Minimal clinically important difference and psychometric properties of the Obstetric Quality of Recovery-10 measure: a systematic review and network meta-analysis.

INTRODUCTION: The Obstetric Quality of Recovery-10 (ObsQoR-10) is a patient-reported outcome measure for evaluating inpatient postpartum recovery. However, the minimal clinically important difference for ObsQoR-10 remains unknown, limiting clinical and research interpretability. The primary aim of this study was to determine the minimal clinically important difference of ObsQoR-10 through systematic review and network meta-analysis of studies and to evaluate its psychometric properties. METHODS: We conducted a systematic review and network meta-analysis of studies and searched relevant databases using keywords relating to 'obstetric quality of recovery.' We included observational and interventional studies reporting more than one psychometric property of ObsQoR-10 at one or more inpatient time-points. Two reviewers independently screened and evaluated study quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Minimal clinically important difference was estimated through triangulation of distribution-based (half of standard deviation of scores) and anchor-based (differences in scores between vaginal delivery and caesarean delivery, and between planned and unplanned caesarean delivery) methods. RESULTS: We included 12 studies with a total of 2017 parturients. Mean (SD) ObsQoR-10 score ranged from 48 (16.3) (caesarean delivery) to 89 (9.3) (vaginal delivery). Distribution-based estimates ranged from 6.7 (95%CI 6.0-7.6) to 8.7 (95%CI 7.9-9.6), while anchor-based estimates ranged from 9.7 (95%CI 2.7-16.5) to 12.4 (95%CI 3.1-21.5). Most studies reported statistically significant differences in scores between delivery modes. Overall, there was moderate evidence for sufficient validity, reliability and responsiveness of ObsQoR-10 across the postpartum period. DISCUSSION: We recommend using a minimal clinically important difference of 7-10 points for ObsQoR-10, with 7 points as the lower-bound estimate. This can be used to help interpret ObsQoR-10 scores in clinical settings and to power future studies using ObsQoR-10 as a primary outcome measure.