Impact of changing positively worded items to negatively worded items in the Swedish web-version of the Quality of Recovery (SwQoR) questionnaire.

RATIONALE, AIMS, AND OBJECTIVES: The Swedish web-version of the Quality of Recovery questionnaire is used to evaluate a person's postoperative recovery after anesthesia and surgery. An earlier study found an increased risk of answering incorrectly when the questionnaire included both positive and negative items. Therefore, this study investigated the effect of changing positively worded items to negatively worded items.

METHODS: This was a cross-sectional study including 90 second-year nursing students. Seven pairs of positively and negatively worded items were evaluated for differences in response as well as agreement between the items.

RESULTS: Two pairs of items showed higher mean values if the item was negatively worded. Between-item agreement for positively worded item scores and their corresponding reverse-coded negatively worded item scores was poor-to-moderate (intraclass correlation coefficient: 0.35-0.76). A moderate agreement was found when testing all positively worded items against the recoded negatively worded items (intraclass correlation coefficient: 0.65). Internal consistency was 0.86 for the positively worded items and 0.76 for the negatively worded items.

CONCLUSIONS: Changing from positive to negative wording produced some differences in Swedish web-version of the Quality of Recovery item scores. Internal consistency was acceptable, but 2 items (not having a general feeling of well-being and not speaking normally) need further refinement.