Development and validation of the convalescence and recovery evaluation (CARE) for measuring quality of life after surgery

Purpose To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery. Method Instrument content was based on qualitative data ascertained from focus groups of patients and input from an expert panel of clinicians and psychometricians. A draft questionnaire was then piloted and revised, leading to the 27-item Convalescence and Recovery Evaluation (CARE). CARE consists of four individually scored domains, which were identified using factor analysis. Test-retest reliability, internal consistency, and convergent validity were assessed. Results Test-retest reliability was high, ranging from 0.78 for the activity domain to > 0.88 for all others. Internal consistency varied over time postoperatively but was moderate to high for all domains throughout. Correlations between the four domains of CARE were low (each r <= 0.57). Moderate agreement was evident between CARE domains and the appropriate components of validated instruments, providing convergent validity. Conclusions CARE is a robust, multi-dimensional measure of convalescence after abdominal and pelvic surgery. CARE can be used to gain a better understanding of the phenomenon of recovery and to measure the impact of new processes of care (e.g., surgical technology adoption) on short-term patient outcomes.