Validation study of a web-based assessment of functional recovery after radical prostatectomy
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RESEARCH
Open Access
Validation study of a web-based assessment of functional recovery after radical prostatectomy Andrew J Vickers1*, Caroline J Savage1, Marwan Shouery1, James A Eastham2, Peter T Scardino2, Ethan M Basch1
Abstract Background: Good clinical care of prostate cancer patients after radical prostatectomy depends on careful assessment of post-operative morbidities, yet physicians do not always judge patient symptoms accurately. Logistical problems associated with using paper questionnaire limit their use in the clinic. We have implemented a web-interface ("STAR”) for patient-reported outcomes after radical prostatectomy. Methods: We analyzed data on the first 9 months of clinical implementation to evaluate the validity of the STAR questionnaire to assess functional outcomes following radical prostatectomy. We assessed response rate, internal consistency within domains, and the association between survey responses and known predictors of sexual and urinary function, including age, time from surgery, nerve sparing status and co-morbidities. Results: Of 1581 men sent an invitation to complete the instrument online, 1235 responded for a response rate of 78%. Cronbach’s alpha was 0.84, 0.86 and 0.97 for bowel, urinary and sexual function respectively. All known predictors of sexual and urinary function were significantly associated with survey responses in the hypothesized direction. Conclusions: We have found that web-based assessment of functional recovery after radical prostatectomy is practical and feasible. The instrument demonstrated excellent psychometric properties, suggested that validity is maintained when questions are transferred from paper to electronic format and when patients give responses that they know will be seen by their doctor and added to their clinic record. As such, our system allows ready implementation of patient-reported outcomes into routine clinical practice.
Background Radical prostatectomy is a mainstay of treatment for early stage prostate cancer. Although associated with excellent rates of cure[1], the procedure leads to erectile and urinary dysfunction. Patients typically experience severe urinary incontinence and erectile dysfunction immediately after surgery, but recover gradually over the course of the first post-operative year[2]. Nonetheless, some patients experience long-term difficulties with sexual function and urinary control[3]. The uncertain nature of return to function is a major source of anxiety for prostate cancer patients recovering from surgery. There are treatments available for urinary and erectile dysfunction after radical prostatectomy. Pelvic floor * Correspondence: [email protected] 1 Department of Epidemiology and Biostatistics, Health Outcomes Group Memorial Sloan-Kettering Cancer Center, 1275 York Avenue New York, NY 10065 USA Full list of author information is available at the end of the article
exercises ("Kegels”) have been shown to improve return of urinary control[4], and procedures such as the male sling can be successful for patients
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