Development of a patient-reported outcome measure for gastrointestinal recovery after surgery (PRO-diGI)

Lee, MJ and Baker, DM and Hawkins, D and Blackwell, S and Arnott, R and Harji, D and Thorpe, G and Chapman, SJ and Jones, GL and Griffiths, E and Hancox, R and Whitehouse, A and Bates, M and McNeill, C and Ghods, M and McDarby, A and Shepperson, A and Hutton, C and Rahman-Casana, S and Ashmore, D and Hooton, G and Pugh, R and Wilson, T and Allinson, V and O'Hare, JL and Collinson, B and Convery, K and Clark, J and Barker-Kirby, C and Fletcher, E and Dean, S and Walker, E and McDermott, F and Park, L and Bennett, M-R and Ashman, S and Conroy, S and Steele, C and Shovelton, C and James, K and Mbogu, E and Roberts, K and Sharp, L and Palmer, L and Smith, A and Wakinshaw, F and Henderson, J and Richardson, M and Kenington, C and Gilmartin, C and Ju, H and Mejia, ML (2025) Development of a patient-reported outcome measure for gastrointestinal recovery after surgery (PRO-diGI). British Journal of Surgery, 112 (4). pp. 1-10. ISSN 0007-1323 DOI: https://doi.org/10.1093/bjs/znaf055

Abstract

Background
After major abdominal surgery, patients may experience significant gastrointestinal dysfunction, including postoperative ileus. Many clinical tools are used to measure this dysfunction, but there is no patient-reported outcome measure (PROM) specific to this group. The aim of this study was to develop a new PROM for this common condition.

Methods
A four-stage approach was undertaken. Stage 1 used semi-structured interviews with 29 patients to explore experiences of gastrointestinal recovery and develop a draft questionnaire. Stage 2 solicited feedback from 18 patients and 15 clinical experts on the face validity of the proposed tool using the Questionnaire on Questionnaires (QQ-10). Stage 3 recruited 297 patients to complete the questionnaire. Principal component analysis reduced the items and identified the domain structure. Test-retest reliability and a pilot assessment of responsiveness were assessed in stage 4 in a sample of 100 patients and in a sample of 68 patients respectively.

Results
The interviews generated 26 subthemes across gastrointestinal recovery and general well-being. An initial questionnaire containing 44 items was developed. The QQ-10 demonstrated high value and low burden, supporting face validity. Tests to reduce the items and identify the domain structure resulted in a 15-item questionnaire across four domains (nausea, eating, well-being, and bowels). Test-retest reliability showed intraclass correlation coefficient values ≥0.7 for all domains. Pilot responsiveness was demonstrated through differences in pre- and post-surgical scores.

Conclusion
PRO-diGI is a PROM for gastrointestinal dysfunction after major abdominal surgery that shows good psychometric properties and demonstrates face validity, reliability, and responsiveness. This now needs external validation to facilitate broader implementation.

More Information

Divisions:	School of Humanities and Social Sciences
Identification Number:	https://doi.org/10.1093/bjs/znaf055
Status:	Published
Refereed:	Yes
Publisher:	Oxford University Press (OUP)
Additional Information:	© The Author(s) 2025
Uncontrolled Keywords:	11 Medical and Health Sciences; Surgery; 3202 Clinical sciences
SWORD Depositor:	Symplectic
Depositing User (symplectic)	Deposited by Mann, Elizabeth
Date Deposited:	16 Apr 2025 10:03
Last Modified:	18 Apr 2025 14:34
Item Type:	Article

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Development of a patient-reported outcome measure for gastrointestinal recovery after surgery (PRO-diGI)

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