Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH 44195, USA.
Surg Obes Relat Dis. 2010 Mar 4;6(2):185-90. doi: 10.1016/j.soard.2009.10.004. Epub 2009 Nov 10.
Most bariatric programs require a preoperative psychological evaluation. The criteria for such decision-making and acceptance rates have been well described in published reports. Most programs have made categorical distinctions of accept, reject, or delay, although this limits utility.
Bariatric surgery candidates (n = 389; 77.1% women; 74.3% white; mean +/- SD BMI 49.84 +/- 11.51 kg/m(2)) were evaluated using the CCBRS across 8 domains of interest in the psychological bariatric literature. Each domain was graded using a 5-point scale (poor, guarded, fair, good, excellent). A summary assessment was also given. The in-patient length of stay and preoperative, 1-, 3-, 6-, 9-, and 12-month BMI changes were assessed in the subset (n = 241) who had undergone surgery.
The CCBRS had excellent internal consistency (Chronbach's alpha = .88) and good consistency across providers (test-retest for overall determination r = .82). Most candidates were deemed acceptable, but 25.7% were initially considered guarded or poor candidates. Only 2.6% of the sample was unable to achieve the goals to improve their candidacy and undergo surgery. Hierarchical regression analyses on the overall CCBRS score demonstrated that unemployment, less education, greater BMI, smoking, and psychiatric medication use were associated with lower assessment scores. Guarded candidates spent significantly longer in the hospital and fair candidates had less preoperative BMI change than guarded or good candidates, although no significant postoperative BMI changes were demonstrated.
The results of our study have shown that the CCBRS is an internally consistent and useful tool for multidimensional psychological assessment of preoperative bariatric candidates.
大多数减重计划都需要进行术前心理评估。关于这种决策的标准和接受率已经在已发表的报告中得到了很好的描述。大多数计划都对接受、拒绝或延迟进行了分类，尽管这限制了其用途。
使用 CCBRS 对 389 名（77.1%为女性；74.3%为白人；平均 +/- SD BMI 为 49.84 +/- 11.51 kg/m²）减重手术候选人进行评估，评估涵盖了心理减重文献中 8 个感兴趣的领域。每个领域都使用 5 分制（差、谨慎、一般、良好、优秀）进行评分。还给出了一个综合评估。在接受手术的 241 名亚组中，评估了住院时间和术前、1 个月、3 个月、6 个月、9 个月和 12 个月的 BMI 变化。
CCBRS 具有极好的内部一致性（Chronbach's alpha =.88）和良好的提供者间一致性（总体确定的重测信度 r =.82）。大多数候选人被认为是可接受的，但 25.7%的人最初被认为是谨慎或较差的候选人。只有 2.6%的样本无法实现改善候选资格并接受手术的目标。对整体 CCBRS 评分的分层回归分析表明，失业、教育程度较低、BMI 较高、吸烟和使用精神科药物与较低的评估分数相关。谨慎的候选人住院时间明显更长，而一般的候选人术前 BMI 变化较小，与谨慎或良好的候选人相比，尽管术后 BMI 变化没有显著差异。
我们的研究结果表明，CCBRS 是一种用于术前减重候选人群多维心理评估的内部一致且有用的工具。
