title: Measurement of quality of recovery using the QoR-40: a quantitative systematic review.
abstract: 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.
authors.affiliation: Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Victoria, Australia.
authors.forename: B F
authors.initials: BF
authors.lastname: Gornall
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
authors.forename: C L
authors.initials: CL
authors.lastname: Smith
authors.forename: J A
authors.initials: JA
authors.lastname: Burke
authors.forename: K
authors.initials: K
authors.lastname: Leslie
authors.forename: M J
authors.initials: MJ
authors.lastname: Pereira
authors.forename: J E
authors.initials: JE
authors.lastname: Bost
authors.forename: K B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: U G
authors.initials: UG
authors.lastname: Nilsson
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: A
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000369:Aged, 80 and over; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011184:Postoperative Period; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: health status; meta-analysis; outcomes