Revisiting HERQL, the hernia-specific quality-of-life assessment instrument, to extend the clinical applicability for abdominal wall hernias
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In the past we have developed and validated the hernia-specific quality of life assessment instrument, HERQL, for groin hernias. In current study we evaluated the conceptual structure and validated HERQL for abdominal wall hernias.
Subjective quality-of-life perceptions from abdominal wall hernia patients were assessed. Clinical responsiveness was evaluated comparing treatment naïve with follow-up hernia patients. Measurement invariance between groin and abdominal wall hernias was approached with structural equation modeling (SEM). Subgroup comparisons were conducted between primary ventral and incisional hernias, as well as the presence of co-morbidity, hernia incarceration, surgical complications, and recurrent abdominal wall hernias.
A total of 775 HERQL assessments, including 167 from abdominal wall hernias, were successfully performed. Cronbach’s alpha coefficients for the summative pain, worse symptoms for treatment-naïve patients, and improving summative pain scores across the pre-operative, immediately post-operative, and post-operative 3-month assessments indicating clinical responsiveness were observed and comparable between groin and abdominal wall hernias. Configural invariance was evidenced by that the same model held true for both types of hernias with multi-group SEM, while mean structure exploration showed that abdominal wall hernia patients reported less latent summative pain (− 0.535, p < 0.0001) but worse latent quality-of-life score (0.207, p < 0.0001). Patients with peri-operative complications suffered from worse pain during mild activities (2.7 versus 1.5, p = 0.01), and patients with recurrent hernias reported compromised global health/quality of life (2 versus 1.6, p = 0.001).
The study successfully validated and extended the clinical applicability of HERQL across distinct types of hernias. Measurement invariance was ascertained and the same HERQL construct could be administered for both abdominal wall and groin hernias in Taiwan.
KeywordsAbdominal wall hernia Quality of life Chronic pain HERQL Validation study Structural equation modeling
The work was supported in part by MOST-103-2314-B-281-004-MY2, CGH-MR-A10510, and MOST-107-2314-B-030-007-MY3. All authors declare that they have no competing interests. This manuscript contained materials presented at the 14th Asia Pacific Hernia Society Conference Annual Meeting held during Nov-29 and Dec-1, Dubai, UAE.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been reviewed and approved by the Institute Review Board of Cathay General Hospital under the access number CGH-P102069 and CGH-P104116.
Informed consent was obtained from all individual participants included in the study.
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