In the United States, 3.6 million individuals and 134 million worldwide give birth each year. Patient-reported outcome measures (PROMs) are low-cost tools that can screen health status in large populations. The Obstetric Quality of Recovery (ObsQoR-10) PROM is a validated tool to measure inpatient postpartum recovery following all delivery types. Outpatient postpartum recovery is complex, with 13 proposed domains, which makes it challenging. A 6-week outpatient PROM, combined with a follow-up clinical visit, helps to provide counseling and discussion.
The Delphi method was used to build consensus and develop a global outpatient postpartum recovery PROM. The study, published in JAMA Network Open, aimed to establish PROMs for outpatient postpartum recovery and analyze them in a multicenter cohort study.
The Stanford Obstetric Recovery Checklist (STORK) was developed by three phases: 1) Identify the postpartum recovery question from published review, 2) Select items by Delphi rounds with 15 experts and patient stakeholders (January 11th to April 12th, 2021), 3) Conduct cognitive debriefing interview with 10 postpartum women to decide STORK items. A prospective, three-center, US longitudinal cohort study was conducted from June 13, 2022, to February 28, 2023. This included individuals who completed the STORK during their inpatient stay and followed up at 2, 6, and 12 weeks postpartum. At 6 weeks, the study assessed STORK for reliability, responsiveness, and validity.
The inclusion criteria were women aged 18 or older who could speak and read English. All delivery modes were included. Participants were approached 12 to 36 hours after childbirth, and postpartum recovery was evaluated longitudinally. Exclusion criteria were participants who could not match the requirements. Informed consent was obtained from each individual.
Data collection included medical, demographic, anesthetic, and obstetric data. Postpartum women completed 2 electronic PROMs by using REDCap software. The 1st was STORK PROM with a score range of 0 to 4. The 2nd was EuroQoL, 5-Dimension 3-levels with a global health visual analog scale (GHVAS) score range of 0 to 100.
Stata, version 14.0 (StataCorp LLC), was used to analyze the data. Data were presented as mean SD (standard deviation) value, numbers (%) with 95% CI (confidence interval), and median IQR (interquartile range). Factor validation was assessed by exploratory factor analysis. Correlations were evaluated by Spearman’s or Pearson’s coefficients. Internal consistency was evaluated by interitem correlation, split-half reliability tests, and Cronbach’s α.
After all delivery modes, 525 individuals were selected (response rate 62% at 6 weeks, mean SD age 33.3 years) after completion of the baseline inpatient postpartum survey. STORK showed validity: 1) 4-facor model was best fit (root mean square residual [RMSR] = 0.05), 2) GHVAS score correlation ρ = 0.52 (95% CI= 0.43 to 0.61) and EQ-5D-3L score correlation was ρ = −0.67 (95% CI= –0.76 to –0.63), 3) STORK can differentiate between patients reporting poor and good recovery (good recovery median STORK score= 151 [IQR = 136 to 163]) and (poor recovery median STORK score = 129 [IQR= 107 to 148], p < 0.001 and 4) high and low score with the subjective assessment. STORK showed reliability (interitem correlation r = 0.20, Cronbach α = 0.92, split-half reliability ρ = 0.98), responsiveness (% increases in STORK score from start to 12 weeks after spontaneous vaginal delivery=19%, operative vaginal delivery=31%, scheduled cesarean delivery=27%, nonscheduled cesarean delivery=20%). STORK showed feasibility (median completion time between 5 and 10 minutes over the study).
STORK was determined to be a responsive, reliable, and valid measure of outpatient postpartum recovery in this cohort research study. However, further research is needed to determine its therapeutic efficacy.
Reference: Sultan P, Pandal P, Murthy A, et al. Development and Validation of the Stanford Obstetric Recovery Checklist (STORK): A Delphi Consensus and Multicenter Clinical Validation Study. JAMA Netw Open. 2025;8(4):e255713. doi:10.1001/jamanetworkopen.2025.5713
