Validation of The Turkish Version of The Obstetric Quality-of-Recovery Score 11 (ObsQoR-11T) After Cesarean Delivery

Validation of The Turkish Version of The Obstetric Quality-of-Recovery Score 11 (ObsQoR-11T) After Cesarean Delivery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of The Turkish Version of The Obstetric Quality-of-Recovery Score 11 (ObsQoR-11T) After Cesarean Delivery Gökhan OZKAN, Umut KARA, Mehmet Emin INCE, Ozhan Ozdemir, Mustafa Ulubay, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1133533/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: To translate and validate the psychometric characteristics of a Turkish version of the Obstetric Quality-of-Recovery score 11 tool used to measure post-cesarean delivery recovery in Turkish-speaking patients. Methods: After the original English version of the Obstetric Quality-of-Recovery score 11 tool was translated into Turkish, it was psychometrically validated to assess the post-cesarean delivery quality of recovery. Validity, reliability, and feasibility were investigated. The Obstetric Quality-of-Recovery score 11 tool was administered to Turkish-speaking patients on postoperative day 1. On postoperative day 1, a global health visual analog scale was used to assess the patient's perceived global recovery. Results: One hundred and eighty-six patients completed their questionnaires, providing a completion rate of 97.35%. The Spearman rho (ρ) correlation coefficient between the Obstetric Quality-of-Recovery score and global health visual analog scale (0-100 points) was 0.850 at postoperative day 1 following surgery (P<0.001). Internal consistency, measured using Cronbach’s alpha, was 0.822. The split-half coefficient was 0.708. The Obstetric Quality-of-Recovery score differed significantly between the emergency and elective cesarean delivery groups (74.54±13.25 vs. 82.50±12.75; P<0.05). The test-retest reliability of the Obstetric Quality-of-Recovery score items was more than 0.6 in 82% of cases, indicating good repeatability and reliability. Conclusion: The Obstetric Quality-of-Recovery score 11 is a valid and reliable tool to measure the post-cesarean quality of recovery in Turkish-speaking patients. The psychometric properties of the Turkish version of the scale to measure the post-cesarean quality of recovery were similar to those of the seminal English version. cesarean delivery cross-cultural comparison patient-reported measures quality of recovery recovery postoperative Introduction Recovery after cesarean delivery (CD) is a multidimensional and complex process influenced by a variety of factors, such as patients, obstetric procedures, and anesthetic characteristics. The majority of research on CD recovery has focused on physiological parameters, including pain, nausea/vomiting, recovery of bowel function, length of hospital stay, recovery timeframes, and the occurrence of adverse events such as poor outcome and mortality (1,2). There is an increasing focus on the patient-perceived quality of recovery (QoR). Patient-reported outcome measures (PROMs) can be used to assess the patient's perspective (3). The Quality of Recovery-40 (QoR-40) score was developed in 2000. It is now widely used. It has also been successfully translated and validated in the Turkish language (4). The Obstetric Quality-of-Recovery (ObsQoR-11) score, derived from the QoR-40 scale, was recently developed to assess recovery in the first 24 hours after CD (5). The ObsQoR-11 scale is a composite patient-reported outcome measurement of the quality of recovery that evaluates four underlying factors as follows. Physical comfort and pain are represented by Factor 1. Factor 2 reflects both physical independence and mental well-being. Factor 3 represents physical independence, whereas Factor 4 supplements Factor 1. The ObsQoR-11 scale provides a score ranging from 0 to 110, with a high score indicating a good recovery. This study aimed to develop the Turkish version of the ObsQoR-11 (ObsQoR-11T) through a translation and cultural adaptation process, and to evaluate the validity and reliability of the ObsQoR-11T for Turkish women who had an elective and emergency cesarean delivery. The authors hypothesized that the ObsQoR-11T would have comprehensive validity and reliability, similar to the original English version. Methods Patient selection This prospective observational cohort study of term women undergoing CD was approved by the Ethics Committee of Gülhane Education and Research Hospital, Turkey (No. 2021/506), and registered with ClinicalTrials.gov (NCT04744311, February 8, 2021). Written informed consent was obtained from all the participants. The study was conducted in line with the principles of the Declaration of Helsinki (6). All methods were carried out following the Strengthening the Reporting of Observational Studies in Epidemiology guideline (7). Patients who underwent surgery at the hospital between January 2021 and August 2021 were enrolled. Women aged >18 years who underwent CD at ≥37 weeks of pregnancy, and were able to read and speak Turkish, were included in the study. Exclusion criteria were lack of fluency in Turkish, inability to obtain written informed consent, and neuropsychiatric disturbance that may bias the ObsQoR-11T measurements. Development of the ObsQoR-11T Permission was received from the author (Doctor Sarah Ciechanowicz) of the original English language version of the ObsQoR-11 scale. The translation technique was performed as per the recommendations of Beaton and Bullinger (8). First, two authors (co-authors UK and MEI) translated the ObsQoR-11 into Turkish with reference to the Turkish version of the validated QoR-40 (QoR-40T) (4). A temporary Turkish version of the ObsQoR-11 was agreed upon, which was then back-translated by a third person (co-author SŞ; healthcare experience in the USA and Turkey). Subsequently, a consensus was made regarding the ObsQoR-11T. The ObsQoR-11T was then tested in a randomly selected cohort of ten intensive care unit nurses. All ObsQoR-11T questions were confirmed to be comprehensible. The final ObsQoR-11T is shown in Table 1. Data collection Informed consent was obtained from each patient before surgery. Demographic characteristics were recorded preoperatively. Intraoperative features were obtained from electronic and written patient records. On the morning of the CD, the ObsQoR-11T scale was explained to the patient. The ObsQoR-11T was administered before (in the waiting section of the operating room) and at the 24th hour (in the clinic room) after the CD. At the 25th hour, a random subset of 20 patients was requested to complete the ObsQoR-11T scale once again. A computer-assisted randomization program was used to determine these patients prior to the study's start. The time required to complete each ObsQoR-11T scale was recorded. The general well-being was measured with a 100-mm global health visual analog scale (VAS) with the ObsQoR-11T questionnaire. The VAS scale ranges from 0 to 100 mm, indicating poor to best possible recovery. The ObsQoR-11T scale and the VAS scale were administered using self-assessment, with assistance as required. Our institutional neuraxial anesthesia regimen includes intrathecal administration of hyperbaric bupivacaine 12–15 mg, with fentanyl 15 mcg, via a single spinal injection. Depending on the anesthesiologist, various analgesics are used during general anesthesia. There is no routine approach. For postoperative analgesia, patients regularly received paracetamol 1 g four times daily unless contraindicated. Patients are also routinely prescribed i.m. diclofenac 75 mg as required after surgery. Intravenous ondansetron 4 mg as required were also prescribed unless contraindicated. Generally, 6 hours after the spinal anesthesia, patients are encouraged to mobilize, and 8 hours after, a trial without a urinary catheter is attempted. Psychometric evaluation of the ObsQoR-11T To measure the convergent validity, the correlation between ObsQoR-11T score and global health VAS score was evaluated. Discriminant validity was tested by comparing the ObsQoR-11T score in two groups divided by the VAS (≥70 mm [good] vs. <70 mm [poor]). To measure the construct validity, the correlation of continuous parameters with the ObsQoR-11T was evaluated. The ObsQoR-11T scores were compared in terms of education level, presence of comorbidities, history of abdominal surgery, parity groups, history of cesarean section, need for elective or emergency cesarean section, emergency category for emergency cesarean section, and type of anesthesia. Cronbach's alpha, split-half reliability, and test-retest reliability were used to measure reliability. The test-retest reliability was analyzed in a subgroup of women who were asked to complete the questionnaire 60 minutes later (at 25 hours), which was correlated to the 24-hour results. The intra-class correlation coefficient was used to assess test-retest reliability. The floor and ceiling effects were calculated by determining if 15% of respondents received the greatest or lowest possible score. The recruitment rate, completion rate, and time taken to complete the scale were used to assess acceptability and feasibility (the investigator measured). Statistical analysis There is no standard approach to determining sample size in scale validity and reliability studies. It is typically recommended that a minimum of 150 participants be used, or that 10 to 20 times the frequency of items on the scale be used. As the original ObsQoR-11 scale was an 11-item scale, we aimed for 200 patients. A total of 180 patients were included in the study due to data loss and other reasons. Measurement data are presented as mean (SD), and categorical data are presented as frequency and percentage, number (%). The normal distribution of the continuous variables was tested using the Kolmogorov-Smirnov test. Correlations between the ObsQoR-11T items and VAS scores were measured using the Spearman rank (ρ) correlation coefficient. Internal consistency was measured using Cronbach α and split-half reliability. Test-retest reliability was measured using the intraclass correlation coefficient. T-test and ANOVA were used to compare continuous parametric data, and the chi-square test was used to compare categorical data. All statistical analyses were performed using SPSS version 25.0 for Windows (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). The null-hypothesis was rejected if the two-tailed P-value was < 0.05. Results A total of 203 patients were screened for eligibility. Of these, 12 did not meet the inclusion criteria. The final sample consisted of 191 patients and there were no refusals (recruitment rate: 100%). After recruitment, five patients were excluded before the postoperative follow-up. A total of 186 patients completed the ObsQoR-11T after CD (completion rate: 97.38%). The mean time taken to complete the postoperative ObsQoR-11T scale was 123±45 seconds. Patient and clinical characteristics are summarized in Table 2. To assess for convergent validity, we evaluated the correlation between the ObsQoR-11T and the VAS for recovery. The Spearman rho (ρ) correlation coefficient was 0.850 (95% CI 0.805 to 0.885) at the postoperative 24th hour following cesarean delivery ( P 0.70). The individual item correlation to the VAS score is demonstrated in Table 3. Patients with a good or poor postoperative recovery, as indicated by a global health VAS ≥70 or <70 mm, respectively, were compared to establish discriminant validity. The median [IQR] ObsQoR-11T score was significantly different between these groups (90 [83.1-94] vs. 71 [66-78.5]) (P<0.0001). There were no statistically significant results in the correlation between the ObsQoR-11T score and the continuous variables (Table 4). In the comparison of the ObsQoR-11T score over categorical variables, only the difference between the emergency and elective CD groups (74.54 ±13.25 vs. 82.50±12.75) was found to be significant (P0.15 (82%), a good indicator of consistency. Split-half reliability with the Spearman-Brown adjustment (which measures the extent to which all parts of the test contribute equally to the desired measurement) was 0.708, implying an equal contribution from all items. The test-retest reliability of the ObsQoR-11T items was r>0.6 in 82% of items and ≥0.45 in the remaining items (no. 4 and 5), suggesting adequate repeatability and reliability (Table 6). The percentage of women who achieved the highest and lowest possible ObsQoR-11 scores at 24 h was 0% (n=0/186). Therefore, no floor or ceiling effects of the scoring tool were demonstrated. The ObsQoR-11T scores were negatively skewed. The level of skewness was -0.515 at 24 h postoperatively, indicating that the majority of the ObsQoR-11T scores were greater than 55 points. Discussion The results of our study showed that the ObsQoR-11T was a valid, reliable, clinically convenient, and suitable scale for measuring the quality of postoperative recovery after both elective and non-elective CD in the Turkish-speaking population. In addition to being an ideal scale for evaluating convergent validity with the ObsQoR-11T, the global health VAS is the most frequently used scale and the gold standard. The QoR-40 scale, which is the source of the ObsQoR-11 scale, lacks content validity for obstetric recovery because it does not include items pertaining to babies. Especially at the postoperative 24th hour, a strong correlation was found between the ObsQoR-11T scores and VAS scores (r=0.850). This achieved the >0.6 criterion for health rating scales, demonstrating that the ObsQoR-11T has excellent convergent validity, and more strongly than the original ObsQoR-11 (r=0.53) (5). Regarding the surgical types including general surgery, orthopedics, and otolaryngological surgeries, the QoR-40T scale was evaluated on the 3rd postoperative day in terms of convergent validity and the result was r=0.468 (4). As such, the ObsQoR-11T is better than the QoR-40T in terms of convergent validity. The discriminant validity of the study was confirmed by comparing women with good or poor postoperative recovery, as indicated by the global health VAS score (9). In the original study (5), the good versus poor recovery median values (100 vs. 87) according to the VAS score after the elective CD were found to be 97 versus 64. In the validation study after non-selective CD 10 , it was found to be 90 versus 71 in the ObsQoR-11T. While discriminatory validity was achieved in all three studies, the difference between the scores is due to the difference between the postoperative recovery procedures of the centers. Moreover, overall floor and ceiling effects were absent. Hence, it is feasible to use ObsQoR-11T after CD. In our study, a statistical difference was observed between the global ObsQoR-11T scores (74 vs. 82) after emergency and elective CD. While the pregnant women for elective CDs were able to psychologically prepare themselves and their expectations, women who underwent emergency CDs did not have any time for preparation. This may explain the difference in the ObsQoR-11T scores during the recovery period. Moreover, complications are naturally more likely to occur in emergency CDs and this may have decreased the quality of the postoperative recovery. In our study, no correlations were found between other recorded demographic and surgical data, and the ObsQoR-11T. In scientific studies based on the specific evaluation of these variables in the future, the ObsQoR-11T score should be evaluated. Unlike the QoR-40T study, correlations of the ObsQoR-11T with these variables could not be shown. This demonstrates that the postoperative recovery period after CD is a more unique and complex process than other surgeries. Cronbach's alpha and split-half reliability were 0.82 and 0.70, respectively, and comparable with those reported for the original ObsQoR-11 and QoR-40T (4,5). Cronbach's alpha was more than 0.7 which is above the recommended criterion (11). Internal consistency was also tested by inter-item correlation, with high values indicating strong item correlation within the instrument. The correlation coefficients between the items and the global ObsQoR-11T scores were between 0.41 and 0.75, and the lowest coefficient value was related to the 6 th item, while the highest coefficient value was related to the 10 th item. In the original study, the lowest values were found in items 8 and 9, while the highest coefficient value was found in item 1 (5). In both the original study and our study, negative correlation values were not obtained in the inter-item correlation matrix. These results were enough to confirm that the ObsQoR-11T possesses adequate reliability. There is no consensus on the timing of test repetition in the QoR studies (11,12). To set a period long enough not to remember the answers given after 24 hours, but short enough not to deviate significantly from the health status at 24 hours, we also performed a retest at the 25 th hour, similar to previous studies. The test–retest reliability was excellent. The presence of questions containing both negative and positive expressions in the same questionnaire causes difficulties in the psychometric evaluation process. While in the first five questions of the questionnaire, the 11-point Likert scale starts from 10, it starts from 0 in the second section consisting of six questions. This sudden change resulted in confusion. The person administering the questionnaire may need to provide guidance with a proactive attitude to prevent confusion. While we typically determine 0 as no pain and 10 as the most severe pain in the postoperative pain assessment using the VAS or NRS, 10 expresses the most pain-free situation in the pain questions, which are the first two questions of the ObsQoR-11 scale. Having two separate questions for pain assessment also caused confusion. Our patients described the pain as ‘‘tolerable pain’’ for moderate pain and ‘‘terrible pain’’ for severe agonizing pain. There are some limitations to our study. To measure responsiveness in the validation studies of the quality of recovery scales, the same questionnaire was applied both preoperatively and postoperatively, and Cohen effect size and standardized response mean measurements were performed (13,14). As there were questions such as "I can hold my baby without help" and "I can breastfeed my baby without help" in the questionnaire, the preoperative ObsQoR-11 evaluation was not completely objective. Moreover, unlike the original study, the preoperative questionnaire was not applied since non-elective cases were also included in our study. The other limitation of our study was that it was single-centered. In addition, if the baby is taken to the neonatal ICU (NICU) after birth, questions 8 and 9 about the baby are not answered therefore ObsQoR-11T measurement can not be used if baby is in NICU. Conclusions In conclusion, current study evaluated the Turkish version of the ObsQoR‐11 scoring tool to measure QoR on the first postoperative day after CD in a single centre. In terms of validity, reliability, clinical acceptability, and feasibility, the ObsQoR-11T performed well. The questionnaire may be used to assess postoperative recovery after CD as a standardized patient-reported outcome measure. Declarations Ethics approval and consent to participate Approved by the Ethics Committee of Gülhane Education and Research Hospital, Turkey (No. 2021/506), and registered with ClinicalTrials.gov (NCT04744311, February 8, 2021). Written informed consent was obtained from all the participants. Consent for publication Not applicable. Availability of data and materials Data are presented in the manuscript. Competing interests The authors declare that they have no competing interests Funding This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors. Authors' contributions GÖ, UK, MEİ conceived the study, analyzed data, wrote and revised the manuscript. UK and MEİ analyzed data, wrote and revised the manuscript. ÖO and MU collected data and revised the manuscript. GÖ and SS conceived the study and revised the manuscript. All authors read and approved the final manuscript. Acknowledgements We would like to thank to Doctor Sarah Ciechanowicz for granting the permission to translate the ObsQoR-11 scale into Turkish. References B. Deniau, N. Bouhadjari, V. Faitot et al. Evaluation of a continuous improvement programme of enhanced recovery after caesarean delivery under neuraxial anaesthesia, Anaesth. Crit. Care Pain Med. 35 (2016) 395–399. https://doi.org/10.1016/j.accpm.2015.11.009. A. Acikel, T. Ozturk, A. Goker, G.G. Hayran, G.T. Keles. Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean Deliveries, Turk. J. Anesth. Reanim. 45 (2017) 41–46. https://doi.org/10.5152/TJAR.2017.38159. F.J. Herrera, J. Wong, F. Chung. A systematic review of postoperative recovery outcomes measurements after ambulatory surgery, Anesth. Analg. 105 (2007) 63–69. https://doi.org/10.1213/01.ane.0000265534.73169.95. S. Karaman, S. Arici, S. Dogru et al. Validation of the Turkish version of the Quality of Recovery-40 questionnaire, Health Qual. Life Outcomes. 12 (2014) 8. https://doi.org/10.1186/1477-7525-12-8. S. Ciechanowicz, T. Setty, E. Robson et al. Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery, Br. J. Anaesth. 122 (2019) 69–78. https://doi.org/10.1016/j.bja.2018.06.011. 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Table 2. Patient demographic and obstetric characteristics ( n = 186) Maternal Age (years), mean (SD) 29.6 (5.6) Parity, n (%) 0 28 (15%) 1 76 (40.8%) 2 50 (26.8%) 3 28 (15%) ≥ 4 4 (2.1%) Weight (kg), mean (SD) 75.12 (13.59) Height (cm), mean (SD) 163.24 (5.17) BMI (kg/m 2 ), mean (SD) 28.18 (4.81) Pre-existing medical conditions, n (%) None 116 (62.3%) Respiratory 6 (3.2%) Cardiovascular 9 (4.8%) Neurological 5 (2.6%) Endocrine 20 (10.7%) Haematological 11 (5.9%) Musculoskeletal 6 (3.2%) Psychiatric 3 (1.6%) Others 10 (5.3%) Gestation, n (%) Single 182 (97.8%) Multiple 4 (2.1%) Education, n (%) Elementary 52 (27.9%) High school 78 (41.9%) University 56 (30.1%) Type of surgery, n (%) Elective CD 92 (49.4%) Emergency CD 94 (50.6%) Obstetric indication for CD, n (%) Covid-19 Disease 4 (2.1%) Pathological CTG 16 (8.6%) Failure to progress 20 (10.7%) Previous CD 102 (54.8%) Breech 2 (1%) Pre-eclampsia 6 (3.2%) Uncontrolled DM 6 (3.2%) Other Maternal Reasons 16 (8.6%) Cephalopelvic disproportion 10 (5.3%) Twins 4 (2.1%) Duration of surgery (min), mean (SD) 58.79 (10.65) Previous CD (%) Yes 102 (54.8%) No 84 (45.1%) Anaesthesia technique (%) Single-shot spinal anesthesia 166 (89.2%) General anesthesia 20 (10.7%) Length of hospital stay (day), Median (IQR) 2.14 (0.58) Table 3. Summary of correlations of ObsQoR-11T items to global QoR VAS (Spearmann’s ρ ) ObsQoR-11T Item Correlation to global QoR VAS score* Spearman r (95% CI) P -value Moderate pain 0.50 (0.39 to 0.60) <0.0001 Severe pain 0.45 (0.33 to 0.56) <0.0001 Nausea or vomiting 0.40 (0.28 to 0.52) <0.0001 Dizzy 0.37 (0.24 to 0.49) <0.0001 Shivering 0.55 (0.44 to 0.64) <0.0001 Comfortable 0.30 (0.16 to 0.43) <0.0001 Mobilise independently 0.69 (0.61 to 0.76) <0.0001 Able to hold baby 0.69 (0.61 to 0.76) <0.0001 Able to nurse/feed baby 0.60 (0.50 to 0.68) <0.0001 Able to take care of personal hygiene 0.65 (0.57 to 0.73) <0.0001 Feeling in control 0.56 (0.45 to 0.65) <0.0001 Table 4. Summary of correlations of clinical characteristics to ObsQoR-11T score for continuous variables (n = 186) Clinical characteristic Correlation to ObsQoR-11 Spearman r (95% CI) P -value Weight 0,175 (0.032 to 0.311) 0,111 Height 0,194 (0.052 to 0.328) 0,077 Maternal age -0,034 (-0.177 to 0.11) 0,746 Duration of surgery 0,116 (-0.028 to 0.255) 0,286 Pre Hbg -0,007 (-0.15 to 0.137) 0,949 Post Hbg -0,027 (-0.17 to 0.117) 0,799 Change in Hbg 0.001 (-0.142 to 0.144) 0.989 LOS -0,116 (-0.255 to 0.028) 0,267 BMI 0,126 (-0.018 to 0.265) 0,255 Table 5. Inter-item correlation matrix for ObsQoR-11T following caesarean delivery ObsQoR-11T item number Total ObsQoR-11T score 1 2 3 4 5 6 7 8 9 10 11 1 0.51 ** - 2 0.60 ** 0,59 ** - 3 0.52 ** 0,02 0,04 - 4 0.49 ** 0,02 0,03 0,78 ** - 5 0.65 ** 0,17 0,16 0,72 ** 0,63 ** - 6 0.41 ** 0,14 0,09 0,13 0,23 * 0,22 * - 7 0.71 ** 0,38 ** 0,42 ** 0,12 0,17 0,34 ** 0,37 ** - 8 0.74 ** 0,24 * 0,28 ** 0,43 ** 0,36 ** 0,41 ** 0,26 * 0,54 ** - 9 0.64 ** 0,12 0,31 ** 0,29 ** 0,25 * 0,37 ** 0,30 ** 0,39 ** 0,64 ** - 10 0.75 ** 0,23 * 0,43 ** 0,32 ** 0,26 * 0,39 ** 0,22 * 0,58 ** 0,59 ** 0.43** - 11 0.61 ** 0,07 0,18 0,25 * 0,22 * 0,32 ** 0,30 ** 0,49 ** 0,46 ** 0,45 ** 0,64 ** - *Correlation is significant at the level 0.05 level (2-tailed) ** Correlation is significant at the level 0.01 level (2-tailed) Table 6. Intra-class correlations for ObsQoR-11T items ObsQoR-11T item Intra-class correlation Moderate pain 0.69 Severe pain 0.64 Nausea or vomiting 0.61 Dizzy 0.45 Shivering 0.48 Comfortable 0.67 Mobilise independently 0.72 Able to hold baby 0.74 Able to nurse/feed baby 0.76 Able to take care of personal hygiene 0.84 Feeling in control 0.78 ObsQoR-11T score 0.79 ObsQoR-11T 24 vs 25 h scores. Spearman correlation >0.6 in 82% of items all items indicates good reliability of the instrument. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 28 Aug, 2022 Reviews received at journal 22 Aug, 2022 Reviewers agreed at journal 22 Aug, 2022 Reviewers invited by journal 13 Jul, 2022 Submission checks completed at journal 05 Jul, 2022 First submitted to journal 30 Jun, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1133533","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":118583054,"identity":"e07732b9-8a84-456a-bfe6-d4983caab094","order_by":0,"name":"Gökhan OZKAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYDCCA2AygYGBvQFIG1iQooUHxDKQIEWLRAKIQYQWvtsHmF98+JMmby75/OqGHwUSDPzt3Ql4tUieS2CznMGTY7hzdk7ZzR6gwyTOnN2AV4vBGQY2Yx6JCsYNt3PSbvAAtRhI5BKjxaDCfsPNM2k3/xCphfkxT0JO4oYb7MduE2WL5BnGNsYZB9KSN5zJYbstYyDBQ9AvfGeYD3/48CfZdsPx489uvvljI8ff3otfCwMDYxs0LngMwCQB5WDA/AFCsz8gRvUoGAWjYBSMQAAAUeJKAQ0NR68AAAAASUVORK5CYII=","orcid":"","institution":"Department of Anaesthesiology and Reanimation, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Gökhan","middleName":"","lastName":"OZKAN","suffix":""},{"id":118583055,"identity":"8a731f3f-ec31-4b4d-b635-9748489de18b","order_by":1,"name":"Umut KARA","email":"","orcid":"","institution":"Department of Anaesthesiology and Reanimation, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Umut","middleName":"","lastName":"KARA","suffix":""},{"id":118583056,"identity":"4018138d-66b8-4e0b-91be-fa2cf230ecb9","order_by":2,"name":"Mehmet Emin INCE","email":"","orcid":"","institution":"Department of Anaesthesiology and Reanimation, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Emin","lastName":"INCE","suffix":""},{"id":118583057,"identity":"521e19b9-b19a-429d-9947-5a54a27c79da","order_by":3,"name":"Ozhan Ozdemir","email":"","orcid":"","institution":"Department of Gynecology and Obstetrics, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ozhan","middleName":"","lastName":"Ozdemir","suffix":""},{"id":118583058,"identity":"9ef91b2c-4f19-4256-be4c-4136bff10c1d","order_by":4,"name":"Mustafa Ulubay","email":"","orcid":"","institution":"Department of Gynecology and Obstetrics, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Ulubay","suffix":""},{"id":118583059,"identity":"1c0d6a22-b366-474c-8b74-e93127fe14c7","order_by":5,"name":"Serkan SENKAL","email":"","orcid":"","institution":"Department of Anaesthesiology and Reanimation, Gülhane Training and Research Hospital, University of Health Science","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Serkan","middleName":"","lastName":"SENKAL","suffix":""}],"badges":[],"createdAt":"2021-12-02 06:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1133533/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1133533/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29622451,"identity":"769b30b0-6228-4109-a91d-a6380473065d","added_by":"auto","created_at":"2022-11-29 00:04:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":330997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1133533/v1/30ab7ea3-ddfd-4b77-b9dc-c397df9800b0.pdf"},{"id":29622450,"identity":"7efc4ba1-0758-4012-9c40-7885cbd0a284","added_by":"auto","created_at":"2022-11-29 00:04:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16834,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-1133533/v1/8ba9eb95bdc9b3707bada3c6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation of The Turkish Version of The Obstetric Quality-of-Recovery Score 11 (ObsQoR-11T) After Cesarean Delivery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRecovery after cesarean delivery (CD) is a multidimensional and complex process influenced by a variety of factors, such as patients, obstetric procedures, and anesthetic characteristics. The majority of research on CD recovery has focused on physiological parameters, including pain, nausea/vomiting, recovery of bowel function, length of hospital stay, recovery timeframes, and the occurrence of adverse events such as poor outcome and mortality (1,2). There is an increasing focus on the patient-perceived quality of recovery (QoR). Patient-reported outcome measures (PROMs) can be used to assess the patient\u0026apos;s perspective (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Quality of Recovery-40 (QoR-40) score was developed in 2000. It is now widely used. It has also been successfully translated and validated in the Turkish language (4).\u0026nbsp;The Obstetric Quality-of-Recovery (ObsQoR-11) score, derived from the QoR-40 scale, was recently developed to assess recovery in the first 24 hours after CD (5).\u0026nbsp;The ObsQoR-11 scale is a \u0026nbsp;composite patient-reported outcome\u0026nbsp;measurement of the quality of recovery that evaluates four underlying factors as follows. Physical comfort and pain are represented by Factor 1. Factor 2 reflects both physical independence and mental well-being. Factor 3 represents physical independence, whereas Factor 4 supplements Factor 1. The ObsQoR-11 scale provides a score ranging from 0 to 110, with a high score indicating a good recovery.\u003c/p\u003e\n\u003cp\u003eThis study aimed to develop the Turkish version of the ObsQoR-11 (ObsQoR-11T) through a translation and cultural adaptation process, and to evaluate the validity and reliability of the ObsQoR-11T for Turkish women who had an elective and emergency cesarean delivery. The authors hypothesized that the ObsQoR-11T would have comprehensive validity and reliability, similar to the original English version.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective observational cohort study of term women undergoing CD was approved by the Ethics Committee of G\u0026uuml;lhane Education and Research Hospital, Turkey (No. 2021/506), and registered with ClinicalTrials.gov (NCT04744311, February 8, 2021). Written informed consent was obtained from all the participants. The study was conducted in line with the principles of the Declaration of Helsinki (6). All methods were carried out following the Strengthening the Reporting of Observational Studies in Epidemiology guideline (7). Patients who underwent surgery at the hospital between January 2021 and August 2021 were enrolled.\u003c/p\u003e\n\u003cp\u003eWomen aged \u0026gt;18 years who underwent CD at \u0026ge;37 weeks of pregnancy, and were able to read and speak Turkish, were included in the study. Exclusion criteria were lack of fluency in Turkish, inability to obtain written informed consent, and neuropsychiatric disturbance that may bias the ObsQoR-11T measurements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevelopment of the ObsQoR-11T\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission was received from the author (Doctor Sarah Ciechanowicz) of the original English language version of the ObsQoR-11 scale. The translation technique was performed as per the recommendations of Beaton and Bullinger (8). First, two authors (co-authors UK and MEI) translated the ObsQoR-11 into Turkish with reference to the Turkish version of the validated QoR-40 (QoR-40T) (4). A temporary Turkish version of the ObsQoR-11 was agreed upon, which was then back-translated by a third person (co-author SŞ; healthcare experience in the USA and Turkey). Subsequently, a consensus was made regarding the ObsQoR-11T. The ObsQoR-11T was then tested in a randomly selected cohort of ten intensive care unit nurses. All ObsQoR-11T questions were confirmed to be comprehensible. The final ObsQoR-11T is shown in Table 1.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from each patient before surgery. Demographic characteristics were recorded preoperatively. Intraoperative features were obtained from electronic and written patient records. On the morning of the CD, the ObsQoR-11T scale was explained to the patient. The ObsQoR-11T was administered before (in the waiting section of the operating room) and at the 24th hour (in the clinic room) after the CD.\u0026nbsp;At the 25th hour, a random subset of 20 patients was requested to complete the ObsQoR-11T scale once again.\u0026nbsp;A computer-assisted randomization program was used to determine these patients prior to the study\u0026apos;s start.\u0026nbsp;The time required to complete each ObsQoR-11T scale was recorded.\u0026nbsp;The general well-being was measured with a 100-mm global \u0026nbsp;health\u0026nbsp;visual analog scale (VAS) with the ObsQoR-11T questionnaire.\u0026nbsp;The VAS scale ranges from 0 to 100 mm, indicating poor to \u0026nbsp;best possible recovery. The ObsQoR-11T scale and the VAS scale were administered using self-assessment, with assistance as required.\u003c/p\u003e\n\u003cp\u003eOur institutional neuraxial anesthesia regimen includes intrathecal administration of hyperbaric bupivacaine 12\u0026ndash;15 mg, with fentanyl 15 mcg, via a single spinal injection. Depending on the anesthesiologist, various analgesics are used during general anesthesia. There is no routine approach. For postoperative analgesia, patients regularly received paracetamol 1 g four times daily unless contraindicated. Patients are also routinely prescribed i.m. diclofenac 75 mg as required after surgery. Intravenous ondansetron 4 mg as required were also prescribed unless contraindicated. Generally, 6 hours after the spinal anesthesia, patients are encouraged to \u0026nbsp;mobilize, and 8 hours after, a trial without a urinary catheter is attempted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychometric evaluation of the ObsQoR-11T\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo measure the convergent validity, the correlation between ObsQoR-11T score and global \u0026nbsp;health VAS score was evaluated.\u0026nbsp;Discriminant validity was tested by comparing the ObsQoR-11T score in two groups divided by the VAS (\u0026ge;70 mm [good] vs. \u0026lt;70 mm [poor]).\u0026nbsp;To measure the construct validity, the correlation of continuous parameters with the ObsQoR-11T was evaluated. The ObsQoR-11T scores were compared in terms of education level, presence of comorbidities, history of abdominal surgery, parity groups, history of cesarean section, need for elective or emergency cesarean section, emergency category for emergency cesarean section, and type of anesthesia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCronbach\u0026apos;s alpha, split-half reliability, and test-retest reliability were used to measure reliability. The test-retest reliability was analyzed in a subgroup of women who were asked to complete the questionnaire 60 minutes later (at 25 hours), which was correlated to the 24-hour results. The intra-class correlation coefficient was used to assess test-retest reliability. The floor and ceiling effects were calculated by determining if 15% of respondents received the greatest or lowest possible score. The recruitment rate, completion rate, and time taken to complete the scale were used to assess acceptability and feasibility (the investigator measured).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no standard approach to determining sample size in scale validity and reliability studies. It is typically recommended that a minimum of 150 participants be used, or that 10 to 20 times the frequency of items on the scale be used. As the original ObsQoR-11 scale was an 11-item scale, we aimed for 200 patients. A total of 180 patients were included in the study due to data loss and other reasons.\u003c/p\u003e\n\u003cp\u003eMeasurement data are presented as mean (SD), and categorical data are presented as frequency and percentage, number (%). The normal distribution of the continuous variables was tested using the Kolmogorov-Smirnov test. Correlations between the ObsQoR-11T items and VAS scores were measured using the Spearman rank (\u0026rho;) correlation coefficient. Internal consistency was measured using Cronbach \u0026alpha; and split-half reliability. Test-retest reliability was measured using the intraclass correlation coefficient. T-test and ANOVA were used to compare continuous parametric data, and the chi-square test was used to compare categorical data. All statistical analyses were performed using SPSS version 25.0 for Windows (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). The null-hypothesis was rejected if the two-tailed P-value was \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 203 patients were screened for eligibility. Of these, 12 did not meet the inclusion criteria. The final sample consisted of 191 patients and there were no refusals (recruitment rate: 100%). After recruitment, five patients were excluded before the postoperative follow-up. A total of 186 patients completed the ObsQoR-11T after CD (completion rate: 97.38%). The mean time taken to complete the postoperative ObsQoR-11T scale was 123\u0026plusmn;45 seconds. Patient and clinical characteristics are summarized in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo assess for convergent validity, we evaluated the correlation between the ObsQoR-11T and the VAS for recovery. The Spearman rho (\u0026rho;) correlation coefficient was 0.850 (95% CI 0.805 to 0.885) at the postoperative 24th hour following cesarean delivery (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.0001).\u0026nbsp;There was a strong correlation between the ObsQoR-11T and the VAS (correlation \u0026gt;0.70).\u0026nbsp;The individual item correlation to the VAS score is demonstrated in Table 3. Patients with a good or poor postoperative recovery, as indicated by a global\u0026nbsp;\u0026nbsp;health\u0026nbsp;VAS \u0026ge;70 or \u0026lt;70 mm, respectively, were compared to establish discriminant validity. The median [IQR] ObsQoR-11T score was significantly different between these groups (90 [83.1-94] vs. 71 [66-78.5]) (P\u0026lt;0.0001).\u0026nbsp;There were no statistically significant results in the correlation between the ObsQoR-11T score and the continuous variables (Table 4). In the comparison of the ObsQoR-11T score over categorical variables, only the difference between the emergency and elective CD groups (74.54 \u0026plusmn;13.25 vs. 82.50\u0026plusmn;12.75) was found to be significant (P\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInternal consistency, measured using Cronbach\u0026rsquo;s alpha, was 0.822. The inter-item correlation matrix for the ObsQoR-11T is outlined in Table 5. Inter-item correlations were mostly at r\u0026gt;0.15 (82%), a good indicator of consistency. Split-half reliability with the Spearman-Brown adjustment (which measures the extent to which all parts of the test contribute equally to the desired measurement) was 0.708, implying an equal contribution from all items. The test-retest reliability of the ObsQoR-11T items was r\u0026gt;0.6 in 82% of items and \u0026ge;0.45 in the remaining items (no. 4 and 5), suggesting adequate repeatability and reliability (Table 6). The percentage of women who achieved the highest and lowest possible ObsQoR-11 scores at 24 h was 0% (n=0/186). Therefore, no floor or ceiling effects of the scoring tool were demonstrated. The ObsQoR-11T scores were negatively skewed. The level of skewness was -0.515 at 24 h postoperatively, indicating that the majority of the ObsQoR-11T scores were greater than 55 points.\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eThe results of our study showed that the ObsQoR-11T was a valid, reliable, clinically convenient, and suitable scale for measuring the quality of postoperative recovery after both elective and non-elective CD in the Turkish-speaking population. In addition to being an ideal scale for evaluating convergent validity with the ObsQoR-11T, the global \u0026nbsp;health VAS is the most frequently used scale and the gold standard. \u0026nbsp;The QoR-40 scale, which is the source of the ObsQoR-11 scale, lacks content validity for obstetric recovery because it does not include items pertaining to babies. Especially at the postoperative 24th hour, a strong correlation was found between the ObsQoR-11T scores and VAS scores (r=0.850).\u0026nbsp;This achieved the \u0026gt;0.6 criterion for health rating scales, demonstrating that the ObsQoR-11T has excellent convergent validity, and more strongly than the original ObsQoR-11 (r=0.53) (5).\u0026nbsp;Regarding the surgical types including general surgery, orthopedics, and otolaryngological surgeries, the QoR-40T scale was evaluated on the 3rd postoperative day in terms of convergent validity and the result was r=0.468 (4). As such, the ObsQoR-11T is better than the QoR-40T in terms of convergent validity.\u003c/p\u003e\n\u003cp\u003eThe discriminant validity of the study was confirmed by comparing women with good or poor postoperative recovery, as indicated by the global\u0026nbsp;\u0026nbsp;health\u0026nbsp;VAS score (9).\u0026nbsp;In the original study (5), the good versus poor recovery median values (100 vs. 87) according to the VAS score after the elective CD were found to be 97 versus 64. In the validation study after non-selective CD\u003csup\u003e10\u003c/sup\u003e, it was found to be 90 versus 71 in the ObsQoR-11T. While discriminatory validity was achieved in all three studies, the difference between the scores is due to the difference between the postoperative recovery procedures of the centers. Moreover, overall floor and ceiling effects were absent. Hence, it is feasible to use ObsQoR-11T after CD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, a statistical difference was observed between the global ObsQoR-11T scores (74 vs. 82) after emergency and elective CD. While the pregnant women for elective CDs were able to psychologically prepare themselves and their expectations, women who underwent emergency CDs did not have any time for preparation. This may explain the difference in the ObsQoR-11T scores during the recovery period. Moreover, complications are naturally more likely to occur in emergency CDs and this may have decreased the quality of the postoperative recovery. In our study, no correlations were found between other recorded demographic and surgical data, and the ObsQoR-11T. In scientific studies based on the specific evaluation of these variables in the future, the ObsQoR-11T score should be evaluated. Unlike the QoR-40T study, correlations of the ObsQoR-11T with these variables could not be shown. This demonstrates that the postoperative recovery period after CD is a more unique and complex process than other surgeries.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCronbach\u0026apos;s alpha and split-half reliability were 0.82 and 0.70, respectively, and comparable with those reported for the original ObsQoR-11 and QoR-40T (4,5). Cronbach\u0026apos;s alpha was more than 0.7 which is above the recommended criterion (11). Internal consistency was also tested by inter-item correlation, with high values indicating strong item correlation within the instrument.\u0026nbsp;The correlation coefficients between the items and the global ObsQoR-11T scores were between 0.41 and 0.75, and the lowest coefficient value was related to the 6\u003csup\u003eth\u003c/sup\u003e item, while the highest coefficient value was related to the 10\u003csup\u003eth\u003c/sup\u003e item. In the original study, the lowest values were found in items 8 and 9, while the highest coefficient value was found in item 1 (5). In both the original study and our study, negative correlation values were not obtained in the inter-item correlation matrix. These results were enough to confirm that the ObsQoR-11T possesses adequate reliability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is no consensus on the timing of test repetition in the QoR studies (11,12). To set a period long enough not to remember the answers given after 24 hours, but short enough not to deviate significantly from the health status at 24 hours, we also performed a retest at the 25\u003csup\u003eth\u003c/sup\u003e hour, similar to previous studies. The test\u0026ndash;retest reliability was excellent.\u003c/p\u003e\n\u003cp\u003eThe presence of questions containing both negative and positive expressions in the same questionnaire causes difficulties in the psychometric evaluation process. While in the first five questions of the questionnaire, the 11-point Likert scale starts from 10, it starts from 0 in the second section consisting of six questions. This sudden change resulted in confusion. The person administering the questionnaire may need to provide guidance with a proactive attitude to prevent confusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile we typically determine 0 as no pain and 10 as the most severe pain in the postoperative pain assessment using the VAS or NRS, 10 expresses the most pain-free situation in the pain questions, which are the first two questions of the ObsQoR-11 scale. Having two separate questions for pain assessment also caused confusion. Our patients described the pain as \u0026lsquo;\u0026lsquo;tolerable pain\u0026rsquo;\u0026rsquo; for moderate pain and \u0026lsquo;\u0026lsquo;terrible pain\u0026rsquo;\u0026rsquo; for severe agonizing pain.\u003c/p\u003e\n\u003cp\u003eThere are some limitations to our study. To measure responsiveness in the validation studies of the quality of recovery scales, the same questionnaire was applied both preoperatively and postoperatively, and Cohen effect size and standardized response mean measurements were performed (13,14). As there were questions such as \u0026quot;I can hold my baby without help\u0026quot; and \u0026quot;I can breastfeed my baby without help\u0026quot; in the questionnaire, the preoperative ObsQoR-11 evaluation was not completely objective. Moreover, unlike the original study, the preoperative questionnaire was not applied since non-elective cases were also included in our study. The other limitation of our study was that it was single-centered. In addition, if the baby \u0026nbsp;is taken to the neonatal ICU (NICU) after birth, questions 8 and 9 about the baby \u0026nbsp;are not answered therefore ObsQoR-11T measurement \u0026nbsp;can not be used if baby is in NICU.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, current study evaluated the Turkish version of the ObsQoR‐11 scoring tool to measure QoR on the first postoperative day after CD in a single centre. In terms of validity, reliability, clinical acceptability, and feasibility, the ObsQoR-11T performed well. The questionnaire may be used to assess postoperative recovery after CD as a standardized patient-reported outcome measure.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eApproved by the Ethics Committee of G\u0026uuml;lhane Education and Research Hospital, Turkey (No. 2021/506), and registered with ClinicalTrials.gov (NCT04744311, February 8, 2021).\u003c/li\u003e\n \u003cli\u003eWritten informed consent was obtained from all the participants.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eData are presented in the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors declare that they have no competing interests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eG\u0026Ouml;, UK, MEİ conceived the study, analyzed data, wrote and revised the manuscript. UK and MEİ analyzed data, wrote and revised the manuscript. \u0026Ouml;O and MU collected data and revised the manuscript. G\u0026Ouml; and SS conceived the study and revised the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank to\u0026nbsp;Doctor Sarah Ciechanowicz\u0026nbsp;for granting the permission\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;to translate the ObsQoR-11 scale into Turkish.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eB. Deniau, N. Bouhadjari, V. Faitot et al. Evaluation of a continuous improvement programme of enhanced recovery after caesarean delivery under neuraxial anaesthesia, Anaesth. Crit. Care Pain Med. 35 (2016) 395\u0026ndash;399. https://doi.org/10.1016/j.accpm.2015.11.009.\u003c/li\u003e\n\u003cli\u003eA. Acikel, T. Ozturk, A. Goker, G.G. Hayran, G.T. Keles. Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean Deliveries, Turk. J. Anesth. Reanim. 45 (2017) 41\u0026ndash;46. https://doi.org/10.5152/TJAR.2017.38159.\u003c/li\u003e\n\u003cli\u003eF.J. Herrera, J. Wong, F. Chung. A systematic review of postoperative recovery outcomes measurements after ambulatory surgery, Anesth. Analg. 105 (2007) 63\u0026ndash;69. https://doi.org/10.1213/01.ane.0000265534.73169.95.\u003c/li\u003e\n\u003cli\u003eS. Karaman, S. Arici, S. Dogru et al. Validation of the Turkish version of the Quality of Recovery-40 questionnaire, Health Qual. Life Outcomes. 12 (2014) 8. https://doi.org/10.1186/1477-7525-12-8.\u003c/li\u003e\n\u003cli\u003eS. Ciechanowicz, T. Setty, E. Robson et al. Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery, Br. J. Anaesth. 122 (2019) 69\u0026ndash;78. https://doi.org/10.1016/j.bja.2018.06.011.\u003c/li\u003e\n\u003cli\u003eWorld Medical Association, World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects, JAMA. 310 (2013) 2191\u0026ndash;2194. https://doi.org/10.1001/jama.2013.281053.\u003c/li\u003e\n\u003cli\u003eE. von Elm, D.G. Altman, M. Egger, S.J. Pocock, P.C. G\u0026oslash;tzsche, J.P. Vandenbroucke, STROBE Initiative, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies, Int. J. Surg. Lond. Engl. 12 (2014) 1495\u0026ndash;1499. https://doi.org/10.1016/j.ijsu.2014.07.013.\u003c/li\u003e\n\u003cli\u003eD.E. Beaton, C. Bombardier, F. Guillemin, M.B. Ferraz. Guidelines for the process of cross-cultural adaptation of self-report measures, Spine. 25 (2000) 3186\u0026ndash;3191. https://doi.org/10.1097/00007632-200012150-00014.\u003c/li\u003e\n\u003cli\u003eA.J. Bowyer, C.F. Royse. Postoperative recovery and outcomes - what are we measuring and for whom?, Anaesthesia. 71 (2016) 72\u0026ndash;77. https://doi.org/10.1111/anae.13312.\u003c/li\u003e\n\u003cli\u003eS. Ciechanowicz, R. Howle, C. Heppolette, B. Nakhjavani, B. Carvalho, P. Sultan. Evaluation of the Obstetric Quality-of-Recovery score (ObsQoR-11) following non-elective caesarean delivery, Int. J. Obstet. Anesth. 39 (2019) 51\u0026ndash;59. https://doi.org/10.1016/j.ijoa.2019.01.010.\u003c/li\u003e\n\u003cli\u003eMcDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York, Oxford University Press. 2006, pp 37-9., in: n.d.\u003c/li\u003e\n\u003cli\u003eB. Kirshner, G. Guyatt. A methodological framework for assessing health indices, J. Chronic Dis. 38 (1985) 27\u0026ndash;36. https://doi.org/10.1016/0021-9681(85)90005-0.\u003c/li\u003e\n\u003cli\u003eP.A. Stark, P.S. Myles, J.A. Burke. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15, Anesthesiology. 118 (2013) 1332\u0026ndash;1340. https://doi.org/10.1097/ALN.0b013e318289b84b.\u003c/li\u003e\n\u003cli\u003eY. Tanaka, T. Wakita, S. Fukuhara et al. Validation of the Japanese version of the quality of recovery score QoR-40, J. Anesth. 25 (2011) 509\u0026ndash;515. https://doi.org/10.1007/s00540-011-1151-2.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e is available in the Supplementary Files section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003ePatient demographic and obstetric characteristics \u0026nbsp;(\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 186)\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eMaternal Age (years), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.51231527093596%\"\u003e\n \u003cp\u003e29.6 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003eParity, n (%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e28 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e76 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e\u0026nbsp;50 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e28 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003e\u0026ge; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eWeight (kg), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e75.12 (13.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eHeight (cm), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e163.24 (5.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e28.18 (4.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePre-existing medical conditions, n (%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e116 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eRespiratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e6 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eCardiovascular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e9 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eNeurological\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e5 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eEndocrine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e20 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eHaematological\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e11 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eMusculoskeletal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e6 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePsychiatric\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e3 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e10 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003eGestation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e182 (97.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eMultiple\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003eEducation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eElementary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e52 (27.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e78 (41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e56 (30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003eType of surgery, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eElective CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e92 (49.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eEmergency CD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e94 (50.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"100%\"\u003e\n \u003cp\u003eObstetric indication for CD, n (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eCovid-19 Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePathological CTG\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e16 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eFailure to progress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e20 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePrevious CD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e102 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eBreech\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePre-eclampsia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e6 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eUncontrolled DM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e6 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eOther Maternal Reasons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e16 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eCephalopelvic disproportion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e10 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eTwins\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e4 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eDuration of surgery (min), mean (SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.51231527093596%\"\u003e\n \u003cp\u003e58.79 (10.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003ePrevious CD (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.51231527093596%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e102 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e84 (45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eAnaesthesia technique (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.51231527093596%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eSingle-shot spinal anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e166 (89.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eGeneral anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e20 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.48768472906404%\"\u003e\n \u003cp\u003eLength of hospital stay (day), Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.51231527093596%\"\u003e\n \u003cp\u003e2.14 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eSummary of correlations of ObsQoR-11T items to global QoR VAS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Spearmann\u0026rsquo;s \u003cem\u003e\u0026rho;\u003c/em\u003e)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003e\u003cstrong\u003eObsQoR-11T Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation to global QoR VAS score*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman r (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eModerate pain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.50 (0.39 to 0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eSevere pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.45 (0.33 to 0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eNausea or vomiting\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.40 (0.28 to 0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eDizzy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.37 (0.24 to 0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eShivering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.55 (0.44 to 0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eComfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.30 (0.16 to 0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eMobilise independently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.69 (0.61 to 0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eAble to hold baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.69 (0.61 to 0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eAble to nurse/feed baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.60 (0.50 to 0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eAble to take care of personal hygiene\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.65 (0.57 to 0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.78109452736319%\"\u003e\n \u003cp\u003eFeeling in control\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.98673300165837%\"\u003e\n \u003cp\u003e0.56 (0.45 to 0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.23217247097844%\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eSummary of correlations of clinical characteristics to ObsQoR-11T score for continuous variables (n = 186)\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation to ObsQoR-11\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman r (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e0,175 (0.032 to 0.311)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e0,194 (0.052 to 0.328)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eMaternal age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e-0,034 (-0.177 to 0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eDuration of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e0,116 (-0.028 to 0.255)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003ePre Hbg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e-0,007 (-0.15 to 0.137)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003ePost Hbg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e-0,027 (-0.17 to 0.117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eChange in Hbg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e0.001 (-0.142 to 0.144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eLOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e-0,116 (-0.255 to 0.028)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72394881170018%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.61791590493601%\"\u003e\n \u003cp\u003e0,126 (-0.018 to 0.265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.6581352833638%\"\u003e\n \u003cp\u003e0,255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eInter-item correlation matrix for ObsQoR-11T following caesarean delivery\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"907\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003eObsQoR-11T item number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal ObsQoR-11T score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.60\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,59\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.52\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,78\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.65\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,72\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,63\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.41\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,23\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,22\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.71\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,38\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,42\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,34\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.74\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,24\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,28\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,36\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,41\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,26\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,54\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.64\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,31\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,29\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,25\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,30\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,64\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.75\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,23\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,43\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,32\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,26\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,39\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,22\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,58\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,59\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e0.43**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.401540154015402%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.62156215621562%\"\u003e\n \u003cp\u003e0.61\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,25\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,22\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,32\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,30\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,49\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.370737073707371%\"\u003e\n \u003cp\u003e0,45\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.270627062706271%\"\u003e\n \u003cp\u003e0,64\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.17051705170517%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Correlation is significant at the level 0.05 level (2-tailed)\u003c/p\u003e\n\u003cp\u003e** Correlation is significant at the level 0.01 level (2-tailed)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eIntra-class correlations for ObsQoR-11T items\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"491\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003e\u003cstrong\u003eObsQoR-11T item\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra-class correlation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eModerate pain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eSevere pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eNausea or vomiting\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eDizzy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eShivering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eComfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eMobilise independently\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eAble to hold baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eAble to nurse/feed baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eAble to take care of personal hygiene\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eFeeling in control\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"55.80448065173116%\"\u003e\n \u003cp\u003eObsQoR-11T score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.19551934826884%\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eObsQoR-11T 24 vs 25 h scores. Spearman correlation \u0026gt;0.6 in 82% of items all items indicates good reliability of the instrument.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"health-and-quality-of-life-outcomes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hqlo","sideBox":"Learn more about [Health and Quality of Life Outcomes](http://hqlo.biomedcentral.com)","snPcode":"12955","submissionUrl":"https://submission.nature.com/new-submission/12955/3","title":"Health and Quality of Life Outcomes","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cesarean delivery, cross-cultural comparison, patient-reported measures, quality of recovery, recovery, postoperative ","lastPublishedDoi":"10.21203/rs.3.rs-1133533/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1133533/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTo translate and validate the psychometric characteristics of a Turkish version of the Obstetric Quality-of-Recovery score 11 tool used to measure post-cesarean delivery recovery in Turkish-speaking patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAfter the original English version of the Obstetric Quality-of-Recovery score 11 tool was translated into Turkish, it was psychometrically validated to assess the post-cesarean delivery quality of recovery. Validity, reliability, and feasibility were investigated. The Obstetric Quality-of-Recovery score 11 tool was administered to Turkish-speaking patients on postoperative day 1. On postoperative day 1, a global \u0026nbsp;health visual analog scale was used to assess the patient's perceived global recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOne hundred and eighty-six patients completed their questionnaires, providing a completion rate of 97.35%. The Spearman rho (ρ) correlation coefficient between the Obstetric Quality-of-Recovery score and global \u0026nbsp;health visual analog scale (0-100 points) was 0.850 at postoperative day 1 following surgery (P\u0026lt;0.001). Internal consistency, measured using Cronbach’s alpha, was 0.822. The split-half coefficient was 0.708. The Obstetric Quality-of-Recovery score differed significantly between the emergency and elective cesarean delivery groups (74.54±13.25 vs. 82.50±12.75; P\u0026lt;0.05). The test-retest reliability of the Obstetric Quality-of-Recovery score items was more than 0.6 in 82% of cases, indicating good repeatability and reliability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe Obstetric Quality-of-Recovery score 11 is a valid and reliable tool to measure the post-cesarean quality of recovery in Turkish-speaking patients. The psychometric properties of the Turkish version of the scale to measure the post-cesarean quality of recovery were similar to those of the seminal English version.\u003c/p\u003e","manuscriptTitle":"Validation of The Turkish Version of The Obstetric Quality-of-Recovery Score 11 (ObsQoR-11T) After Cesarean Delivery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-29 00:04:12","doi":"10.21203/rs.3.rs-1133533/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-08-28T09:08:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-08-22T18:25:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7d32fefc-611c-4235-b300-77871eda573c_SNPRID","date":"2022-08-22T17:05:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-07-13T20:15:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-07-05T05:09:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Health and Quality of Life Outcomes","date":"2022-06-30T07:05:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"health-and-quality-of-life-outcomes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hqlo","sideBox":"Learn more about [Health and Quality of Life Outcomes](http://hqlo.biomedcentral.com)","snPcode":"12955","submissionUrl":"https://submission.nature.com/new-submission/12955/3","title":"Health and Quality of Life Outcomes","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"381cd837-e7c8-41ec-bd7e-3b44e403e9fe","owner":[],"postedDate":"November 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-11-29T00:04:12+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-29 00:04:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1133533","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1133533","identity":"rs-1133533","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}