A critical COSMIN-informed scoping review of complex abdominal wall hernia quality of life tools: making a case for patient-driven tool development

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Abstract
Background Health-Related Quality of Life (HRQoL) is increasingly recognized as a key outcome measure in Complex Abdominal Wall Hernia (CAWH) surgery. However, selecting an appropriate HRQoL tool is challenging due to the variety of available instruments and their variable psychometric properties. Aim This scoping review systematically reviews and evaluates the six CAWH-specific HRQoL tools using the Consensus-based Standards for the Selection of Measurement Instruments (COSMIN) framework. The aim of this scoping review was to assess the clinical suitability and developmental robustness of CAWH-specific HRQoL instruments. This review does not assess post-operative HRQoL outcomes, but rather evaluates the design, content, and methodological quality of CAWH-specific tools themselves using the COSMIN framework. Methods A scoping review was conducted in accordance with PRISMA-ScR and informed by COSMIN and Joanna Briggs Institute (JBI) scoping methodology. Four databases (MEDLINE, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov) were searched (March 2024) to identify studies that used or evaluated CAWH-specific HRQoL tools. Tools were assessed across key COSMIN domains: conceptual framework, psychometric properties, respondent burden, and patient involvement in development. Results Six CAWH-specific HRQoL instruments were identified: CCS, HerQLes, EuraHS-QoL, AAS/mAAS, AHQ, and HERQL. While these tools demonstrated utility, none fully integrated patient perspectives from initial domain development, and all exhibited gaps in content and structural validity. Comparative psychometric data across tools were limited, further complicating selection. Conclusion Despite growing interest in measuring HRQoL in CAWH surgery, existing tools show important developmental limitations. While these tools demonstrate utility, none fully integrate patient perspectives throughout their development, and all exhibit gaps in content and structural validity. Additionally, comparative psychometric data remain limited, further complicating tool selection. Given these limitations, there is a clear need for further development—either by refining existing tools or creating a new, patient-informed HRQoL instrument that adheres to robust psychometric standards.

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