Pook Makena, Elhaj Hiba, El Kefraoui Charbel, Balvardi Saba, Pecorelli Nicolo, Lee Lawrence, Feldman Liane S, Fiore Julio F
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
Surg Endosc. 2022 Nov;36(11):8490-8497. doi: 10.1007/s00464-022-09145-6. Epub 2022 Feb 25.
Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of functional capacity. This study assessed construct validity and responsiveness of the DASI as a measure of recovery after colorectal surgery.
Data from a trial on early mobilization after colorectal surgery were analyzed. Patients completed the DASI questionnaire preoperatively and at postoperative weeks (POW) 2 and 4. Construct validity was assessed by testing the primary a priori hypotheses that postoperative DASI scores (1) are higher in patients without vs with postoperative complications and (2) correlate with six-minute walk test distance (6MWD). Exploratory analyses assessed the association between DASI scores and (1) preoperative physical status [higher (ASA ≤ 2) vs lower (ASA > 2)], (2) stoma creation (no stoma vs stoma), (3) age [younger (≤ 75 years) vs older (> 75 years)], (4) time to readiness for discharge [shorter (≤ 4 days) vs longer (> 4 days)], and (5) surgical approach (laparoscopic vs open). Responsiveness was assessed by testing a priori hypotheses that DASI scores are higher (1) preoperatively vs at POW2 and (2) at POW4 vs POW2. Mean differences in DASI scores were obtained using linear regression. The association between DASI and 6MWD was assessed via Pearson correlation.
We analyzed data from 100 patients undergoing colorectal surgery (mean age 65; 57% male; 81% laparoscopic). Mean DASI scores were 47.9 ± 12.1 preoperatively, 22.4 ± 12.7 at POW2, and 33.2 ± 15.7 at POW4. The data supported our two primary construct validity hypotheses, as well as 3/5 exploratory hypotheses. Both responsiveness hypotheses were supported.
Our findings support that the DASI questionnaire can be a useful tool to assess postoperative recovery of functional capacity in research and clinical practice.
手术康复患者非常重视恢复到术前的身体功能水平。杜克活动状态指数（DASI，一份包含12个条目的问卷）可能是评估术后功能能力恢复的一个简单而可靠的工具。本研究评估了DASI作为结直肠手术后恢复情况指标的结构效度和反应性。
分析了一项关于结直肠手术后早期活动的试验数据。患者在术前、术后第2周（POW2）和第4周（POW4）完成DASI问卷。通过检验以下主要先验假设来评估结构效度：（1）无术后并发症与有术后并发症的患者术后DASI评分更高；（2）DASI评分与6分钟步行试验距离（6MWD）相关。探索性分析评估了DASI评分与以下因素之间的关联：（1）术前身体状况[较高（美国麻醉医师协会身体状况分级≤2级）与较低（美国麻醉医师协会身体状况分级>2级）]；（2）造口形成（无造口与有造口）；（3）年龄[较年轻（≤75岁）与较年长（>75岁）]；（4）出院准备时间[较短（≤4天）与较长（>4天）]；（5）手术方式（腹腔镜手术与开放手术）。通过检验以下先验假设来评估反应性：（1）术前DASI评分高于POW2时；（2）POW4时DASI评分高于POW2时。使用线性回归获得DASI评分的平均差异。通过Pearson相关性评估DASI与6MWD之间的关联。
我们分析了100例接受结直肠手术患者的数据（平均年龄65岁；57%为男性；81%为腹腔镜手术）。术前DASI平均评分为47.9±12.1，POW2时为22.4±12.7，POW4时为33.2±15.7。数据支持了我们的两个主要结构效度假设以及5个探索性假设中的3个。两个反应性假设均得到支持。
我们的研究结果支持DASI问卷可作为研究和临床实践中评估术后功能能力恢复的有用工具。
