Preliminary validation of a diary approach to monitor daily adolescent and parental predictors of post-operative recovery - A longitudinal diary study in adolescents undergoing spinal fusion surgery.

Abstract

Background: About one in five adolescents undergoing major surgery develops chronic post-surgical pain (CPSP). Various risk and resilience factors for recovery and CPSP have been identified, including parental processes. However, research commonly relies on nomothetic data, while the psychometric properties of diaries assessing pediatric post-surgical recovery in everyday life are understudied. Therefore, this study aimed to evaluate the preliminary reliability, validity, and variability of diary data in adolescents, and their parents, after spinal fusion surgery.

Methods: Adolescents with Idiopathic Scoliosis (AIS) undergoing spinal fusion surgery, and their parents, were asked to complete daily diaries for seven consecutive days at five time points, i.e., before surgery (T0), at 3-week (T1), 6-week (T2), 6-month (T3) and 12-month (T4) post-surgery. Diaries were developed based on validated questionnaires measuring relevant constructs of pediatric post-surgical recovery. Internal consistency, test-retest reliability, convergent, divergent and concurrent criterion validity, and variability were examined.

Results: The sample comprised n=95 adolescents and n=95 parents. Overall compliance rate was approximately 80 % in both adolescents and parents, with a total of 5282 diary entries analysed. Internal consistency for multi-item variables ranged from good to excellent (α=.82-.93) for adolescent data and acceptable to excellent (α=.74-.93) for parent data. All test-retest correlations were significant, and large (ρ=.60-.76) for adolescent data, and medium to large for parent data (ρ=.57-.80). Regarding validity, all but three correlations between diary variables were significant. Furthermore, diary variables generally correlated significantly with corresponding questionnaire data. Variability was low in some variables.

Conclusion: The results provide the first evidence for the psychometric properties, with regard to reliability, validity and variability, for diary measures to monitor processes of post-surgical recovery in everyday life in adolescents undergoing spinal fusion surgery. However, replication is suggested, for refinement and further validation, with particular attention to variability and evaluation of sensitivity to change.