Development and reliability and validity testing of a patient-reported symptom and function scale for patients with pectus excavatum after the Nuss procedure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Qibin ¹ , XIE Liang ² , ZHANG Dongkun ² , DENG Cheng ² , TANG Yong ² , WU Yinghong ² , SHI Qiuling ³ ,  QIAO Guibin ^1,2

1. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, 510080, P. R. China;
3. School of Public Health, Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding?author：

QIAO Guibin, Email: guibinqiao@126.com

Keywords：

Pectus excavatum; Nuss repair; patient-reported outcomes; symptom and function scale; reliability and validity test

DOI：

10.7507/1007-4848.202406067

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Objective To develop a symptom and function assessment scale for patients after Nuss procedure for pectus excavatum and to test its reliability and validity. Methods Following the principles and procedures of patient-reported outcome (PRO) scale development stipulated by the U.S. Food and Drug Administration, an initial draft was formed through literature analysis, qualitative interviews, and Delphi expert consultation. The preliminary draft was used to conduct a pre-survey on patients who underwent Nuss procedure for pectus excavatum at Guangdong Provincial People's Hospital, and the reliability and validity of the scale were tested. Results A preliminary PRO-based symptom and function scale was constructed, covering two domains: symptoms and impact on daily functions. The symptom dimension included six items: chest tightness, palpitations, pain, shortness of breath, foreign body sensation of the steel plate, and distress; while the impact on daily functions included four items: difficulty in getting out of bed or lying down, raising arms, bending over, and standing or sitting for a long time. A total of 73 patients who underwent Nuss procedure for pectus excavatum were included in the questionnaire survey, with 70 valid questionnaires collected, including 64 males and 6 females, with 56 patients aged 12-17 years and 14 patients ≥18 years. Through exploratory factor analysis, two common factors were extracted, with a cumulative variance contribution rate of 70%. The Cronbach’s α coefficient of the scale was 0.917. Conclusion The scale developed in this study has good reliability and validity, high reliability and stability, and can be used as an evaluation tool for the recovery status of patients after Nuss procedure for pectus excavatum.

Citation： CHEN Qibin, XIE Liang, ZHANG Dongkun, DENG Cheng, TANG Yong, WU Yinghong, SHI Qiuling, QIAO Guibin. Development and reliability and validity testing of a patient-reported symptom and function scale for patients with pectus excavatum after the Nuss procedure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(8): 1234-1239. doi: 10.7507/1007-4848.202406067 Copy

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2.	Kelly RE. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation[J]. Semin Pediatr Surg, 2008, 17(3): 181-193.
3.	Koumbourlis AC. Pectus excavatum: pathophysiology and clinical characteristics[J]. Paediatr Respir Rev, 2009, 10(1): 3-6.
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12.	Lenz ER, Suppe F, Gift AG, et al. Collaborative development of middle-range nursing theories: toward a theory of unpleasant symptoms[J]. ANS Adv Nurs Sci, 1995, 17(3): 1-13.
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14.	王柳森, 王志宏, 張兵, 等. 德爾菲法在老年膳食質量指數修訂中的應用[J]. 衛生研究, 2024, 53(1):49-54.Wang LS, Wang ZH, Zhang B, et al. Application of Delphi method in the revision of dietary quality index in the elderly[J]. J Hyg Res, 2024, 53(1): 49-54.
15.	張馨戈. 乳腺科醫護人員對乳腺癌生存者性功能障礙知信行量表的研制[D]. 華北理工大學, 2019.Zhang XG. Study on knowledge, attitude and practice scale of sexual dysfunction in breast cancer survivors among medical staff in breast cancer staff[D]. North China University of Science and Technology, 2019.
16.	諶璐. 腹膜透析生活質量量表的編制及考評[D]. 南京中醫藥大學, 2015.Chen L. Development and validation of the quality of life scale for peritoneal dialysis patients[D]. Nanjing University of Traditional Chinese Medicine, 2015.
17.	李其飛. 中醫高血壓病PRO量表的研制[D]. 廣州中醫藥大學, 2014.Li QF. The establishment of PRO questionnaire used in the evaluation of the clinical effectiveness of hypertension in TCM[D]. Guangzhou University of Traditional Chinese Medicine, 2014.
18.	常娟. 漏斗胸術后疼痛的護理[J]. 中國藥物與臨床, 2016, 16(2): 298-300.Chang J. Nursing care for postoperative pain in pectus carinatum[J]. Chin Remed Clin, 2016, 16(2): 298-300.
19.	Wang J, He L, Tian D, et al. Risk factors of chronic pain after Nuss procedure in patients with pectus excavatum[J]. J Clin Anesthesiol, 2021, 37(2): 138-141.
20.	陳磊, 林靈虹, 林敏娟. 疼痛護理在行漏斗胸Nuss術患兒中的應用效果[J]. 中西醫結合護理(中英文), 2022, 8(5): 178-180.Chen L, Lin LH, Lin MJ. Nursing care for postoperative pain in children undergoing Nuss procedure for pectus excavatum[J]. J Clin Nurs Pract, 2022, 8(5): 178-180.
21.	張鑫. 鄉村青年教師專業發展的影響因素與支持策略研究—以H省為例[D]. 哈爾濱師范大學, 2023.Zhang X. Study on influencing factors and supporting strategies of rural young teachers’ professional development: take H province as an example[D]. Harbin Normal University, 2023.
22.	張海力. 多維度多準則中成藥綜合評價方法構建及應用研究[D]. 中國中醫科學院, 2023.Zhang HL. Development and application of a multi-dimensional and multi-criteria comprehensive evaluation for Chinese patent medicine[D]. China Academy of Chinese Medical Sciences, 2023.

1. Huddleston CB. Pectus excavatum[J]. Semin Thorac Cardiovasc Surg, 2004, 16(3): 225-232.
2. Kelly RE. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation[J]. Semin Pediatr Surg, 2008, 17(3): 181-193.
3. Koumbourlis AC. Pectus excavatum: pathophysiology and clinical characteristics[J]. Paediatr Respir Rev, 2009, 10(1): 3-6.
4. Nuss D, Kelly RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum[J]. J Pediatr Surg, 1998, 33(4): 545-552.
5. Zhong W, Ye J, Feng J, et al. Effects of pectus excavatum on the spine of pectus excavatum patients with scoliosis[J]. J Healthc Eng, 2017, 2017: 5048625.
6. Krasopoulos G, Dusmet M, Ladas G, et al. Nuss procedure improves the quality of life in young male adults with pectus excavatum deformity[J]. Eur J Cardiothorac Surg, 2006, 29(1): 1-5.
7. Metzelder ML, Kuebler JF, Leonhardt J, et al. Self and parental assessment after minimally invasive repair of pectus excavatum: lasting satisfaction after bar removal[J]. Ann Thorac Surg, 2007, 83(5): 1844-1849.
8. Hoksch B, Kocher G, Vollmar P, et al. Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study[J]. Eur J Cardiothorac Surg, 2016, 50(5): 934-939.
9. 于青松. 基于患者報告結局建立鼻咽癌放射性口干評價體系的研究[D]. 重慶醫科大學, 2022.Yu QS. The establishment of a radiation-induced xerostomia evaluation system for nasopharyngeal carcinoma based on patient-reported outcomes[D]. Chongqing Medical University, 2022.
10. 王瑞娟, 朱康寧. 老年急性期快速恢復病房病人健康需求的質性研究[J]. 全科護理, 2024, 22(2): 199-203.Wang RJ, Zhu KN, Qualitative study on health needs of patients in acute care for the elderly unit[J]. Chin Gen Pract Nurs, 2024, 22(2): 199-203.
11. U. S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance[J]. Health Qual Life Outcomes, 2006, 4: 79.
12. Lenz ER, Suppe F, Gift AG, et al. Collaborative development of middle-range nursing theories: toward a theory of unpleasant symptoms[J]. ANS Adv Nurs Sci, 1995, 17(3): 1-13.
13. 黃方超, 王玉環, 張宏英. 社區-居家式老年人長期護理的服務內容[J]. 中國老年學雜志, 2011, 31(11): 2055-2057.Huang FC, Wang YH, Zhang HY. Service content of community-based home care for the elderly[J]. Chin J Gerontol, 2011, 31(11): 2055-2057.
14. 王柳森, 王志宏, 張兵, 等. 德爾菲法在老年膳食質量指數修訂中的應用[J]. 衛生研究, 2024, 53(1):49-54.Wang LS, Wang ZH, Zhang B, et al. Application of Delphi method in the revision of dietary quality index in the elderly[J]. J Hyg Res, 2024, 53(1): 49-54.
15. 張馨戈. 乳腺科醫護人員對乳腺癌生存者性功能障礙知信行量表的研制[D]. 華北理工大學, 2019.Zhang XG. Study on knowledge, attitude and practice scale of sexual dysfunction in breast cancer survivors among medical staff in breast cancer staff[D]. North China University of Science and Technology, 2019.
16. 諶璐. 腹膜透析生活質量量表的編制及考評[D]. 南京中醫藥大學, 2015.Chen L. Development and validation of the quality of life scale for peritoneal dialysis patients[D]. Nanjing University of Traditional Chinese Medicine, 2015.
17. 李其飛. 中醫高血壓病PRO量表的研制[D]. 廣州中醫藥大學, 2014.Li QF. The establishment of PRO questionnaire used in the evaluation of the clinical effectiveness of hypertension in TCM[D]. Guangzhou University of Traditional Chinese Medicine, 2014.
18. 常娟. 漏斗胸術后疼痛的護理[J]. 中國藥物與臨床, 2016, 16(2): 298-300.Chang J. Nursing care for postoperative pain in pectus carinatum[J]. Chin Remed Clin, 2016, 16(2): 298-300.
19. Wang J, He L, Tian D, et al. Risk factors of chronic pain after Nuss procedure in patients with pectus excavatum[J]. J Clin Anesthesiol, 2021, 37(2): 138-141.
20. 陳磊, 林靈虹, 林敏娟. 疼痛護理在行漏斗胸Nuss術患兒中的應用效果[J]. 中西醫結合護理(中英文), 2022, 8(5): 178-180.Chen L, Lin LH, Lin MJ. Nursing care for postoperative pain in children undergoing Nuss procedure for pectus excavatum[J]. J Clin Nurs Pract, 2022, 8(5): 178-180.
21. 張鑫. 鄉村青年教師專業發展的影響因素與支持策略研究—以H省為例[D]. 哈爾濱師范大學, 2023.Zhang X. Study on influencing factors and supporting strategies of rural young teachers’ professional development: take H province as an example[D]. Harbin Normal University, 2023.
22. 張海力. 多維度多準則中成藥綜合評價方法構建及應用研究[D]. 中國中醫科學院, 2023.Zhang HL. Development and application of a multi-dimensional and multi-criteria comprehensive evaluation for Chinese patent medicine[D]. China Academy of Chinese Medical Sciences, 2023.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Development and reliability and validity testing of a patient-reported symptom and function scale for patients with pectus excavatum after the Nuss procedure

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