Patient reported outcome measures evaluating postpartum maternal health and wellbeing: a systematic review and evaluation of measurement properties
O'Byrne, L. J., Bodunde, E. O., Maher, G. M., Khashan, A. S., Greene, R. M., Browne, J. P., and McCarthy, F. P.
OBJECTIVE: To systematically review and evaluate postpartum health and wellbeing patient reported outcome measures (PROMs) across all domains of postpartum health using the Consensus-based standards for the selection of health Measurement instruments (COSMIN) guidelines.
DATA SOURCES: Based on a pre-prepared published protocol, a systematic search of PubMed, EMBASE and CINAHL was undertaken identifying patient reported outcome tools. The protocol was registered with PROSPERO (CRD42021283472) and this work follows COSMIN guidelines for systematic reviews.
STUDY ELIGIBILITY CRITERIA: Studies eligible for inclusion assessed a PROM examining postpartum women's health and wellbeing with no limitation on domain. The aim of the included studies was to evaluate one or more measurement properties of the PROM.
STUDY APPRAISAL AND SYNTHESIS: Data extraction and the methodological assessment of the quality of the PROM were assessed by two reviewers independently based on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, hypotheses testing for construct validity, and responsiveness, as defined by COSMIN. The standard used for content validity were the domains of importance to women in postpartum health and wellbeing proposed by the international consortium for health outcome measurements (ICHOM). These outcome domains for patient reported health status are; mental health, health related quality of life (HRQoL), incontinence, pain with intercourse, breastfeeding, and motherhood role transition. The quality of the methods was rated an overall rating of results was awarded level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment tool; and a level of recommendation was awarded for each tool.
RESULTS: There were 10,324 studies identified in the initial search, of which 29 tools identified from 41 eligible studies included in the review. Twenty one tools were awarded an 'A' grading of recommendation for use as a PROM in postpartum women set out by COSMIN standards. Of these 'A' rated tools 80% (17) examined the domain of mental health, five examined HRQoL, four examined breastfeeding, role transition was represented in six. No 'A' recommended tools examined postpartum incontinence or pain with intercourse. Three tools did not cover domains as recommended by ICHOM, 5 tools were awarded a 'B' rating requiring more research prior to their recommendation for use. The majority of tools were awarded very low-moderate GRADE level of evidence. The highest quality tool that covered multiple domains of postpartum health and wellbeing found was the postpartum women's quality of Life Questionnaire (PQOL).
CONCLUSION: This systematic review identifies the best performing PROMs to assess postpartum health and wellbeing. No individual tool covers all six domains of postpartum health and wellbeing. The highest quality tool that covers multiple domains of postpartum health and wellbeing was the PQoL. The PQoL captures four of the six domains of importance to women, with domains of incontinence and sexual health unevaluated. The domain of urinary incontinence was represented by ICIQ-UI SF which requires further psychometric analysis prior to its recommended use. Postpartum sexual health, not represented by any tool, necessitates development of a PROM. A postpartum PROM would be best provided by a combination of tools, further research is required prior to its implementation.