Body contouring following massive weight loss is a rapidly expanding field in plastic surgery. However, healthcare payers are reluctant to fund such procedures, viewing them as purely cosmetic. This has resulted in a flurry of studies assessing quality of life (QoL) and patient satisfaction following body contouring surgery in this cohort of patients to establish an evidence base to support the idea that body contouring is as much (or even more) a functional procedure as it is cosmetic. However, the methods employed in these studies are seldom ideal, and hence the conclusions are unreliable. The gold standard to assess QoL and patient satisfaction is to use patient specific psychometrically validated patient reported outcome (PRO) measures. Developing such measures consists of a three-step process which includes a review of the current literature, qualitative patient interviews to determine what patients consider the most important, and expert opinion. This study aims to appraise the currently available literature on assessment of QoL and patient satisfaction in body contouring surgery patients. This will hopefully provide an understanding of methodological weaknesses in current studies and inform future investigators of the design of ideal instruments for assessing QoL and patient satisfaction in body contouring patients.
Body contouring surgery has undergone a rapid expansion in the last decade, becoming one of the fastest growing areas within plastic surgery. As the number of obese individuals continues to increase, bariatric surgery has come to the fore as the method of choice for rapidly losing excess weight with approximately one quarter of patients opting for bariatric surgery [
However, it has been a challenge to convince healthcare payers of the importance of body contouring procedures to the overall outcome of massive weight loss patients. Whereas funding for bariatric surgery has become easier to obtain due to mounting evidence of its benefits on the health of obese individuals and the economic implications of this benefit, it has yet to filter down to body contouring surgery. Most healthcare systems still consider body contouring to be a cosmetic procedure and are reluctant to fund such operations. This in turn has led to a number of studies addressing body contouring surgery following massive weight loss in patients who have already had bariatric surgery. The primary areas of focus of this research can be divided into two: (1) surgical outcomes in terms of procedure related complications and (2) the quality of life (QoL) and psychosocial outcome of body contouring in massive weight loss patients. In terms of procedure related complications, it has been shown that as operator experience increases, complication rates drop [
The gold standard for measuring the impact of body contouring surgery on massive weight loss individuals is to use patient-specific, well-constructed psychometrically validated patient reported outcome (PRO) measures (also known as instruments). PRO instruments are any report of the status of a patient's condition that comes directly from the patient without interpretation by a surgeon or other healthcare professional [
A systematic review of PRO instruments to measure quality of life and patient satisfaction following body contouring surgery was undertaken by Reavey et al. They identified five PRO measures with varying psychometric validity: one general plastic surgery (DAS 59), three breast reduction (BRASSQ, BRS, Breast-Q), and one liposuction instrument (FQAD). Following this, Reavey et al. called for the development of new PRO measures specific to this population [
An attempt was made to make the search for the literature as systematic as possible. Hence, the PRISMA statement for systematic reviews was adhered to [
The predetermined inclusion and exclusion criteria for this review were used to determine eligibility of a study to be included in the review.
Inclusion criteria include the following: the study population was restricted to massive weight loss patients; patients included in the study had either one or more of what is considered a body contouring procedure (e.g., abdominoplasty, panniculectomy, thoracoplasty, brachioplasty, mastopexy/plasty, thigh lift, etc.); a clearly defined method of measuring improvement in quality of life and/or psychosocial function; english language publication.
Exclusion criteria include the following: Studies measuring only overall “satisfaction” with body contouring procedures. Studies measuring the desire for body contouring in postmassive weight loss patients who believed they may attain some functional/psychosocial benefits from body.
The literature search was then carried out on Medline, Embase, CINAHL, PsycINFO, Google Scholar, and the Cochrane databases from inception till March 2013 for studies on the topic of improvement in quality of life and psychosocial function following body contouring surgery in massive weight loss patients. The keywords used are shown in Table
Search terms used with the Boolean operation AND to combine terms.
Body contouring | Body image | Massive weight loss/MWL | ||
Abdominoplasty | ||||
Panniculectomy | Psychological function | Postbariatric | ||
Torsoplasty | Weight reduction | |||
Thoracoplasty | AND | AND | ||
Brachioplasty/arm lift | Quality of life | |||
Thigh lift | ||||
Reduction mammaplasty/breast reduction | QoL | |||
Facelift | Psychosocial function |
The title and abstract of all identified studies were examined. In cases where suitability of a study for inclusion in the review was unclear, the entire paper was obtained and assessed for suitability. Data was extracted onto a Performa which included the data categories listed.
Demographics include the following: mean age of study subjects; number of subjects; gender distribution, male: female; BMI postbariatric surgery/postmassive weight loss.
Preoperative characteristics (i.e., prior to body contouring surgery but post-bariatric/massive weight loss): time period between bariatric surgery and body contouring surgery; instrument for measurement of quality of life (QoL) and QoL as per that particular instrument of prebody contouring; instrument for measurement of psychosocial function and psychosocial function prebody contouring; body contouring procedures performed.
Postoperative characteristics (i.e., following body contouring surgery): QoL following body contouring surgery; psychosocial function following body contouring surgery; length of follow-up postbody contouring surgery.
Other considerations: psychometric assessment of tools employed; validity and test-retest reliability.
The search retrieved a total of 89 studies. Following removal of duplicates, 45 studies remained. 25 studies were excluded following screening of the title and abstract. The entire papers of the remaining 20 articles were reviewed to establish suitability for inclusion. 11 studies were excluded as they did not meet the eligibility criteria leaving 9 studies for inclusion. The reference lists of these 9 studies were then hand searched to identify any further studies. Two studies were identified in this manner, resulting in a total of 11 studies for inclusion in the review. A flow diagram of the search strategy is provided in Figure
Systematic review flow diagram.
A summary of the characteristics of each study is provided in Table
Summary of characteristics of studies cited for this review.
Study | Number of patients | Procedure(s) | Control group | Pyschosocial function assessed | Quality of life assessed | Average weight loss following bariatric surgery | Study design: |
Mean age |
---|---|---|---|---|---|---|---|---|
Lazar et al. [ |
41 (32 females, 9 males) | Abdominoplasty | No | Yes | Yes | 40.2 kg | R | Median age 38 years |
Song et al. [ |
18 (16 females, 2 males) | Panniculectomy or abdominoplasty |
No | Yes | Yes |
|
P |
|
Cintra Jr. et al. [ |
16 (all females) | Abdominoplasty | No | Yes | Yes | 23.8 kg/m2 | R |
|
Stuerz et al. [ |
34 (30 females, 4 males) | Abdominoplasty | Yes | Yes | Yes | 16 kg/m2 | P |
|
Pecori et al. [ |
10 (all females) | Abdominoplasty (7), leg and/or arm lifts (8), torsoplasty (2) | Yes | Yes | No | 49 kg | R | Range 28–56 years |
Lanier [ |
50 (28 females, 22 males) | Abdominoplasty (24), facelift (18) Reduction mammaplasty (10) Blepharoplasty (8), mastopexy (8), thigh reduction (5), arm reduction (2) | No | Yes | No | 126 lbs | R | Not stated |
Menderes et al. [ |
11 (7 females, 4 males) | Abdominoplasty (11), reduction mammaplasty (3), lateral thigh lift (2), gynaecomastia (3), medial thigh lift (1), liposuction (3) | No | Yes | No | 57.6 kg | R | 37.4 years |
Van Der Beek et al. [ |
43 (41 females, 2 males) | Primarily abdominoplasty and breast reduction/augmentation | No | No | Yes | 51.3 kg | R | 41.5 years |
Singh et al. [ |
104 (85 females, 19 males) | Unspecified | Yes | Yes | Yes | N/A | R | 42 |
Coriddi et al. [ |
49 (40 females, 9 males) | Panniculectomy and abdominoplasty | No | Yes | Yes | 21.5 k/m2 | P | 45.8 |
Klassen et al. [ |
43 (40 females, 3 males) | Abdominoplasty (31), liposuction (18), Upper arm lift (14), breast lift (10), lift (9), buttock lift (6) | No | Yes | Yes | N/A | R | 47 |
Two questionnaires that had been designed specifically for the study yet had not been validated were administered to 41 patients. The first tool was a three-item subjective questionnaire that assessed: the patient’s most problematic body areas after weight loss: abdomen, breasts, thigh, and/or arms; consequences on QoL of abdominal skin overhanging: current life, dressing, aesthetics, psychological status, and/or sexual relations; ranking the effects of abdominoplasty on each of the previously mentioned QoL areas as: very good, good, average quite bad, or bad.
The second tool was a nine-item questionnaire designed by a trained psychologist to assess psychological status. The questions in this tool were as follows: How do you feel today? What is your opinion of your abdominoplasty? Are the results in accordance with your expectations? Are the scars a problem for you? Do you like your new body? Do other people regard you differently now? Has your daily life improved? What if abdominoplasty had been contraindicated? If you had to do it over again, would you undergo abdominoplasty?
The first questionnaire was administered once to assess preabdominoplasty body perception and QoL and for a second time to assess postbody contouring perception of improvement. The second tool was administered once to assess psychological status with all data being collected after an average follow-up period of 57.7 months (range 41 to 80 months).
In terms of the 5 areas of QoL assessed, aesthetics was the primary area of concern with 38 patients stating that they considered the abdomen an area of concern affecting their QoL prior to abdominoplasty. The next most concerning areas in terms of QoL were psychological status (36), dressing (33), sexual relations (27), and current life (15). After abdominoplasty, patients evaluated their QoL as good or very good in all of the above domains.
The second tool to assess psychological status following abdominoplasty again seemed to suggest that abdominoplasty did have a positive impact on their psychological status with 84.6% saying their daily life improved following the procedure. The results of the psychological questionnaire are presented in Table
Psychological evaluation questionnaire and patient answers.
Questions | Yes (%) | Good (%) | No (%) | Bad (%) | Intermediate opinion (%) |
---|---|---|---|---|---|
How do you feel today? | 65.4 | 15.4 | 19.2 | ||
What is your opinion about abdominoplasty? | 50 | 23.1 | 26.9 | ||
Are the results in accordance with your expectations? | 61.5 | 38.5 | |||
Are the scars a problem for you? | 61.5 | 11.6 | 26.9 | ||
Do you like your new body? | 53.9 | 11.5 | 34.6 | ||
Do other people regard you differently now? | 61.5 | 38.5 | |||
Has your daily life improved? | 84.6 | 7.7 | 7.7 | ||
What if abdominoplasty had been contraindicated? | 38.5 | 61.5 | |||
Would you agree to redo abdominoplasty? | 96.1 | 3.9 |
Assessed body image, quality of life, and other measures in a prospective manner using a number of different instruments as shown in Table
Instruments used by Song et al. [
Area of assessment | Outcome measures | General or specifically developed for study |
---|---|---|
Body perception and ideals | Pictorial body image assessment (PBIA) | Modified version of the Stunkard Silhouette tool developed specifically for this study |
| ||
Body image satisfaction and areas of distress | (i) Body image and satisfaction assessment (BISA) |
(i) Specifically developed for this study |
| ||
General and condition specific quality of life | (i) Health related quality of life (HR-QoL) |
(i) A general instrument to measure QoL |
| ||
Mood | Beck’s inventory | General instrument to assess mood |
Description of each of the outcome tools employed by Song et al. [
Outcome measure | Description |
---|---|
PBIA | A pictorial representation from underweight to severely obese on a 13-point scale on which the patient indicates which one they believe they were before bariatric surgery, their appearance before body contouring surgery, and their personal ideal silhouette |
| |
BISA | Divides the body into 10 areas (e.g., thighs, abdomen) with a visual analogue scale from 0, signifying extreme dissatisfaction, to 10, signifying perfect satisfaction. A possible maximum score of 100 and minimum of 0 |
| |
CBIA | Assesses areas of greatest dissatisfaction. The patient is handed a blank canvass of human outlines representing the front and back views on which they circle up to three areas of distress. These areas are anatomically coded in order to detect changes in areas of distress as patients underwent body contouring |
| |
HR-QoL | A modification of the SF-36 questionnaire which is used to assess physical function, self-esteem, sexual function, physical distress, and work function |
| |
PBSQoL | A quality of life measure that was specifically designed for the postbariatric weight loss patient population. It assessed areas such as feelings of attractiveness, skin rash and infection, ease of exercise, public embarrassment about loose skin, ease of shopping, and clothing fit |
| |
Beck’s inventory | A highly sensitive and validated measure of depression symptoms used to assess mood |
At 3 months, body image and satisfaction as measured by the BISA tool improved significantly
In terms of QoL measured by the HR-QoL, the mean score prebody contouring at 3 months postbody contouring and at 6 months postbody contouring remained around the same mark and there was not a statistically significant improvement. On the other hand, the PBSQoL scores which were collated from 13 patients however revealed a statistically significant improvement in the quality of life.
Assessed quality of life in 16 female patients following abdominoplasty after massive weight loss. A validated tool known as the Adaptive Operationalized Diagnostic Scale (AODS)—as described below—was used to assess QoL.
AODS: A 31-item instrument consisting of 4 domains: affectivity/personal relations, productivity, social/cultural performance, and organic/somatic health. Together they evaluate physical and mental health, social adjustment, body image, self-concept, self-esteem, and mood and feelings. Results are summarized in five levels of adaptation from good (level 1) to very severe maladaptation (level 5) for each domain and as a final score for a complete test.
The patients were questioned by a trained psychologist using this tool after an interval of approximately 1–3 years following abdominoplasty. The best overall response corresponded to the social and cultural domain, where 81.3% of patients had good adaptation (level 1). For the other three domains, results were remarkably similar with 62.5% of the tests displaying the highest value of adaptation (level 1) and few complete failures. Final scoring for the complete test is demonstrated in Table
Final results of the quality of life questionnaire.
Category | Level | Result (%) |
---|---|---|
Good adaptation | 1 | 43.8 |
Mild adaptation | 2 | 37.5 |
Moderate maladaptation | 3 | 6.3 |
Severe maladaptation | 4 | 6.3 |
Very severe maldaptation | 5 | 6.3 |
In terms of specific subtopics in the domains sited in Table
Carried out a prospective study including 31 postbody contouring patients with a control group of 26 patients who had undergone gastric banding and who had lost weight but who had not undergone body contouring surgery for comparison. The instruments used in this study are listed in Table
Description of outcome tools used by Stuerz et al. [
Outcome measure | Description |
---|---|
Strauss and Appelt’s Questionnaire for assessing one’s own body | This questionnaire consists of 52 items which are answered with “true” or “not true” and consists of four subscales: |
| |
Subscale “Emphasis on attractiveness” of the Body Perception Questionnaire by Paulus | This is a 22-item scale which assesses the extent to which appearance is adjusted to meet social norms |
| |
The Life Satisfaction Questionnaire | Covers ten areas of life, is, an index of general life satisfaction, and includes, healthiness, work life, financial status, leisure, partnership, relationship to own children, own person, sexuality, friends/relatives, and residence |
| |
The Hospital Anxiety and Depression Scale | A self-rating scale which consists of two separate subscales for anxiety and depression (each with 7 items) and is used to detect states of depression and anxiety |
| |
Author’s general questionnaire | Developed by the authors of the study and inquires about factors such as financing, expectations, reasons, desire for any other plastic surgery, dealing with the scar, satisfaction, effects on leisure activities, sexuality, inhibitions, and preoperative surgical information |
In terms of body image which was assessed via the Strauss and Appelt’s Questionnaire, there were improvements in all four areas listed in Table
The author’s General Questionnaire after surgery revealed that abdominoplasty resulted in a change in leisure activities in 21 patients, reduced inhibitions in 20 patients, and improved sexual relationships in 27 patients.
Studied body image issues in four groups of patients who are described in Table
Description of patient groups in the study carried out by Pecori et al. [
Group | Number of patients | Description |
---|---|---|
OB group | 20 | Morbidly obese women prior to biliopancreatic diversion (BPD) |
POST group | 20 | >2 years following BPD |
POST-A group | 10 | Postobese women following BPD who required cosmetic procedures |
POST-B group | 10 | Postobese women after BPD and subsequent cosmetic surgery |
Control | 20 | Lean and healthy individuals |
The two groups particularly relevant to our purposes are the POST-A group and POST-B group. Body image in each of the groups was evaluated by means of the Body Uneasiness Test (BUT), a self-administered questionnaire which had displayed satisfactory test-retest reliability and internal consistency in previous studies. A description of the domains assessed by the BUT questionnaire is provided in the description of the two parts of the body uneasiness test used by Pecori et al. below.
Part 1: explores body-related and shape-related psychopathology. Results are expressed in both a combined Global Severity Index and in scores of 5 subscales:
weight phobia (fear of being or becoming fat); body image concerns (overconcerned with physical appearance); avoidance; compulsive self-monitoring (rituals involving checking physical appearance); depersonalization (feelings of detachment or estrangement from one’s body). Part 2: indicates dissatisfaction with the overall body shape and with the different parts of one’s body. Results are expressed in two domains: Positive Symptom Total and Positive Index Distress Symptom.
Table
BUT score data in subjects of POST-A and POST-B groups (mean ± SD).
POST-A | POST-B | |
---|---|---|
Global severity index |
|
|
Weight phobia |
|
|
Body image concern |
|
|
Avoidance |
|
|
Compulsive self-monitoring |
|
|
Depersonalization |
|
|
Positive symptoms total |
|
|
Positive index distress |
|
|
50 patients (28 women and 22 men) underwent a variety of body contouring procedures. Following these procedures, a questionnaire was administered to the patients asking the following questions: Did the surgical procedure enable you to feel better about yourself in regard to the way you look and feel? Did the operative procedure provide you an incentive to maintain your weight reduction goal?
Forty-eight of the 50 patients returned the questionnaire (96% response rate). Thirty-nine patients (82%) answered “Yes” when asked whether plastic surgery after weight reduction had improved their self-esteem. Thirty-four patients (72%) stated that the body contouring surgery did not provide an incentive to maintain their weight reduction goal. Thus this study showed that self-esteem in massive weight loss patients could be improved by body contouring surgery but did not affect long-term weight maintenance which may require behaviour modification through the team efforts of a weight reduction counselor, therapist, and surgeon.
11 patients (7 women and 4 men) who underwent body contouring surgery following vertical banded gastroplasty (VBG) had their self-consciousness assessed by the Derriford Appearance Scale. The questionnaire administered was modified from its original structure, taking into account local norms. The modified questionnaire consisted of 3 subscales: general self-consciousness (GSC) of appearance; social self-consciousness (SSC) of appearance; and sexual and bodily self-consciousness of appearance (SBSC).
The difference between the original questionnaire and the final modified version is given in Table
Modification of the Derriford Appearance Scale by Menderes et al. [
Derriford appearance |
Original no. of |
No. of questions in |
---|---|---|
GSC | 17 | 12 |
SSC | 20 | 9 |
SBSC | 9 | 5 |
Each of the patients were asked to answer each of the questions in each subscale with one of five possible statements (from almost never to almost always), and the level of distress was measured with statements (from not at all distressed to extremely distressed) in a Likert type format.
The results are shown in Table
Evaluation of self-consciousness.
Preoperative perception of SC | Perception of SC between bariatric and plastic surgical interventions | Perception of SC after bariatric and plastic surgery interventions | |
---|---|---|---|
General self-consciousness | 34.3 (3.1) | 27.6 (2.5) | 21.2 (1.9) |
Social self-consciousness | 25.1 (2.8) | 19.4 (2.1) | 16.6 (1.8) |
Self-consciousness of appearance | 17.7 (3.5) | 11.8 (2.3) | 8.2 (1.6) |
Assessed quality of life and satisfaction with body contouring surgery in 43 patients who had undergone bariatric surgery. Quality of life was assessed by the Obesity Psychosocial State Questionnaire (OPSQ) (Table
The Obesity Psychosocial State Questionnaire (OPSQ).
Scales | Example item |
---|---|
Physical function | To kneel or duck easily |
Mental well-being | To feel depressed (reversed score) |
Physical appearance | To feel fat when someone takes a picture (reverse score) |
Social acceptance | To be discriminated because of my weight (reverse score) |
Self-efficacy | To feel helpless toward my eating behaviour (reversed score) |
Intimacy | To have sexual problems because of my weight (reversed score) |
Social network | To visit friends and acquaintances |
There were improvements in almost all domains with the greatest improvements being in the physical functioning and physical appearance domains
Applied the SF-36 questionnaire to a total of 104 individuals belonging to four groups of patients including a control group (27 patients), an obese group (31 patients), a postbariatric surgery group (30 patients), and a postbody contouring surgery group (16 patients). The SF-36 questionnaire consists of 8 scales that assess both physical and mental components of health as shown in Table
The eight scales of the SF-36 which assess physical and mental components of health.
Scale | Measures |
---|---|
Physical component | |
Physical functioning | Limitations in physical activities due to health problems |
Role-physical | Limitations in usual daily activities due to health problems |
Bodily pain | Pain experienced due to health problems |
General health | General health perceptions |
Vitality | Self-perceived energy and fatigue |
Mental component | |
Social functioning | Limitations in social activities due to physical or emotional problems |
Role-emotional | Limitations in usual daily activities due to emotional problems |
Mental health | Perceived well-being and the presence of any psychological distress |
Comparison of the outcomes for the social functioning and role-emotional components of the SF-36 questionnaire between the postbariatric surgery and postbody contouring groups found a statistically significant reduction in QoL in the postbody contouring group compared to the postbariatric surgery group. However, physical functioning was considerably improved in the postbody contouring group compared to the postbariatric surgery group, although not to a statistically significant degree.
Conducted a prospective telephone survey assessing several functional outcomes and satisfaction before and after body contouring surgery (Table
Functional status survey before and after abdominal contouring surgery.
Question* | Before body contouring | After body contouring |
---|---|---|
Neck pain | ||
Back pain | ||
Shoulder pain | ||
Abdominal pain | ||
Pain during exercise | ||
Difficulties with walking | ||
Difficulties with standing | ||
Difficulties with posture | ||
Difficulties with sleeping | ||
Difficulties with travel | ||
Difficulties with work tasks | ||
Difficulties with personal hygiene | ||
Difficulties with toilet habits | ||
Difficulties finding clothes | ||
Lymphedema | ||
Skin irritation | ||
Lower extremity paresthesias |
||
Lower extremity weakness | ||
| ||
Question† | Before body contouring | After body contouring |
| ||
Ability to climb stairs | ||
Ability to descend stairs | ||
Ability to jog/run | ||
Ability to rise from a |
||
Ability to play with kids | ||
Ability to do household tasks | ||
| ||
Satisfaction‡ | ||
| ||
Would you have this |
||
Would you recommend this |
†Respondents reported on a 10-point Likert scale ranging from 1 (completely able) to 10 (unable).
‡Respondents reported on a 10-point Likert.
Apart from shoulder pain, there were statistically significant improvements in all functional outcomes between the pre- and postbody contouring groups. In terms of satisfaction, 91.8 percent of patients said that they would have their body contouring procedure again or would recommend it to a friend.
Used qualitative patient interviews to obtain information regarding quality of life and satisfaction issues in body contouring surgery. Forty-three massive weight loss postbody contouring surgery patients were interviewed. The interviews took the form of patients describing their weight loss journey with probes to explore the impact of obesity, weight loss, and body contouring surgery on their quality of life. Analysis of the interviews revealed a number of important health and aesthetic concerns which were explained in terms of 5 core themes. Appearance-related concerns. Physical health concerns. Sexual health concerns. Psychological health concerns. Social health concerns.
Although no quantitative methods were employed to assess the impact of body contouring surgery on massive weight loss patients, this qualitative study demonstrated that body contouring leads to an overall improvement in the 5 core themes cited above and was an important step in the completion of the entire weight loss process for patients. Furthermore, the issues cited above enable investigators to appreciate QOL issues from the patient's perspective and may provide the conceptual framework necessary to help develop more specific PRO instruments.
Table
Summary of instruments employed in each study, psychometric validity, modification by investigators, and if they were patient reported outcome measures.
Study | Questionnaire/s employed | Psychometrically validated? | Modified for study? | Patient reported? |
---|---|---|---|---|
Lazar et al. [ |
(1) Three-item subjective questionnaire | (1) No | (1) N/A | (1) Yes |
(2) Nine-item psychological status questionnaire designed by trained psychologist | (2) No | (2) N/A | (2) Yes | |
| ||||
Song et al. [ |
(1) Pictorial body image assessment |
(1) No |
(1) N/A |
(1) Yes |
| ||||
(1) Strauss and Appelt's questionnaire (for assessing body image) | (1) Yes | (1) No | (1) Yes | |
Stuerz et al. [ |
(2) “Emphasis on attractiveness” subscale of the Body Perception Questionnaire by Paulus | (2) Yes | (2) Yes | (2) Yes |
(3) The life satisfaction questionnaire | (3) Yes | (3) No | (3) Yes | |
(4) The hospital anxiety and depression scale | (4) Yes | (4) No | (4) Yes | |
(5) Author's general questionnaire | (5) No | (5) N/A | (5) Yes | |
| ||||
Cintra et al. [ |
Adaptive Operationalized Diagnostic Scale | Yes | No | Yes |
| ||||
Pecori et al. [ |
Body uneasiness test | Yes | No | Yes |
| ||||
Lanier [ |
2 questions devised by investigators | No | N/A | Yes |
| ||||
Menderes et al. [ |
Derriford appearance scale | Yes | Yes | Yes |
| ||||
Van Der Beek et al. [ |
The obesity psychosocial state questionnaire | Yes | No | Yes |
| ||||
Singh et al. [ |
SF-36 | Yes | No | Yes |
| ||||
Coriddi et al. [ |
(1) Functional status survey |
No | N/A | Yes |
| ||||
Klassen et al. [ |
Qualitative interview | N/A | N/A | Yes |
Psychometric validity includes a number of concepts. Some of the essential concepts include: content validity—refers to the instrument incorporating relevant questions/sections of interest within it (i.e., how adequately the sampling of items reflects its aims). The questions included within an instrument are usually determined by experts within the field in which the instrument was designed for use; construct validity—essentially involves a conceptual definition of the construct to be measured by the instrument and then assessing the internal structure of its components and the theoretical relationship of its item and subscale scores; concurrent validity—compares the outcomes of the newly developed instrument with established “gold standard” instruments to determine how well the new instrument purports to measure what it measures in comparison to older, better established instruments; predictive validity—this assesses an instrument's ability to predict future outcomes (e.g., resource use or treatment outcomes); test-retest reliability—this ascertains the extent of agreement when the same instrument is applied to the same cohort of patients by the same investigator at two different time points; interrater reliability—refers to the degree of agreement between outcomes when the same instrument is applied to the same cohort of patients by two or more different investigators; sensitivity to change—the extent to which the instrument demonstrates change over time in comparison to “gold standard” measures (e.g., change measured my more established measures); acceptability/Feasibility/Utility—this is a measure of how useful and acceptable the instrument is to the investigator and or patient.
In an ideal setting, each PRO instrument would have been validated for every category mentioned above. This would ensure that the instrument measures what it was designed for with a high degree of accuracy. However, this is not always possible or necessary. As long as content validity, construct validity, and predictive validity are satisfactory, the instrument could potentially provide accurate measures of the concept of interest. Table
Squires et al. present an advanced protocol for the psychometric assessment of instruments based on the Standards for Educational and Psychological Testing [
All measures used were patient reported as indicated in Table
As mentioned above, a systematic review of PRO instruments to measure quality of life and patient satisfaction following body contouring surgery identified five PRO measures with varying psychometric validity. However, it must be pointed out that none of these measures have been specifically developed for body contouring surgery patients, and hence the title of the study is a misnomer to its content. Reavey et al. conclude that there is a need to develop specific PRO measures for this group of patients. This review has found a number of studies which have attempted to assess QoL and patient satisfaction in postbody contouring massive weight loss patients with less than ideal PRO measures. Hence, the author agrees that there is an urgent need to develop specific and well constructed PRO instruments in order to obtain reliable information regarding QoL and patient satisfaction following body contouring surgery in MWL patients. Furthermore, future investigators should use newer techniques of assessing psychometric validity of newly developed instruments which are both more convenient and reliable compared to more traditional techniques.
There is no conflict of interests to declare.
The author would like to thank Ian Wilkes, Pauline Kewell, and the rest of the staff at the Warner Library for their assistance in obtaining papers for this review.