Minimal clinically important difference and psychometric properties of the Obstetric Quality of Recovery‐10 measure: a systematic review and network meta‐analysis
Moe Takenoshita, Satyam Ghimire, Lu Tian, Aleesha Jethwa, Phillip Callihan, Fatine Karkri, Lindsay E. Blake, Pervez SultanSummary
Introduction
The Obstetric Quality of Recovery‐10 (ObsQoR‐10) is a patient‐reported outcome measure for evaluating inpatient postpartum recovery. However, the minimal clinically important difference for ObsQoR‐10 remains unknown, limiting clinical and research interpretability. The primary aim of this study was to determine the minimal clinically important difference of ObsQoR‐10 through systematic review and network meta‐analysis of studies and to evaluate its psychometric properties.
Methods
We conducted a systematic review and network meta‐analysis of studies and searched relevant databases using keywords relating to ‘obstetric quality of recovery.’ We included observational and interventional studies reporting more than one psychometric property of ObsQoR‐10 at one or more inpatient time‐points. Two reviewers independently screened and evaluated study quality using the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Minimal clinically important difference was estimated through triangulation of distribution‐based (half of standard deviation of scores) and anchor‐based (differences in scores between vaginal delivery and caesarean delivery, and between planned and unplanned caesarean delivery) methods.
Results
We included 12 studies with a total of 2017 parturients. Mean (SD) ObsQoR‐10 score ranged from 48 (16.3) (caesarean delivery) to 89 (9.3) (vaginal delivery). Distribution‐based estimates ranged from 6.7 (95%CI 6.0–7.6) to 8.7 (95%CI 7.9–9.6), while anchor‐based estimates ranged from 9.7 (95%CI 2.7–16.5) to 12.4 (95%CI 3.1–21.5). Most studies reported statistically significant differences in scores between delivery modes. Overall, there was moderate evidence for sufficient validity, reliability and responsiveness of ObsQoR‐10 across the postpartum period.
Discussion
We recommend using a minimal clinically important difference of 7–10 points for ObsQoR‐10, with 7 points as the lower‐bound estimate. This can be used to help interpret ObsQoR‐10 scores in clinical settings and to power future studies using ObsQoR‐10 as a primary outcome measure.