Validation of the French version of the Amsterdam preoperative anxiety and information scale (APAIS)

Background: Most patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire for information. The purpose of this study was to translate the APAIS into French and to evaluate the psychometric properties of the French version of the APAIS. Methods: The process consisted of two steps. The first step involved the production of a French version of the APAIS that was semantically equivalent to the original version. In the second step, we evaluated the psychometric properties of the French version, including the internal consistency and reliability, the differential item functioning, and the external validity. Participants older than 18, undergoing elective surgery (except obstetric), able to understand and read French, and able to complete a self-report questionnaire were eligible for inclusion in the study. A forward-backward translation was performed. The psychometric evaluation covered three domains: internal validity, external validity, and acceptability. Within 4-48 h after surgery, the patients were asked to complete the "Evaluation du Vecu de l'ANesthesie" questionnaire" (EVAN) questionnaire, which is a validated, multi-dimensional questionnaire that assesses the patient's experiences in the perioperative period. Results: A database with 175 patients was created. The principal component factor analysis revealed the same three-dimensional structure as the original scale. The confirmatory factor analysis showed a strong fit with a root mean square error of approximation of 0.069 and a comparative fit index of 1.00. The amount of differential item functioning (DIF) between the subgroups of patients (i.e., based on age, gender, type of anaesthesia or surgery, premedication, ASA physical status, and ambulatory course) was low. The APAIS was strongly correlated with the dimensions of the EVAN. Each dimension had a low proportion of missing values (ranging from 0.6 to 2.9%), which indicates good acceptability of the questionnaire. Conclusions: The French version of the APAIS is valid and reliable. The availability of this tool enables the evaluation of anxiety in French patients undergoing anaesthesia.