sample of 3459 patients from 17 studies originating in nine countries. RESULTS We confirmed content, construct, and convergent [pooled r=0.58, 95% confidence interval (CI): 0.51-0.65] validity. Reliability was confirmed by excellent intraclass correlation (pooled α=0.91, 95% CI: 0.88-0.93), test-retest reliability (pooled r=0.90, 95% CI: 0.86-0.92), and inter-rater reliability (intraclass correlation=0.86). The clinical utility of the QoR-40 instrument was supported by high patient recruitment into evaluation studies (97%), and an excellent completion and return rate (97%). The mean time to complete the QoR-40 was 5.1 (95% CI: 4.4-5.7) min. CONCLUSIONS The QoR-40 is a widely used and extensively validated measure of quality of recovery. The QoR-40 is a suitable measure of postoperative quality of recovery in a range of clinical and research situations.

Improved recovery after music and therapeutic suggestions during general anaesthesia: a double-blind randomised controlled trial

Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra‐operative period under general anaesthesia could improve the recovery of hysterectomy patients.

The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial

OBJECTIVE To evaluate the effect of bed rest with music on the first postoperative day to decrease stress for patients who have undergone heart surgery. METHODS A repeated-measures randomized controlled trial was used. The study took place in a cardiothoracic intermediary unit of a university hospital in Sweden. Fifty-eight patients who had undergone open coronary artery bypass grafting or aortic valve replacement surgery were included. Stress response was assessed by determining the serum cortisol, heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels. At 12:00 noon on postoperative day 1, patients were allocated to receive 30 minutes of uninterrupted bed rest with music and then 30 minutes of bed rest or alternatively 60 minutes of uninterrupted bed rest. The music was soft and relaxing, included different melodies in new-age style, played with a volume at 50 to 60 dB, and distributed through a music pillow connected to an MP3 player. RESULTS After 30 minutes of bed rest, there was a significant difference in s-cortisol levels between the groups; 484. 4 mmol/L in the music group versus 618.8 mmol/L in the control group (P < .02). However, this difference in s-cortisol levels was not found 30 minutes later (ie, after a total of 60 minutes). There was no difference in heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels between the groups. CONCLUSION There is sufficient practical evidence of stress reduction to suggest that a proposed regimen of listening to music while resting in bed after open heart surgery be put into clinical use.

Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery; a randomized controlled trial.

Background: This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate postoperative in daycare surgery.

School-aged children’s experiences of postoperative music medicine on pain, distress and anxiety

Aim:  To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school‐aged children who had undergone day surgery.

Calm or not calm : the question of anxiety in the perianesthesia patient

Preoperative anxiety can be a major problem for the patient. Three distinct dimensions of preoperative anxiety are known: fear of the unknown, fear of feeling ill, and fear for life. The aim of this study was to investigate whether patients feel anxiety (calm or not calm) preoperatively before undergoing an elective day care surgery and also to elucidate the factors contributing to a patients current state of mind. A prospective study with 161 American Society of Anesthesiologists I-II outpatients scheduled for elective surgery was conducted. In a questionnaire the patients were asked to state if they were feeling calm or not and to describe factors contributing to their current mood. If responding that they did not feel calm, the participants were asked to rate the level of anxiety on a Numeric Rating Scale, 1-10. The results showed that 57% (n = 91) of the participants stated that they did not feel calm. A significantly higher proportion of women did not feel calm (65%), P < .05. Significantly more participants with a previous experience of surgery felt calm (90%), P < .01. In all, 190 statements were submitted. The results show that nearly half of the participants felt calm before surgery. The reasons were earlier positive experiences, feeling of security and caring, being well-informed, and having positive expectations. Furthermore, a higher proportion of women did not feel calm preoperatively. This indicates a need before surgery to routinely document and evaluate the individual patients state of mind and reasons for the state of mind. This individual preoperative care can make it possible to provide emotional support, decrease anxiety, and give the patient a more positive surgical experience.

The Effect of Music Intervention in Relation to Gender During Coronary Angiographic Procedures: A Randomized Clinical Trial:

Several studies have evaluated music interventions prior and after coronary angiography and percutaneous coronary intervention (PCI), but there is no clear evidence showing that music has an effect on patients during these procedures. The purpose was to investigate the effects of music on anxiety, angina, pain, relaxation, and comfort in patients during angiographic procedures and to evaluate gender differences. The study was a four-armed, prospective randomized controlled trial included 240 patients undergoing coronary angiography and/or PCI. Patients were allocated to receive relaxing music, MusiCure® or standard care during the procedure. Outcome measures were; puncture pain and the discomfort related to it, angina and the discomfort related to it, anxiety, experience of the sound environment, discomfort of lying still, and the doses of anxiolytics and analgesics during the procedure. No differences were found between the music and control groups regarding any of the trial endpoints or gender-related differences. The overall rating of the sound environment and feeling of relaxation was high. In conclusion, music intervention in patients undergoing angiographic procedures was highly feasible, but not effective in this study though the delivery of music went smoothly and did not disturb the examination and patients and staff alike looked favorably on it.

Music Interventions in Patients During Coronary Angiographic Procedures: A Randomized Controlled Study of the Effect on Patients' Anxiety and Well-Being

Background: A cardiac catheterization laboratory can be a frightening environment and music can be a supportive source of environmental sound that stimulates and maintains relaxation. Aim: To test the effects of patient focused music versus loudspeaker music versus standard sound on patients experiences of anxiety and well-being during coronary angiographic procedures. Methods: A prospective, randomized, controlled trial of 98 subjects undergoing elective coronary angiogram and/or percutaneous coronary intervention. The subjects were randomly allocated to three different groups of sound environments: a control group (the usual sound environment), a patient focused music group (audio pillow) or to a loudspeaker music group. Results: Anxiety decreased significantly and well-being increased significantly in the two music groups compared to the control group. There was a significantly more positive impression of the sound environment in the patient focused music group compared to the two other groups. Conclusion: This study showed that the use of a specially designed music reduced anxiety and increased well-being in patients during coronary angiographic procedures. However, patient focused music seemed to be more preferable. The sound environment was rated more positively by the subjects listening to music via audio pillow. The music delivered via loudspeakers seemed to distract the staff during the examination at the cardiac catheterization laboratory.

Assessment of recovery after day surgery using a modified version of quality of recovery-40

Assessment of recovery after day surgery using a modified version of quality of recovery-40

Endotracheal tube size and sore throat following surgery: a randomized-controlled study

Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia.