Validation study of a web-based assessment of functional recovery after radical prostatectomy

Abstract

Background: Good clinical care of prostate cancer patients after radical prostatectomy depends on careful assessment of post-operative morbidities, yet physicians do not always judge patient symptoms accurately. Logistical problems associated with using paper questionnaire limit their use in the clinic. We have implemented a web-interface ("STAR") for patient-reported outcomes after radical prostatectomy.

Methods: We analyzed data on the first 9 months of clinical implementation to evaluate the validity of the STAR questionnaire to assess functional outcomes following radical prostatectomy. We assessed response rate, internal consistency within domains, and the association between survey responses and known predictors of sexual and urinary function, including age, time from surgery, nerve sparing status and co-morbidities.

Results: Of 1581 men sent an invitation to complete the instrument online, 1235 responded for a response rate of 78%. Cronbach's alpha was 0.84, 0.86 and 0.97 for bowel, urinary and sexual function respectively. All known predictors of sexual and urinary function were significantly associated with survey responses in the hypothesized direction.

Conclusions: We have found that web-based assessment of functional recovery after radical prostatectomy is practical and feasible. The instrument demonstrated excellent psychometric properties, suggested that validity is maintained when questions are transferred from paper to electronic format and when patients give responses that they know will be seen by their doctor and added to their clinic record. As such, our system allows ready implementation of patient-reported outcomes into routine clinical practice.

Figure 1

Recovery of sexual (black lines) and urinary (gray lines) function by time from surgery. Values are reported for a man with one comorbidity who received bilateral nerve sparing and was age 62 at surgery. Scores have been rescaled so that the maximum scores for both urinary and sexual function are 100. Dashed lines are 95% CI.

Figure 2

Recovery of sexual (black lines) and urinary (gray lines) function by age at the time of surgery. Values are reported for a man 12 months after surgery who had one comorbidity and who received bilateral nerve sparing. Scores have been rescaled so that the maximum scores for both urinary and sexual function are 100. Dashed lines are 95% CI.