421: Quality of Recovery - 40 � Sinhala Questionnaire: Psychometric Evaluation

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Developing methodology/technology

Background and Aims: Quality of recovery is complex. However, it’s an important outcome measure of the early postoperative health status, with major emphasis on measuring patient-reported outcomes to better estimate the overall well-being of patients.
Quality of Recovery – 40 (QoR-40) is a globally used, patient-rated, validated questionnaire to assess patient-reported postoperative recovery outcomes in physical, psychological, social, and pain domains. In the absence of a culturally adapted and psychometrically tested patient-reported tool in the majority spoken Sinhala language in Sri Lanka, this study aims to evaluate the validity and reliability of the Sinhala-translated QoR-40 questionnaire among postoperative surgical patients.

Methods: Forward-backward translation of QoR-40 to Sinhala was done with the participation of bilingual language and subject experts. Cultural adaptation and content validity were established through subject-expert consensus using the Modified Delphi technique and pre-tested among 15 patients to establish face validity. Validation study included patients over 18 years (n=264), who comprehend Sinhala, and undergone orthopedic, obstetric, or gynecological procedures at a tertiary care hospital in Sri Lanka. Non-probability consecutive sampling was done until the sample size reached. Exploratory factor and parallel analysis were conducted to assess construct validity. Internal consistency was evaluated using Cronbach’s alpha and corrected item–total correlations.

Results: Analysed data of 240 completed questionnaires, comprised of orthopaedic 52 (21.7%), gynaecology 126 (52.5%) and obstetric 62 (25.8%) patients, majority females 213 (88.8%), ASA 11 (73.8%). Factor analysis supported an eight-factor structure, explaining 71.4% of the total variance broadly reflective of the original domains of QoR-40 (emotional state, physical comfort, psychological support, physical independence, and pain), though with some cross-loadings. Internal consistency (0.954), assessed by Cronbach’s alpha, indicated excellent reliability. All items met acceptable psychometric thresholds (loading >0.4 on at least one factor OR item-total correlation >0.3), with no indication to remove any item from the scale.

Conclusions: The Sinhala-translated QoR-40 demonstrated strong construct validity and excellent reliability, confirming its suitability as a culturally appropriate patient-reported outcome measure for assessing postoperative quality of recovery in five domains: pain, physical comfort, physical independence, psychological support, and emotional state in Sinhala-speaking patients in Sri Lanka. QoR-40-Sin would be a useful tool in assessing recovery in ERAS pathways and evaluating postsurgical outcomes following multimodal analgesic therapies, both in clinical and research studies and quality assurance processes. Recommends further studies to explore its responsiveness and longitudinal performance.

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Presenting Author: Prof Thamasi Rekhha Makuloluwa
Submitting Author: Thamasi Makuloluwa

Senior Author: Prof Thamasi Rekha Makuloluwa

IASP 2026 Global Year theme of Neuropathic Pain: No

• Prof Thamasi Rekha Makuloluwa: MBBS, MD (Anaesthesiology), FRCA - Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka (Retd)
• Dr Chandana Karunathilaka: MBBS, MS, MRCS, MCh - Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka
• Dr BGCSM Banagala: MBBS, MD, MRCOG - Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka
• Dr Nirosha P. Edirisinghe: PhD, BScN, DIT, RN - Department of Fundamental Nursing, Faculty of Nursing, University of Colombo, Sri Lanka