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Patient-reported outcome measures evaluating postpartum maternal health and well-being: a systematic review and evaluation of measurement properties

Open AccessPublished:September 06, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100743

      OBJECTIVE

      This study aimed to systematically review and evaluate postpartum health and well-being using patient-reported outcome measures across all domains of postpartum health using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines.

      DATA SOURCES

      Based on a preprepared published protocol, a systematic search of PubMed, Embase, and CINAHL was undertaken to identify patient-reported outcome tools. The protocol was registered with the International Prospective Register of Systematic Reviews (registration number CRD42021283472), and this work followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines for systematic reviews.

      STUDY ELIGIBILITY CRITERIA

      Studies eligible for inclusion included those that assessed a patient-reported outcome measure examining postpartum women's health and well-being with no limitation on the domain. The included studies aimed to evaluate one or more measurement properties of the patient-reported outcome measure.

      METHODS

      Data extraction and the methodological assessment of the quality of the patient-reported outcome measure were assessed by 2 reviewers independently based on content validity, structural validity, internal consistency, cross-cultural validity or measurement invariance, reliability, measurement error, hypotheses testing for construct validity, and responsiveness, as defined by the COnsensus-based Standards for the selection of health Measurement INstruments. The standard used for content validity were the domains of importance to women in postpartum health and well-being proposed by the International Consortium for Health Outcomes Measurement. The outcome domains for patient-reported health status include mental health, health-related quality of life, incontinence, pain with intercourse, breastfeeding, and motherhood role transition. The quality of the methods was rated an overall rating of results, awarded a level of evidence, and assessed using the Grading of Recommendations, Assessment, Development, and Evaluations 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 were identified from 41 eligible studies included in the review. Moreover, 21 tools were awarded an “A” grading of recommendation for use as a patient-reported outcome measure in postpartum women following the COnsensus-based Standards for the selection of health Measurement Instruments standards. Of the “A”-rated tools, 17 (80%) examined the domain of mental health, 5 examined health-related quality of life, 4 examined breastfeeding, and 6 represented role transition. No “A”-recommended tool examined postpartum incontinence or pain with intercourse. Of note, 3 tools did not cover domains as recommended by the International Consortium for Health Outcomes Measurement, and 5 tools were awarded a “B” rating, requiring more research before their recommendation for use. Here, most tools were awarded very low-moderate Recommendations, Assessment, Development, and Evaluations level of evidence. Moreover, the highest quality tool identified that covered multiple domains of postpartum health and well-being was the women's Postpartum Quality-of-Life Questionnaire.

      CONCLUSION

      This systematic review identified the best performing patient-reported outcome measures to assess postpartum health and well-being. No individual tool covers all 6 domains of postpartum health and well-being. Here, the highest quality tool found that covered multiple domains of postpartum health and well-being was the Postpartum Quality-of-Life Questionnaire. The Postpartum Quality-of-Life Questionnaire captures 4 of 6 domains of importance to women, with domains of incontinence and sexual health unevaluated. The domain of urinary incontinence was represented by the International Consultation on Incontinence Questionnaire Short Form, which requires further psychometric analysis before its recommended use. Postpartum sexual health, not represented by any tool, necessitates the development of a patient-reported outcome measure. A postpartum patient-reported outcome measure would be best provided by a combination of tools; however, further research is required before its implementation.

      Key words

      Why was this study conducted?

      This systematic review aimed to identify the best performing patient-reported outcome measures (PROMs) to assess postpartum health and well-being.

      Key findings

      PROMs highlighted domains where there is the greatest scope for improvement and can be used to detect a variation between providers and institutions. Currently, there is no consensus in the literature on postpartum PROMs.

      What does this add to what is known?

      Currently, a postpartum PROM would be best provided by a combination of high-performing tools.
      Ensuring quality healthcare is provided to women during pregnancy, and childbirth is key to improving health outcomes for mothers and their babies. Delivering patient-centered quality healthcare cannot be achieved without accurate, reliable, and relevant patient-reported information.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      Patient-reported outcome measures (PROMs) are structured, validated questionnaires that give an insight into the effect that an intervention or therapy has on the patient. PROMs support real-world clinical effectiveness assessment for different care models and interventions and can describe variations across sociodemographic and clinical groups.
      • Dawson J
      • Doll H
      • Fitzpatrick R
      • Jenkinson C
      • Carr AJ.
      The routine use of patient reported outcome measures in healthcare settings.
      ,
      • Black N.
      Patient reported outcome measures could help transform healthcare.
      In addition, PROMs highlight domains where there is the greatest scope for improvement and can be used to detect variation between providers and institutions that cannot be explained by differences in case mix; however, for learning to occur, a standardized framework for appraisal must occur.
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      The standardized use of PROM can allow agencies to better identify the focus of resources and services as tailored by the patient's need, increasing the quality and cost-effectiveness of the services provided.
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      A recent shift toward patient-centered care is consistent with increasing PROM use globally.
      • Dawson J
      • Doll H
      • Fitzpatrick R
      • Jenkinson C
      • Carr AJ.
      The routine use of patient reported outcome measures in healthcare settings.
      The need for a PROM that can be used within maternity settings has been gaining attention in the literature over the past decade.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      ,
      • Mogos MF
      • August EM
      • Salinas-Miranda AA
      • Sultan DH
      • Salihu HM.
      A systematic review of quality of life measures in pregnant and postpartum mothers.
      A maternity PROM has been identified as a priority by the Core Outcomes in Women's and Newborn's Health initiative, an international initiative led by research journal editors that was established to standardize core outcomes reported in women's health research.
      • Devane D
      • Begley CM
      • Clarke M
      • Horey D
      • OBoyle C.
      Evaluating maternity care: a core set of outcome measures.
      To date, there is no consensus on a PROM within maternity care.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      ,
      • Mogos MF
      • August EM
      • Salinas-Miranda AA
      • Sultan DH
      • Salihu HM.
      A systematic review of quality of life measures in pregnant and postpartum mothers.
      The development of a maternity PROM that covers antenatal, intrapartum, postpartum, and neonatal care is challenging. This work focused on a postpartum PROM that would facilitate patient-driven changes to the maternity system. Further work will be required to assess the tools’ reliability and responsiveness over time.
      We specifically focused on a postpartum PROM as a reflection of childbirth morbidity and maternal well-being after delivery. This period is ill defined with traditional postnatal care provided at 42 days (6 weeks) after delivery, per World Health Organization (WHO) recommendation,
      World Health Organization
      WHO technical consultation on postpartum and postnatal care.
      but many researchers examining patient well-being and recovery to baseline recommend postnatal care at 6 to 12 months after delivery.
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      The International Consortium for Health Outcomes Measurement (ICHOM) has undertaken research evaluating domains of importance to women after delivery to a maximal timeframe of 6 months.
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      The proposed outcomes that matter the most according to the ICHOM are survival, morbidity, patient-reported health and well-being, and patient satisfaction with care. Within the patient-reported health and well-being outcome, the domains rated as most important to patients are (1) health-related quality of life (HRQoL), (2) incontinence, (3) pain with intercourse, (4) breastfeeding confidence and success, (5) role transition (mother-infant attachment and confidence in the role as a mother), and (6) mental health.
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      Using terms, such as HRQoL and health and well-being, can be problematic as the definitions and the use of these terms have been indistinguishable at times in the literature.
      • Karimi M
      • Brazier J.
      Health, health-related quality of life, and quality of life: what is the difference?.
      Here, we used the concept of health and well-being as defined by the WHO, health as “a state of complete physical, social, and mental well-being and not merely the absence of disease or infirmity” and well-being as “encompass[ing] quality of life [QoL], as well as the ability of people and societies to contribute to the world in accordance with a sense of meaning and purpose.”

      Health promotion glossary of terms 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

      The ICHOM used the domain of HRQoL as a domain of postpartum well-being of importance to women; here, we included any tool identifying and examining QoL or HRQoL in the postpartum setting.

      Objectives

      Research conducted using poor or unknown quality PROMs is both wasteful and unethical.
      • Prinsen CAC
      • Mokkink LB
      • Bouter LM
      • et al.
      COSMIN guideline for systematic reviews of patient-reported outcome measures.
      Selecting the best outcome measure instruments in a methodologically sound way is recommended by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and has guided the current study. Therefore, this study aimed to systematically review, critically evaluate, and summarize outcome measurement tools that have been psychometrically evaluated to assess postpartum health and well-being across all domains of postpartum health and give recommendations for the most suitable tools for use. Using a postpartum PROM will give insight into women's health and well-being after maternity healthcare intervention during childbirth. This work has supported the call for maternity care PROMs that evaluate real-world clinical effectiveness and has highlighted domains where there is the greatest scope for change.

      Methods

      Protocol and registration

      This systematic review follows the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines
      • Page MJ
      • McKenzie JE
      • Bossuyt PM
      • et al.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      and the COSMIN guidelines for conducting systematic reviews on a PROM.
      • Prinsen CAC
      • Mokkink LB
      • Bouter LM
      • et al.
      COSMIN guideline for systematic reviews of patient-reported outcome measures.
      The preprepared protocol for this review was published
      • O'Byrne L
      • Maher G
      • Khashan A
      • Greene R
      • Browne J
      • McCarthy FP.
      Patient reported outcome measures in childbirth and postpartum maternal quality of life: a protocol for systematic review of measurement properties.
      and registered with the International Prospective Register of Systematic Reviews (identification number CRD42021283472).

      Eligibility criteria, information sources, and search strategy

      A systematic literature search was performed across PubMed, Embase, and CINAHL from inception of databases to November 2021. The search thread included construct search, population search with a measurement properties filter, and exclusion filter as recommended by COSMIN.
      • Prinsen CAC
      • Mokkink LB
      • Bouter LM
      • et al.
      COSMIN guideline for systematic reviews of patient-reported outcome measures.
      We chose to not include a “type of instrument” in our search strategy as it could have possibly excluded potential tools of interest; a full search strategy is available in the Appendix. We included studies in all languages. The screening of titles, abstracts, and full texts was performed by 2 review authors (L.J.O. and E.O.B.) independently to identify eligible studies.
      The eligibility criteria for this review followed the COSMIN guidelines for systematic reviews of PROM recommendations. Eligible studies included generic and specific PROMs that assessed postpartum women's health and well-being, where the study sample included >50% postpartum women as advised by COSMIN.
      • Mokkink LB
      • Prinsen C
      • Patrick DL.
      The aim of the eligible study should be the evaluation of one or more measurement properties of the tool or the evaluation of the interpretability of the PROMs of interest. Studies that only use the PROM as a measurement instrument for the outcome of interest or in which the PROM was used for the validation of another instrument were excluded. Only full-text articles were included. All peer-reviewed studies with an assessment tool designed for patient completion were considered. The selection of titles and abstracts was performed by 2 reviewers independently (L.J.O. and E.O.B.) using the Rayyan
      • Ouzzani M
      • Hammady H
      • Fedorowicz Z
      • Elmagarmid A.
      Rayyan-a web and mobile app for systematic reviews.
      online reviewing system. If a study was deemed relevant by at least 1 reviewer, the full-text article was retrieved and screened.

      Data extraction

      The standardized data collection tool recommended by COSMIN was used by 2 authors (L.J.O. and E.O.B.) to extract the data from eligible studies. Information extracted included characteristics of the PROM, the included samples, and the domains of postpartum health and well-being.

      Assessment of risk of bias and data synthesis

      As recommended by COSMIN,
      • Prinsen CAC
      • Mokkink LB
      • Bouter LM
      • et al.
      COSMIN guideline for systematic reviews of patient-reported outcome measures.
      the methodological quality of the included studies was assessed using the risk of bias checklist. This included structural validity, internal consistency, cross-cultural validity or measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness. Each study was rated as very good, adequate, doubtful, or inadequate. The psychometric measurement properties of each study were rated against the updated criteria for good measurement, with each study rated as sufficient (+), insufficient (−), or indeterminate (?). The evidence was summarized per measurement property using a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, and the quality of the evidence was graded as high, moderate, low, or very low.
      Adequate content validity (the degree to which the content of a PROM is an adequate reflection of the construct to be measured) was determined if a PROM evaluated an appropriate domain of postpartum health and well-being, as defined by the ICHOM. The domains for pregnancy and childbirth proposed by the ICHOM were used as a standard for content validity as no gold standard exists. These domains scored >70% agreement as part of their working groups Delphi process as being important outcome domains to be included in the standard set. Importantly, this working group included not only experts in the field but also patients, including subsequent patient focus groups, to identify any emerging topics not covered.
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      Structural validity was evaluated as per the COSMIN taxonomy, using factor analyses or item response theory or Rasch analyses. Internal consistency for multiple studies was graded as sufficient if Cronbach α for most domains was at least 0.70. Reliability was deemed sufficient if the intraclass correlation coefficient score or weighted kappa was above 0.70. The measurement error identifies the smallest detectable change that signified a clinically significant difference in score results. Hypothesis testing on multiple studies was awarded as sufficient if most authors agreed with the tested hypothesis. No gold standard measure of postpartum health and well-being currently exists; therefore, criterion validity was not assessed as recommended by COSMIN. As described by COSMIN, responsiveness aims to show that the instrument truly measures changes in the constructs it intends to measure. A sufficient responsiveness level was awarded if 75% of the results were following the authors’ proposed hypotheses as defined by COSMIN. The GRADE approach reviewed the following 4 factors: (1) risk of bias (ie, the methodological quality of the studies), (2) inconsistency (ie, unexplained inconsistency of results across studies), (3) imprecision (ie, total sample size [downgraded 1 level if <100] of the available studies), and (4) indirectness (ie, evidence from different populations compared with evidence from the population of interest in the review). The included PROMs were classified into 3 categories: PROMs with evidence for sufficient content validity (any level) and at least low-quality evidence for sufficient internal consistency (recommended for use and given an “A” grading), PROMs categorized not in A or C (further validation needed and given a “B” grading,” and PROMs with high-quality evidence for an insufficient measurement property (should not be recommended for use and were given a “C” grading).

      Results

      Study selection

      There were 10,324 records identified in our search. After the removal of the duplicates, 9739 records were screened by 2 reviewers (L.J.O. and E.O.B.) independently by title and abstract. There were 101 records screened by full text by both reviewers, 70 of which were further assessed for eligibility. A total of 41 eligible studies were included in our review, evaluating 29 tools (Figure 1).
      Figure 1
      FigurePRISMA flow diagram
      O'Byrne. Postpartum patient reported outcome measures: systematic review and evaluation. Am J Obstet Gynecol MFM 2022.
      PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

      Study characteristics

      The included PROMs evaluating postpartum health and well-being are summarized in Table 1. All the eligible studies evaluated the psychometric properties of the tool in the postpartum period. There were 29 unique tools identified from the 41 included studies.
      • Gausia K
      • Fisher C
      • Algin S
      • Oosthuizen J.
      Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample.
      • Montazeri A
      • Torkan B
      • Omidvari S.
      The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version.
      • Busonera A
      • Cataudella S
      • Lampis J
      • Tommasi M
      • Zavattini GC.
      Psychometric properties of the postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.
      • Baghirzada L
      • Downey KN
      • Macarthur AJ.
      Assessment of quality of life indicators in the postpartum period.
      • Stramrood CA
      • Huis In ’t Veld EM
      • Van Pampus MG
      • et al.
      Measuring posttraumatic stress following childbirth: a critical evaluation of instruments.
      • Norhayati MN
      • Aniza AA
      • Nik Hazlina NH
      • Azman MY
      Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
      • Jradi H
      • Alfarhan T
      • Alsuraimi A.
      Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women.
      • Martin CR
      • Redshaw M.
      Establishing a coherent and replicable measurement model of the Edinburgh Postnatal Depression Scale.
      • Escribano S
      • Oliver-Roig A
      • Cano-Climent A
      • Richart-Martínez M
      • Persson EK
      • Juliá-Sanchis R.
      The Spanish version of the Mothers’ Postnatal Sense of Security Scale: psychometric properties and predictive utility.
      • Mortazavi F
      • Mousavi SA
      • Chaman R
      • Khosravi A.
      Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors.
      • Savage McGlynn E
      • Martin CR
      • Redshaw M.
      How mothers feel: validation of a measure of maternal mood.
      • Sultan P
      • Kamath N
      • Carvalho B
      • et al.
      Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study.
      • Cano-Climent A
      • Oliver-Roig A
      • Cabrero-García J
      • de Vries J
      • Richart-Martínez M.
      The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women.
      • Sultan P
      • Kormendy F
      • Nishimura S
      • Carvalho B
      • Guo N
      • Papageorgiou C.
      Comparison of spontaneous versus operative vaginal delivery using Obstetric Quality of Recovery-10 (ObsQoR-10): an observational cohort study.
      • Nikan F
      • Asghari Jafarabadi M
      • Mohammad-Alizadeh-Charandabi S
      • Mirghafourvand M
      • Montazeri A
      • Asadi S
      Psychometric properties of the Iranian version of a postpartum women's quality of life questionnaire (PQOL): a methodological study.
      • Beck CT
      • Gable RK.
      Postpartum depression screening scale: Spanish version.
      • Slavin V
      • Gamble J
      • Creedy DK
      • Fenwick J.
      Perinatal incontinence: psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.
      • Slavin V
      • Gamble J
      • Creedy DK
      • Fenwick J
      • Pallant J.
      Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population - Validation of the PROMIS Global Short Form.
      • Tsuchiya M
      • Mori E
      • Sakajo A
      • Iwata H
      • Maehara K
      • Tamakoshi K.
      Cross-sectional and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers.
      • Noor NM
      • Aziz AA
      • Mostapa MR
      • Awang Z.
      Validation of the Malay version of the inventory of functional status after childbirth questionnaire.
      • McVeigh C
      • Chaboyer W.
      Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian population.
      • Nakić Radoš S
      • Matijaš M
      • Kuhar L
      • Anđelinović M
      • Ayers S.
      Measuring and conceptualizing PTSD following childbirth: validation of the city birth trauma scale.
      • Sandoz V
      • Hingray C
      • Stuijfzand S
      • Lacroix A
      • El Hage W
      • Horsch A.
      Measurement and conceptualization of maternal PTSD following childbirth: psychometric properties of the City Birth Trauma Scale-French Version (City BiTS-F).
      • Aydın R
      • Kukulu K.
      Adaptation of the Barkin scale of maternal functioning and examination of the psychometric properties.
      • Handelzalts JE
      • Hairston IS
      • Matatyahu A.
      Construct validity and psychometric properties of the Hebrew version of the City Birth Trauma scale.
      • Denis A
      • Callahan S
      • Bouvard M.
      Evaluation of the French version of the Multidimensional Scale of Perceived Social Support during the postpartum period.
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      • Razurel C
      • Kaiser B
      • Dupuis M
      • Antonietti JP
      • Sellenet C
      • Epiney M.
      Validation of the post-delivery perceived stress inventory.
      • Small R
      • Lumley J
      • Yelland J
      • Brown S.
      The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia.
      • Barkin JL
      • Wisner KL
      • Wisniewski SR.
      The psychometric properties of the Barkin index of maternal functioning.
      • Ansariniaki M
      • Lamyian M
      • Ahmadi F
      • Rahimi Foroushani A
      • Curry CL
      • Barkin JL
      Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.
      • Hernández-Martínez A
      • Martínez-Vázquez S
      • Rodríguez-Almagro J
      • Khan KS
      • Delgado-Rodríguez M
      • Martínez-Galiano JM.
      Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period.
      • Ohashi Y
      • Kitamura T
      • Sakanashi K
      • Tanaka T.
      Postpartum bonding disorder: factor structure, validity, reliability and a model comparison of the postnatal bonding questionnaire in Japanese mothers of infants.
      • Wittkowski A
      • Wieck A
      • Mann S.
      An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
      The Edinburgh Postnatal Depression Scale (EPDS) had the most validation studies included (n=4) with a total number of 1755 patients.
      • Gausia K
      • Fisher C
      • Algin S
      • Oosthuizen J.
      Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample.
      ,
      • Montazeri A
      • Torkan B
      • Omidvari S.
      The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version.
      ,
      • Jradi H
      • Alfarhan T
      • Alsuraimi A.
      Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women.
      ,
      • Small R
      • Lumley J
      • Yelland J
      • Brown S.
      The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia.
      This was followed by the City Birth Trauma Scale (n=3) with a total number of 1648 patients,
      • Nakić Radoš S
      • Matijaš M
      • Kuhar L
      • Anđelinović M
      • Ayers S.
      Measuring and conceptualizing PTSD following childbirth: validation of the city birth trauma scale.
      ,
      • Sandoz V
      • Hingray C
      • Stuijfzand S
      • Lacroix A
      • El Hage W
      • Horsch A.
      Measurement and conceptualization of maternal PTSD following childbirth: psychometric properties of the City Birth Trauma Scale-French Version (City BiTS-F).
      ,
      • Handelzalts JE
      • Hairston IS
      • Matatyahu A.
      Construct validity and psychometric properties of the Hebrew version of the City Birth Trauma scale.
      the Barkin Index of Maternal Functioning (BIMF; n=3) with 831 patients,
      • Aydın R
      • Kukulu K.
      Adaptation of the Barkin scale of maternal functioning and examination of the psychometric properties.
      ,
      • Barkin JL
      • Wisner KL
      • Wisniewski SR.
      The psychometric properties of the Barkin index of maternal functioning.
      ,
      • Ansariniaki M
      • Lamyian M
      • Ahmadi F
      • Rahimi Foroushani A
      • Curry CL
      • Barkin JL
      Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.
      and the Postnatal Bonding Questionnaire (PBQ) with 466 patients.
      • Busonera A
      • Cataudella S
      • Lampis J
      • Tommasi M
      • Zavattini GC.
      Psychometric properties of the postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.
      ,
      • Ohashi Y
      • Kitamura T
      • Sakanashi K
      • Tanaka T.
      Postpartum bonding disorder: factor structure, validity, reliability and a model comparison of the postnatal bonding questionnaire in Japanese mothers of infants.
      • Wittkowski A
      • Wieck A
      • Mann S.
      An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
      • Matsunaga A
      • Ohashi Y
      • Sakanashi K
      • Kitamura T.
      Factor structure of the postpartum Bonding Questionnaire: configural invariance and measurement invariance across postpartum time periods.
      There were 17 studies that examined the domain of mental health, 6 studies that evaluated role transition to motherhood, and 5 studies that examined HRQoL. Of note, 1 tool examined urinary incontinence in postpartum women. The incontinence domain recommended by the ICHOM also included anal incontinence, but there is no psychometric evaluation study in postpartum women with an anal incontinence tool. Additional domains represented in the evaluated tools not proposed by the ICHOM included social support, postpartum recovery, and fatigue tools.
      Table 1Included studies and properties of PROMs
      O'Byrne. Postpartum patient reported outcome measures: systematic review and evaluation. Am J Obstet Gynecol MFM 2022.
      Measure (tool)DomainsMode of administrationAuthor and yearNo. of patientsOriginal languageAvailable translationTime of postpartum assessment
      EPDSMental healthQuestionnaireGausia et al,
      • Gausia K
      • Fisher C
      • Algin S
      • Oosthuizen J.
      Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample.
      2007 (Bangla)Montazeri et al,
      • Montazeri A
      • Torkan B
      • Omidvari S.
      The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version.
      2007 (Iranian)Small et al,
      • Small R
      • Lumley J
      • Yelland J
      • Brown S.
      The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia.
      2007 (Australian Vietnamese and Filipino)Martin et al,
      • Martin CR
      • Redshaw M.
      Establishing a coherent and replicable measurement model of the Edinburgh Postnatal Depression Scale.
      2018
      1001001310245EnglishMultiple0–9 mo
      PQOLMental health

      Role transition

      Breastfeeding

      HRQoL

      Physical function

      Social support
      QuestionnaireNikan et al,
      • Nikan F
      • Asghari Jafarabadi M
      • Mohammad-Alizadeh-Charandabi S
      • Mirghafourvand M
      • Montazeri A
      • Asadi S
      Psychometric properties of the Iranian version of a postpartum women's quality of life questionnaire (PQOL): a methodological study.
      2016
      500ChineseEnglish

      Persian
      0–12 mo after delivery
      PROMIS GSFMental health

      HRQoL

      Physical pain and fatigue

      Social support
      QuestionnaireSlavin et al, 2019a
      • Denis A
      • Callahan S
      • Bouvard M.
      Evaluation of the French version of the Multidimensional Scale of Perceived Social Support during the postpartum period.
      263EnglishEnglish6 and 26 wk
      13-PAFSMental health Physical fatigue

      Emotional function cognitive function
      QuestionnaireTsuchiya et al,
      • Tsuchiya M
      • Mori E
      • Sakajo A
      • Iwata H
      • Maehara K
      • Tamakoshi K.
      Cross-sectional and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers.
      2016
      3632English

      Chinese
      English

      Chinese
      After delivery to 6 mo
      IFSACRole transition

      Household

      Social

      Personal care
      QuestionnaireNoor et al,
      • Noor NM
      • Aziz AA
      • Mostapa MR
      • Awang Z.
      Validation of the Malay version of the inventory of functional status after childbirth questionnaire.
      2015McVeigh et al,
      • McVeigh C
      • Chaboyer W.
      Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian population.
      2002
      108173EnglishEnglish1–6 mo
      PDSSMental healthQuestionnaireVogeli et al,
      • Vogeli JM
      • Hooker SA
      • Everhart KD
      • Kaplan PS.
      Psychometric properties of the postpartum depression screening scale beyond the postpartum period.
      2018

      Beck et al,
      • Beck CT
      • Gable RK.
      Postpartum depression screening scale: Spanish version.
      2003
      238

      377
      EnglishEnglish, Spanish2 wk to 15 mo
      CBTSMental healthQuestionnaireNakić Radoš et al, 2019
      • Nakić Radoš S
      • Matijaš M
      • Kuhar L
      • Anđelinović M
      • Ayers S.
      Measuring and conceptualizing PTSD following childbirth: validation of the city birth trauma scale.


      Sandoz et al,
      • Sandoz V
      • Hingray C
      • Stuijfzand S
      • Lacroix A
      • El Hage W
      • Horsch A.
      Measurement and conceptualization of maternal PTSD following childbirth: psychometric properties of the City Birth Trauma Scale-French Version (City BiTS-F).
      2022

      Handelzalts et al,
      • Handelzalts JE
      • Hairston IS
      • Matatyahu A.
      Construct validity and psychometric properties of the Hebrew version of the City Birth Trauma scale.
      2018
      603

      541

      504
      Croatian

      French

      Hebrew
      English0–12 mo
      MSPSSMental health

      Social support
      QuestionnaireDenis et al,
      • Denis A
      • Callahan S
      • Bouvard M.
      Evaluation of the French version of the Multidimensional Scale of Perceived Social Support during the postpartum period.
      2015
      148EnglishEnglish

      French
      1–4 mo
      EQ-5DMental health

      HRQoL

      Mobility

      Self-care

      Usual activity

      Pain or discomfort
      QuestionnaireJansen et al,
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      2007
      141EnglishEnglishDays 1 and 2

      6 mo
      SF-36Mental health

      Physical health
      QuestionnaireJansen et al,
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      2007
      141EnglishEnglish0, 1, 3, and 6 wk
      MFIFatigueQuestionnaireJansen et al,
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      2007
      141DutchDutch

      English
      Days 1 and 2
      PDPSIMental health

      Stress
      QuestionnaireRazurel et al,
      • Razurel C
      • Kaiser B
      • Dupuis M
      • Antonietti JP
      • Sellenet C
      • Epiney M.
      Validation of the post-delivery perceived stress inventory.
      2014
      235EnglishEnglish French0–2 d
      FASFatigueQuestionnaireCano-Climent et al,
      • Cano-Climent A
      • Oliver-Roig A
      • Cabrero-García J
      • de Vries J
      • Richart-Martínez M.
      The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women.
      2017
      870EnglishEnglish

      Spanish
      Day of discharge
      BIMFBreastfeeding

      Mental health

      Role transition

      Social support
      QuestionnaireAydin et al,
      • Wittkowski A
      • Wieck A
      • Mann S.
      An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
      2018

      Barkin et al,
      • Barkin JL
      • Wisner KL
      • Wisniewski SR.
      The psychometric properties of the Barkin index of maternal functioning.
      2014

      Ansariniaki et al,
      • Ansariniaki M
      • Lamyian M
      • Ahmadi F
      • Rahimi Foroushani A
      • Curry CL
      • Barkin JL
      Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.
      2021
      235

      346

      250
      EnglishEnglish

      Turkish

      Persian
      6–10 wk
      PDSMental healthQuestionnaireDikmen-Yildiz 2017
      • Dikmen-Yildiz P
      • Ayers S
      • Phillips L
      Screening for birth-related PTSD: Psychometric properties of the Turkish version of the posttraumatic diagnostic scale in postpartum women in Turkey.
      858EnglishTurkish0–6 mo
      PPQMental healthQuestionnaireHernández-Martínez et al,
      • Hernández-Martínez A
      • Martínez-Vázquez S
      • Rodríguez-Almagro J
      • Khan KS
      • Delgado-Rodríguez M
      • Martínez-Galiano JM.
      Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period.
      2021
      432EnglishEnglish

      Spanish

      Chinese

      Korean
      <6 mo
      PBQRole transitionQuestionnaireOhashi et al,
      • Matsunaga A
      • Ohashi Y
      • Sakanashi K
      • Kitamura T.
      Factor structure of the postpartum Bonding Questionnaire: configural invariance and measurement invariance across postpartum time periods.
      2016

      Wittkowski et al,
      • Wittkowski A
      • Wieck A
      • Mann S.
      An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
      2007

      Busonera et al,
      • Busonera A
      • Cataudella S
      • Lampis J
      • Tommasi M
      • Zavattini GC.
      Psychometric properties of the postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.
      2017
      247

      96

      123
      EnglishJapanese

      English
      5 d to 1 mo
      MIBSRole transition

      Bonding
      QuestionnaireWittkowski et al,
      • Wittkowski A
      • Wieck A
      • Mann S.
      An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
      2007
      96EnglishEnglish2–4 d
      NHPMental healthQuestionnaireBaghirzada et al,
      • Baghirzada L
      • Downey KN
      • Macarthur AJ.
      Assessment of quality of life indicators in the postpartum period.
      2013
      125EnglishEnglish2–4 d
      WHOQOL-BREFHRQoLQuestionnaireWebster 2009
      • Webster J
      • Nicholas C
      • Velacott C
      • Cridland N
      • Fawcett L
      Validation of the WHOQOL-BREF among women following childbirth.
      320EnglishEnglish2–4 d
      TES-BMental healthQuestionnaireStramrood et al,
      • Stramrood CA
      • Huis In ’t Veld EM
      • Van Pampus MG
      • et al.
      Measuring posttraumatic stress following childbirth: a critical evaluation of instruments.
      2010
      428EnglishEnglish2–6 mo
      ICIQ-UI SFIncontinenceQuestionnaireSlavin et al,
      • Beck CT
      • Gable RK.
      Postpartum depression screening scale: Spanish version.
      2019
      263EnglishEnglish6–26 wk
      MOS-SSSSocial supportQuestionnaireNorhayati et al,
      • Norhayati MN
      • Aniza AA
      • Nik Hazlina NH
      • Azman MY
      Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
      2015
      144MalayEnglish0–1 mo
      PASSMental healthQuestionnaireJradi et al,
      • Jradi H
      • Alfarhan T
      • Alsuraimi A.
      Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women.
      2020
      125Arabic

      English
      EnglishNo specific time reported
      PPSS-SRole transition

      Breastfeeding

      Sense of security
      QuestionnaireEscribano et al,
      • Escribano S
      • Oliver-Roig A
      • Cano-Climent A
      • Richart-Martínez M
      • Persson EK
      • Juliá-Sanchis R.
      The Spanish version of the Mothers’ Postnatal Sense of Security Scale: psychometric properties and predictive utility.
      2020
      928Swedish

      English
      English1–3 mo
      WHO-5Mental health

      HRQoL
      QuestionnaireMortazavi et al,
      • Mortazavi F
      • Mousavi SA
      • Chaman R
      • Khosravi A.
      Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors.
      2015
      341EnglishEnglish

      Farsi
      2 mo
      MMCLMental healthQuestionnaireMcGlynn et al,
      • Savage McGlynn E
      • Martin CR
      • Redshaw M.
      How mothers feel: validation of a measure of maternal mood.
      2020
      504EnglishEnglish0–3 mo
      ObsQOR-10Postpartum Recovery

      Breastfeeding
      QuestionnaireSultan 2020
      • Sultan P
      • Kamath N
      • Carvalho B
      • et al.
      Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study.


      Sultan et al, 2020a
      • Sultan P
      • Kormendy F
      • Nishimura S
      • Carvalho B
      • Guo N
      • Papageorgiou C.
      Comparison of spontaneous versus operative vaginal delivery using Obstetric Quality of Recovery-10 (ObsQoR-10): an observational cohort study.
      215

      123
      EnglishEnglish72 h to 3 d
      PSS-SRMental health

      Postpartum PTSD
      QuestionnaireStramrood et al,
      • Stramrood CA
      • Huis In ’t Veld EM
      • Van Pampus MG
      • et al.
      Measuring posttraumatic stress following childbirth: a critical evaluation of instruments.
      2010
      428EnglishEnglish2–6 mo
      13-PAFS, 13-Item Postnatal Accumulated Fatigue Scale; BIMF, Barkin Index of Maternal Functioning; CBTS, City Birth Trauma Scale; EPDS, Edinburgh Postnatal Depression Scale; FAS, Fatigue Assessment Scale; HRQoL, health-related quality of life; ICIQ-UI SF, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form; IFSAC, Inventory of Functional Status After Childbirth; MFI, Multidimensional Fatigue Inventory; MIBS, Mother-Infant Bonding Scale; MMCL, Maternal Mood Checklist; MOS-SSS, Medical Outcome Study Social Support Survey; MSPSS, Multidimensional Scale of Perceived Social Support; NHP, Nottingham Health Profile; ObsQOR-10, Obstetric Quality of Recovery-10; PASS, Perinatal Anxiety Screening Scale; PBQ, Postnatal Bonding Questionnaire; PDPSI, Postdelivery Perceived Stress Inventory; PDSS, Postpartum Depression Screening Scale; PPQ, Perinatal Post-Traumatic Stress Disorder Questionnaire; PPSS-S, Parent's Postnatal Sense of Security Scale; PQOL, Postpartum Quality-of-Life Questionnaire; PROMIS GSF, Patient-Reported Outcomes Measurement Information System Global Short Form; PROM, patient-reported outcome measure; PSS-SR, PTSD Symptom Scale Self-Report; PDS, Posttraumatic Diagnostic Scale in Postpartum; TES-B, Traumatic Event Scale-B; SF-36, 36-Item Short Form Health Survey; WHO-5, 5-Item World Health Organization Well-Being Index; WHOQOL-BREF, World Health Organization Quality of Life Brief Version.

      Risk of bias in assessing methodological quality and overall rating of individual studies

      There were 41 individual studies included in the review. The risk of bias checklist developed by COSMIN was used for assessing the individual methodological quality of eligible studies. The results of the 8 measurement properties examining the risk of bias are included in appendix sTable 1. Many of the studies that assessed psychometric properties of a tool scored “very good” across the 8 measurement properties assessment methods following the COSMIN recommendations. Very few studies examined all 8 psychometric properties of the tools, with many only examining structural validity, internal consistency, and hypothesis testing. No study examined cross-cultural validity appropriately using multiple factor group analysis or differential item functioning, and measurement error was not assessed as set out by COSMIN using the smallest detectable change, limits of agreement, or minimal important change. The overall quality rating of individual study methods, as guided by the COSMIN criteria for good measurement properties, is also included in sTable 1.

      Psychometric measurements properties for the included patient-reported outcome measures

      Individual study results for risk of bias and good measurement properties are pooled to give the tool an overall rating. The modified GRADE approach by COSMIN was used to award a level of evidence presented in appendixs Table 2. A summary of these results is presented in Table 2.
      Table 2Pooled results for tools
      O'Byrne. Postpartum patient reported outcome measures: systematic review and evaluation. Am J Obstet Gynecol MFM 2022.
      VariableContent validityStructural validityInternal consistencyCross cultural validityReliabilityMeasurement errorHypothesis testingResponsivenessRecommendation
      MethodsResultsGradeMethodsResultsGradeMethodsResultsGradeMethodsResultsGradeMethodsResultsGradeMethodsResultsGradeMethodsResultsGrade
      MMCL+Very good+LowVery good+LowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+LowNot assessed+Very lowA
      WHO-5+Very good+ModerateVery good+ModerateNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+ModerateNot assessed+ModerateA
      CBTS+Very good+Very LowVery good+HighNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery Good+HighNot Assessed?Very lowA
      EPDS+Very good+ModerateVery Good+ModerateNot assessed?Very LowVery good+ModerateNot assessed?Very lowVery good+ModerateNot assessed?Very LowA
      PQOL+Very good+HighVery good+HighNot assessed?Very lowVery good+HighNot assessed?Very lowVery good+HighNot assessed?Very lowA
      PROMIS GSF+Very good+HighVery good+HighNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+HighNot assessed?Very lowA
      PDSS+Very goodModerateVery good+ModerateNot assessed?Very lowVery good+ModerateNot assessed?Very lowVery good?ModerateVery good+ModerateA
      EQ-5D+Not assessed?Very lowNot assessed?Very lowNot assessed?Very lowInadequate?Very lowNot assessed?Very lowVery good+HighVery good+HighB
      SF-36+Not assessed?Very lowVery good+HighNot assessed?Very lowInadequate?Very lowNot assessed?Very lowVery good+HighVery good+HighA
      PDPSI+Very good+ModerateVery good+ModerateNot assessed?Very lowAdequateModerateNot assessed?Very lowAdequate+ModerateNot assessed?Very lowA
      FAS?Very good+ModerateVery good+ModerateNot assessed?Very lowInadequateModerateNot assessed?Very lowVery good+ModerateNot assessed?Very lowC
      Barkin Index of Maternal Functioning+Very good+Moderatevery good+ModerateNot assessed?Very lowVery good+Very lowNot assessed?Very lowVery good+LowNot assessed?Very lowA
      PPQ+Very goodLowVery good+LowNot assessed?Very lowInadequate?LowNot assessed?Very lowVery good+LowNot assessed?Very lowA
      WHOQOL-BREF+Not assessed?Very lowVery good+ModerateNot assessed?Very lowVery good?ModerateNot assessed?Very lowVery good+ModerateNot assessed?Very lowA
      PASS+Inadequate?Very lowVery good+LowNot assessed?Very lowInadequate+LowNot assessed?Very lowVery good+LowNot assessed?Very lowA
      NHP+Not assessed?Very lowVery good+HighNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+HighNot assessed?Very lowA
      TES-B+Not assessed?Very lowVery good+LowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery goodLowNot assessed?Very lowA
      PSS-SR+Not assessed?Very lowVery good+LowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery goodLowNot assessed?Very lowA
      PDS+Very good?LowVery good+LowNot assessed?Very lowVery good+LowNot assessed?Very lowVery good+LowVery good+ModerateA
      MOS-SSS?Very good+Very lowVery good+Very lowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowInadequateVery lowNot assessed?Very lowC
      MSPSS+Very goodModerateVery good+ModerateNot assessed?Very lowInadequateModerateNot assessed?Very lowAdequate+ModerateDoubtful?Very lowA
      PPSS-S+Very good+ModerateVery good+ModerateNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowAdequate+ModerateNot assessed?Very lowA
      IFSAC+Not assessed?Very lowVery goodVery lowNot assessed?Very lowVery goodModerateNot assessed?Very lowVery good+ModerateNot assessed?Very lowB
      ObsQOR-10+Not assessed?Very lowVery good+HighNot assessed?Very lowVery good+HighNot assessed?Very lowVery goodVery lowVery good+HighA
      PBQ+Not assessed?Very lowVery good+LowNot assessed?Very lowVery good+ModerateNot assessed?Very lowVery good+LowNot assessed?ModerateA
      MIBS+Not assessed?Very lowVery goodVery lowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+Very lowNot assessedHighB
      ICIQ-UI SF+Inadequate?Very lowInadequate?Very lowNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+HighVery goodHighB
      13-PAFS+Very good+ModerateVery goodModerateNot assessed?Very lowNot assessed?Very lowNot assessed?Very lowVery good+HighNot assessed?Very lowB
      MFI?Not assessed?Very lowVery good+HighNot assessed?Very lowInadequate?Very lowInadequate?Very lowVery good+HighVery good+HighC
      Methods rating is presented as follows: very good, adequate, doubtful, inadequate, or not assessed. Overall rating is presented as follows: sufficient (+), insufficient (−), inconsistent (+ or −), or indeterminate (?).
      Recommendation:
      “A” indicates PROMs with evidence for sufficient content validity (any level) and at least low-quality evidence for sufficient internal consistency. “B” indicates PROMs categorized not in “A” or “C.” “C” indicates PROMs with high-quality evidence for an insufficient measurement property or PROMS with inadequate validity.
      13-PAFS, 13-Item Postnatal Accumulated Fatigue Scale; BIMF, Barkin Index of Maternal Functioning; CBTS, City Birth Trauma Scale; EPDS, Edinburgh Postnatal Depression Scale; FAS, Fatigue Assessment Scale; HRQoL, health-related quality of life; ICIQ-UI SF, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form; IFSAC, Inventory of Functional Status After Childbirth; MFI, Multidimensional Fatigue Inventory; MIBS, Mother-Infant Bonding Scale; MMCL, Maternal Mood Checklist; MOS-SSS, Medical Outcome Study Social Support Survey; MSPSS, Multidimensional Scale of Perceived Social Support; NHP, Nottingham Health Profile; ObsQOR-10, Obstetric Quality of Recovery-10; PASS, Perinatal Anxiety Screening Scale; PBQ, Postnatal Bonding Questionnaire; PDPSI, Postdelivery Perceived Stress Inventory; PDSS, Postpartum Depression Screening Scale; PPQ, Perinatal Post-Traumatic Stress Disorder Questionnaire; PPSS-S, Parent's Postnatal Sense of Security Scale; PQOL, Postpartum Quality-of-Life Questionnaire; PROMIS GSF, Patient-Reported Outcomes Measurement Information System Global Short Form; PROM, patient-reported outcome measure; PSS-SR, PTSD Symptom Scale Self-Report; PDS, Posttraumatic Diagnostic Scale in Postpartum; TES-B, Traumatic Event Scale-B; SF-36, 36-Item Short Form Health Survey; WHO-5, 5-Item World Health Organization Well-Being Index; WHOQOL-BREF, World Health Organization Quality of Life Brief Version.
      The most frequently assessed psychometric properties for the pooled results for tools were structural validity and internal consistency as seen in Table 2. Most tools, which examined these properties, scored “very good” on their methods as proposed by COSMIN. No tool had included studies that had evaluated cross-cultural validity, which refers to the degree to which the performance of the items on a translated or culturally adapted instrument is an adequate reflection of the performance of the items of the original version of the instrument. There were 8 tools that scored as having had sufficient reliability: EPDS, Postpartum Quality-of-Life Questionnaire (PQOL), Postpartum Depression Screening Scale (PDSS), BIMF, Obstetric Quality of Recovery-10 (ObsQoR-10), Posttraumatic Diagnostic Scale in Postpartum (PDS), PBQ, and Perinatal Anxiety Screening Scale (PASS). The measurement error was not examined in the included studies.
      Hypothesis testing was performed in all but one tool, Medical Outcome Study Social Support Survey (MOS-SSS).
      • Norhayati MN
      • Aniza AA
      • Nik Hazlina NH
      • Azman MY
      Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
      Most often, studies compared their tool and its performance against a selected comparator tool for hypothesis testing. Of the 29 tools, 11 examined the property of responsiveness: Maternal Mood Checklist (MMCL), EPDS, Multidimensional Scale of Perceived Social Support (MSPSS), Patient-Reported Outcomes Measurement Information System Global Short Form (PROMIS GSF), PDSS, ObsQoR-10, EQ-5D, 36-Item Short Form Health Survey, Multidimensional Fatigue Inventory (MFI), PDS, and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF).

      Grading of Recommendations, Assessment, Development, and Evaluations assessment of included patient-reported outcome measures

      The GRADE result was awarded for the overall tool after the study result of each psychometric property had been pooled; the pooled results for tools are presented in Table 2. The GRADE level of evidence for structural validity and internal consistency was awarded “high” for 2 tools, the PQOL and PROMIS GSF, with the other included tools scoring moderate to very low. Reliability had 2 tools that scored “high,” the PQOL and ObsQoR-10, with most tools scoring very low. Hypothesis testing and responsiveness had the most “high” scores, 9 and 6, respectively. Overall, the PQOL scored the highest on the measurement properties assessed, followed by the PROMIS GSF.

      Recommendations

      The recommendations for use from COSMIN are PROMs with evidence for sufficient content validity (any level) and at least low-quality evidence for sufficient internal consistency (“A”). There were 21 tools that had an “A” recommendation, meaning that they can be recommended for use and the results can be trusted. The domain of mental health was the most represented domain with 17 of 21 “A”-recommended tools, all except MSPSS, Parent's Postnatal Sense of Security Scale (PPSS-S), ObsQoR-10, and PBQ. HRQoL was represented by 4 “A”-recommended tools: 5-Item World Health Organization Well-Being Index (WHO-5), PQOL, PROMIS GSF, and World Health Organization Quality of Life Brief Version (WHOQOL-BREF). The domain of breastfeeding represented 4 “A”-recommended tools PROMIS GSF, BIMF, PPSS-S, and ObsQoR-10. The domain of role transition was recommended by 3 “A”-recommended tools: PQOL, BIMF, and PPSS-S. Incontinence and pain with intercourse were not covered by any “A”-rated tool. There were 3 tools in our review (covering fatigue and social support in isolation) that did not have sufficient content validity and were awarded a “C” recommendation; these were the fatigue assessment scale (FAS),
      • Cano-Climent A
      • Oliver-Roig A
      • Cabrero-García J
      • de Vries J
      • Richart-Martínez M.
      The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women.
      MFI,
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      and MOS-SSS.
      • Norhayati MN
      • Aniza AA
      • Nik Hazlina NH
      • Azman MY
      Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
      The tools recommended as “B” require further evaluation of their quality before recommendation for use.
      Of the “A”-recommended tools, the PQOL covered the most domains, including HRQoL, mental health, role transition, and breastfeeding. It scored sufficiently for structural validity, internal consistency, reliability, and hypothesis testing, with a high grade of evidence. However, the PQOL did not cover all domains of postpartum health and well-being. Furthermore, the PROMIS GSF and WHOQOL-BREF scored highly, with PROMIS GSF covering the domains of mental health and HRQoL and WHOQOL-BREF covering the domain of HRQoL.

      Comment

      Principal findings

      There were 21 PROMs found to be recommended for use in postpartum women. The most frequently represented domain was postpartum mental health, with 17 of 21 tools covering mental health. The only 2 tools that did not cover this domain were PPSS-S, which focused on postpartum security, and ObsQoR-10, which evaluated postpartum recovery. HRQoL was represented by 4 “A”-recommended tools, including the WHO-5, PQOL, PROMIS GSF, and WHOQOL-BREF. The domain of breastfeeding was also represented by 4 “A”-recommended tools, including PROMIS, BIMF, PPSS-S, and ObsQoR-10, whereas the domain of role transition was represented by PQOL, BIMF, and PPSS-S.

      Comparison with existing literature

      To date, there is no consensus on a PROM within maternity care.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      ,
      • Mogos MF
      • August EM
      • Salinas-Miranda AA
      • Sultan DH
      • Salihu HM.
      A systematic review of quality of life measures in pregnant and postpartum mothers.
      We have chosen to include all tools that examined health and well-being in the postpartum period in this review. The ICHOM recommended domains of importance to postpartum women, including HRQoL. HRQoL has multiple competing definitions in the literature as Karimi et al
      • Karimi M
      • Brazier J.
      Health, health-related quality of life, and quality of life: what is the difference?.
      have explored, which often overlap with the concepts of QoL and health.
      • Karimi M
      • Brazier J.
      Health, health-related quality of life, and quality of life: what is the difference?.
      ,
      • Hays RD
      • Reeve BB.
      Measurement and modeling of health-related quality of life.
      ,

      Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59-65. PMID: 7996652.

      Here, any tool that identified examining the concept of HRQoL or QoL was included in this domain.
      We chose to use the broader concept of health and well-being as the overarching approach to this topic. The WHO has defined health as “a state of complete physical, social, and mental well-being and not merely the absence of disease or infirmity” and well-being as “encompass[ing] [QoL], as well as the ability of people and societies to contribute to the world in accordance with a sense of meaning and purpose.”

      Health promotion glossary of terms 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

      This broader definition of all aspects of health, QoL, and a person's ability to interact with the world around them aligned with the concept of a postpartum PROM.
      There were 3 tools that did not meet the criteria for sufficient content validity following ICHOM-proposed domains. These were the FAS
      • Cano-Climent A
      • Oliver-Roig A
      • Cabrero-García J
      • de Vries J
      • Richart-Martínez M.
      The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women.
      ; the MFI, both of which are generic tools designed to assess fatigue
      • Jansen AJ
      • Essink-Bot ML
      • Duvekot JJ
      • van Rhenen DJ.
      Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
      ; and the MOS-SSS, a generic tool examining social, emotional, and informational support.
      • Norhayati MN
      • Aniza AA
      • Nik Hazlina NH
      • Azman MY
      Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
      There was no study examining the domain of sexual health psychometrically evaluated in postpartum women. The domain most underrepresented in our study was the postpartum incontinence domain. The ICIQ-UI SF used for urinary incontinence was the only 1 psychometrically evaluated incontinence tool study in postpartum women by Slavin et al.
      • Slavin V
      • Gamble J
      • Creedy DK
      • Fenwick J.
      Perinatal incontinence: psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.
      The Slavin study aimed to evaluate perinatal incontinence, which included urinary and fecal incontinence, but the tool examining anal incontinence (Wexner Scale) could not be evaluated as there were insufficient numbers of women identified as suffering with anal incontinence after delivery.
      The tool with the highest rating that covered the most domains was the PQOL. The PQOL was designed in China by Zhou et al,
      • Zhou SZ
      • Wang XL
      • Wang Y.
      Design of a questionnaire for evaluating the quality of life of postpartum women (PQOL) in China.
      with a robust development procedure, including the Delphi process with expert and postpartum women involvement and item selection using multiple COSMIN-recommended methods (expert scoring, factor analysis, coefficient of variation, item-removed Cronbach alpha, item-expected domain correlation, item-unexpected domain correlation, and test-retest correlation analysis). The study included in this systematic review was performed in an Iranian cohort by Nikan et al.
      • Nikan F
      • Asghari Jafarabadi M
      • Mohammad-Alizadeh-Charandabi S
      • Mirghafourvand M
      • Montazeri A
      • Asadi S
      Psychometric properties of the Iranian version of a postpartum women's quality of life questionnaire (PQOL): a methodological study.
      The PQOL scored highly in structural validity, internal consistency, reliability, and hypothesis testing but did not assess cross-cultural validity or responsiveness. The PQOL is a 40-item tool that uses a 5-point Likert scale; it is freely available and easy to administer, with a completion time of 5 to 10 minutes for patients to score. Nikan et al
      • Nikan F
      • Asghari Jafarabadi M
      • Mohammad-Alizadeh-Charandabi S
      • Mirghafourvand M
      • Montazeri A
      • Asadi S
      Psychometric properties of the Iranian version of a postpartum women's quality of life questionnaire (PQOL): a methodological study.
      reported the ability to discriminate between delivery type, postpartum depression, and socioeconomic status. The limitation of this tool is that it does not cover sexual health or incontinence, which are both important domains for postpartum health.

      Strengths and limitations

      This study examined the psychometric properties of the available tools evaluating postpartum health and well-being.
      The evaluation of individual domain-specific PROMs has been previously published, for example, mental health,
      • Vogeli JM
      • Hooker SA
      • Everhart KD
      • Kaplan PS.
      Psychometric properties of the postpartum depression screening scale beyond the postpartum period.
      postpartum recovery,
      • Sultan P
      • Sharawi N
      • Blake L
      • et al.
      Use of patient-reported outcome measures to assess outpatient postpartum recovery: a systematic review.
      and incontinence,
      • Slavin V
      • Gamble J
      • Creedy DK
      • Fenwick J.
      Perinatal incontinence: psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.
      but no work exists examining multidomain PROMs or a combination of PROMs suitable to universally examine postpartum health and well-being. Moreover, we have expanded on the domains put forward by the work of the ICHOM.
      This research has also highlighted areas requiring further research, specifically psychometric evaluation of tools examining postpartum sexual health and incontinence.
      Previous reviews on PROM for pregnancy and childbirth
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      highlighted the lack of PROM in this area, with Dickenson et al
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      concluding that a variety of assessment tools could help develop a specific PROM on this topic. This research has been able to make recommendations regarding the most suitable tools currently available for use as a suitable postpartum PROM. This work has fulfilled many calls for the development of a postpartum PROM to improve the quality of maternity care and reduce morbidity and mortality for women.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      ,
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      A limitation of this study was that the only tools that have been psychometrically evaluated were included in this review. There may be appropriate tools that have not undergone psychometric evaluation to date that were not included in this research that could be used as a postpartum PROM. Secondly, despite the ICHOM having patient involvement and focus groups to identify the domains of importance to postpartum women, these may not cover all the domains of importance to all postpartum women. Important tools that have been graded highly by their psychometric properties may be beneficial in including in a postpartum PROM, such as those examining social support and fatigue. Such tools have been included in this work but have not been graded as such.

      Conclusion and implications

      Using high-quality PROM in this population can lead to service provision changes of value to women. No universal PROM has been used to longitudinally evaluate women's health and well-being across delivery groups and differing morbidities to identify areas of change. No single highly rated tool covers all domains of postpartum health. The future direction of this work can achieve this by specifically completing the validation of the postpartum incontinence tool, the ICIQ-UI SF, and incorporating a sexual health evaluation assessment with the use of the top-rated multidomain tool, the PQOL, blending appropriately assessed tools to achieve a clinically valuable and validated PROM.
      PROMs must be incorporated into women's healthcare to drive patient-centered change with clinically significant differences in outcomes for women.
      • Dickinson F
      • McCauley M
      • Smith H
      • van Den Broek N.
      Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
      ,
      • Mahmud A
      • Morris E
      • Johnson S
      • Ismail KM.
      Developing core patient-reported outcomes in maternity: PRO-Maternity.
      ,
      • Nijagal MA
      • Wissig S
      • Stowell C
      • et al.
      Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
      To date, a postpartum PROM that covers all domains of postpartum care would be most sufficiently produced by using an assembly of highly rated tools that assess the domains of importance to women in postpartum care. The feasibility and acceptability of such tools would require further exploration.

      Appendix. Supplementary materials

      References

        • Dickinson F
        • McCauley M
        • Smith H
        • van Den Broek N.
        Patient reported outcome measures for use in pregnancy and childbirth: a systematic review.
        BMC Pregnancy Childbirth. 2019; 19: 1-8
        • Mahmud A
        • Morris E
        • Johnson S
        • Ismail KM.
        Developing core patient-reported outcomes in maternity: PRO-Maternity.
        BJOG. 2014; 121: 15-19
        • Dawson J
        • Doll H
        • Fitzpatrick R
        • Jenkinson C
        • Carr AJ.
        The routine use of patient reported outcome measures in healthcare settings.
        BMJ. 2010; 340: c186
        • Black N.
        Patient reported outcome measures could help transform healthcare.
        BMJ. 2013; 346: 1-5
        • Nijagal MA
        • Wissig S
        • Stowell C
        • et al.
        Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal.
        BMC Health Serv Res. 2018; 18: 1-12
        • Mogos MF
        • August EM
        • Salinas-Miranda AA
        • Sultan DH
        • Salihu HM.
        A systematic review of quality of life measures in pregnant and postpartum mothers.
        Appl Res Qual Life. 2013; 8: 219-250
        • Devane D
        • Begley CM
        • Clarke M
        • Horey D
        • OBoyle C.
        Evaluating maternity care: a core set of outcome measures.
        Birth. 2007; 34: 164-172
        • World Health Organization
        WHO technical consultation on postpartum and postnatal care.
        World Health Organization, Geneva, Switzerland2010
        • Karimi M
        • Brazier J.
        Health, health-related quality of life, and quality of life: what is the difference?.
        Pharmacoeconomics. 2016; 34: 645-649
      1. Health promotion glossary of terms 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

        • Prinsen CAC
        • Mokkink LB
        • Bouter LM
        • et al.
        COSMIN guideline for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1147-1157
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • O'Byrne L
        • Maher G
        • Khashan A
        • Greene R
        • Browne J
        • McCarthy FP.
        Patient reported outcome measures in childbirth and postpartum maternal quality of life: a protocol for systematic review of measurement properties.
        HRB Open Res. 2021; 4: 117
        • Mokkink LB
        • Prinsen C
        • Patrick DL.
        COSMIN manual for systematic reviews of Proms, user manual. 2018; : 78
        • Ouzzani M
        • Hammady H
        • Fedorowicz Z
        • Elmagarmid A.
        Rayyan-a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Gausia K
        • Fisher C
        • Algin S
        • Oosthuizen J.
        Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample.
        J Reprod Infant Psychol. 2007; 25: 308-315
        • Montazeri A
        • Torkan B
        • Omidvari S.
        The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version.
        BMC Psychiatry. 2007; 7: 11
        • Busonera A
        • Cataudella S
        • Lampis J
        • Tommasi M
        • Zavattini GC.
        Psychometric properties of the postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.
        Midwifery. 2017; 55: 15-22
        • Baghirzada L
        • Downey KN
        • Macarthur AJ.
        Assessment of quality of life indicators in the postpartum period.
        Int J Obstet Anesth. 2013; 22: 209-216
        • Stramrood CA
        • Huis In ’t Veld EM
        • Van Pampus MG
        • et al.
        Measuring posttraumatic stress following childbirth: a critical evaluation of instruments.
        J Psychosom Obstet Gynaecol. 2010; 31: 40-49
        • Norhayati MN
        • Aniza AA
        • Nik Hazlina NH
        • Azman MY
        Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.
        Asia Pac Psychiatry. 2015; 7: 398-405
        • Jradi H
        • Alfarhan T
        • Alsuraimi A.
        Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women.
        BMC Pregnancy Childbirth. 2020; 20: 1-8
        • Martin CR
        • Redshaw M.
        Establishing a coherent and replicable measurement model of the Edinburgh Postnatal Depression Scale.
        Psychiatry Res. 2018; 264: 182-191
        • Escribano S
        • Oliver-Roig A
        • Cano-Climent A
        • Richart-Martínez M
        • Persson EK
        • Juliá-Sanchis R.
        The Spanish version of the Mothers’ Postnatal Sense of Security Scale: psychometric properties and predictive utility.
        Res Nurs Health. 2020; 43: 651-661
        • Mortazavi F
        • Mousavi SA
        • Chaman R
        • Khosravi A.
        Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors.
        Turk Psikiyatri Derg. 2015; 26: 1-7
        • Savage McGlynn E
        • Martin CR
        • Redshaw M.
        How mothers feel: validation of a measure of maternal mood.
        J Eval Clin Pract. 2020; 26: 1242-1249
        • Sultan P
        • Kamath N
        • Carvalho B
        • et al.
        Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study.
        Am J Obstet Gynecol MFM. 2020; 2100202
        • Cano-Climent A
        • Oliver-Roig A
        • Cabrero-García J
        • de Vries J
        • Richart-Martínez M.
        The Spanish version of the Fatigue Assessment Scale: reliability and validity assessment in postpartum women.
        PeerJ. 2017; 5: e3832
        • Sultan P
        • Kormendy F
        • Nishimura S
        • Carvalho B
        • Guo N
        • Papageorgiou C.
        Comparison of spontaneous versus operative vaginal delivery using Obstetric Quality of Recovery-10 (ObsQoR-10): an observational cohort study.
        J Clin Anesth. 2020; 63109781
        • Nikan F
        • Asghari Jafarabadi M
        • Mohammad-Alizadeh-Charandabi S
        • Mirghafourvand M
        • Montazeri A
        • Asadi S
        Psychometric properties of the Iranian version of a postpartum women's quality of life questionnaire (PQOL): a methodological study.
        Iran Red Crescent Med J. 2016; 18: e35460
        • Beck CT
        • Gable RK.
        Postpartum depression screening scale: Spanish version.
        Nurs Res. 2003; 52: 296-306
        • Slavin V
        • Gamble J
        • Creedy DK
        • Fenwick J.
        Perinatal incontinence: psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.
        Neurourol Urodyn. 2019; 38: 2209-2223
        • Slavin V
        • Gamble J
        • Creedy DK
        • Fenwick J
        • Pallant J.
        Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population - Validation of the PROMIS Global Short Form.
        BMC Pregnancy Childbirth. 2019; 19: 1-19
        • Tsuchiya M
        • Mori E
        • Sakajo A
        • Iwata H
        • Maehara K
        • Tamakoshi K.
        Cross-sectional and longitudinal validation of a 13-item fatigue scale among Japanese postpartum mothers.
        Int J Nurs Pract. 2016; 22: 5-13
        • Noor NM
        • Aziz AA
        • Mostapa MR
        • Awang Z.
        Validation of the Malay version of the inventory of functional status after childbirth questionnaire.
        BioMed Res Int. 2015; 2015972728
        • McVeigh C
        • Chaboyer W.
        Reliability and validity of the Inventory of Functional Status after Childbirth when used in an Australian population.
        Nurs Health Sci. 2002; 4: 107-112
        • Nakić Radoš S
        • Matijaš M
        • Kuhar L
        • Anđelinović M
        • Ayers S.
        Measuring and conceptualizing PTSD following childbirth: validation of the city birth trauma scale.
        Psychol Trauma. 2020; 12: 147-155
        • Sandoz V
        • Hingray C
        • Stuijfzand S
        • Lacroix A
        • El Hage W
        • Horsch A.
        Measurement and conceptualization of maternal PTSD following childbirth: psychometric properties of the City Birth Trauma Scale-French Version (City BiTS-F).
        Psychol Trauma. 2022; 14: 696-704
        • Aydın R
        • Kukulu K.
        Adaptation of the Barkin scale of maternal functioning and examination of the psychometric properties.
        Health Care Women Int. 2018; 39: 50-64
        • Handelzalts JE
        • Hairston IS
        • Matatyahu A.
        Construct validity and psychometric properties of the Hebrew version of the City Birth Trauma scale.
        Front Psychol. 2018; 9: 1726
        • Denis A
        • Callahan S
        • Bouvard M.
        Evaluation of the French version of the Multidimensional Scale of Perceived Social Support during the postpartum period.
        Matern Child Health J. 2015; 19: 1245-1251
        • Jansen AJ
        • Essink-Bot ML
        • Duvekot JJ
        • van Rhenen DJ.
        Psychometric evaluation of health-related quality of life measures in women after different types of delivery.
        J Psychosom Res. 2007; 63: 275-281
        • Razurel C
        • Kaiser B
        • Dupuis M
        • Antonietti JP
        • Sellenet C
        • Epiney M.
        Validation of the post-delivery perceived stress inventory.
        Psychol Health Med. 2014; 19: 70-82
        • Small R
        • Lumley J
        • Yelland J
        • Brown S.
        The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia.
        Soc Psychiatry Psychiatr Epidemiol. 2007; 42: 70-78
        • Barkin JL
        • Wisner KL
        • Wisniewski SR.
        The psychometric properties of the Barkin index of maternal functioning.
        J Obstet Gynecol Neonatal Nurs. 2014; 43: 792-802
        • Ansariniaki M
        • Lamyian M
        • Ahmadi F
        • Rahimi Foroushani A
        • Curry CL
        • Barkin JL
        Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.
        BMC Pregnancy Childbirth. 2021; 21: 1-10
        • Hernández-Martínez A
        • Martínez-Vázquez S
        • Rodríguez-Almagro J
        • Khan KS
        • Delgado-Rodríguez M
        • Martínez-Galiano JM.
        Validation of perinatal post-traumatic stress disorder questionnaire for Spanish women during the postpartum period.
        Sci Rep. 2021; 11: 5567
        • Ohashi Y
        • Kitamura T
        • Sakanashi K
        • Tanaka T.
        Postpartum bonding disorder: factor structure, validity, reliability and a model comparison of the postnatal bonding questionnaire in Japanese mothers of infants.
        Healthcare (Basel). 2016; 4: 50
        • Wittkowski A
        • Wieck A
        • Mann S.
        An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the postpartum Bonding Questionnaire in a sample of primiparous mothers.
        Arch Womens Ment Health. 2007; 10: 171-175
        • Matsunaga A
        • Ohashi Y
        • Sakanashi K
        • Kitamura T.
        Factor structure of the postpartum Bonding Questionnaire: configural invariance and measurement invariance across postpartum time periods.
        J Psychiatr Res. 2021; 135: 1-7
        • Vogeli JM
        • Hooker SA
        • Everhart KD
        • Kaplan PS.
        Psychometric properties of the postpartum depression screening scale beyond the postpartum period.
        Res Nurs Health. 2018; 41: 185-194
        • Dikmen-Yildiz P
        • Ayers S
        • Phillips L
        Screening for birth-related PTSD: Psychometric properties of the Turkish version of the posttraumatic diagnostic scale in postpartum women in Turkey.
        Eur J Psychotraumatol. 2017; 8https://doi.org/10.1080/20008198.2017.1306414
        • Webster J
        • Nicholas C
        • Velacott C
        • Cridland N
        • Fawcett L
        Validation of the WHOQOL-BREF among women following childbirth.
        Aust New Zeal J Obstet. Gynaecol. 2010; 50: 132-137
        • Hays RD
        • Reeve BB.
        Measurement and modeling of health-related quality of life.
        in: Heggenhougen K Quah S International encyclopedia of public health. Academic Press, San Diego, CA2008: 241-252 (Volume 4)
      2. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59-65. PMID: 7996652.

        • Zhou SZ
        • Wang XL
        • Wang Y.
        Design of a questionnaire for evaluating the quality of life of postpartum women (PQOL) in China.
        Qual Life Res. 2009; 18: 497-508
        • Sultan P
        • Sharawi N
        • Blake L
        • et al.
        Use of patient-reported outcome measures to assess outpatient postpartum recovery: a systematic review.
        JAMA Netw Open. 2021; 4e2111600