Responsiveness and Interpretability of Incontinence Severity Scores and FIQL in Patients with Fecal Incontinence: a Secondary Analysis from a Randomized Controlled Trial

Overview

Journal Int Urogynecol J

Publisher Springer

Specialties Gynecology & Obstetrics
Urology

Date 2012 Jul 19

PMID 22806487

Citations 28

Authors

E M J Bols

H J M Hendriks

L C M Berghmans

C G M I Baeten

R A de Bie

Affiliations

Soon will be listed here.

Abstract

Introduction And Hypothesis: This study aims to assess the responsiveness and interpretability of the Vaizey score, Wexner score, and the Fecal Incontinence Quality of Life Scale (FIQL) for use in the evaluation of patients with fecal incontinence (FI).

Methods: Eighty patients with FI with a mean age of 59.3 (SD ± 11.9) were enrolled in a randomized controlled trial. The patient-reported outcomes were tested for internal and external responsiveness, longitudinal construct validity, and interpretability.

Results: All total scores proved to have both adequate to excellent responsiveness and longitudinal construct validity, and changes were in agreement with subjective improvement. Due to variability in minimally important change estimates (Vaizey score -5 to -3, Wexner score -3 to -2, FIQL 1.1 to 1.2), they should be used as indicators. All patient-reported outcomes showed psychometric or practical limitations.

Conclusions: The instruments available to date to evaluate severity and quality of life in FI do not yet attain the highest levels of psychometric soundness. As the focus of patients may differ from that of physicians, it is recommended that several measures should be included for evaluation. So far, there are suggestions that the Wexner score is most suitable for severity assessment and the FIQL for evaluating quality of life.

Citing Articles

The impact of plasma-rich platelet injection to perianal sphincters on incontinence and quality of life in patients with rectal cancer after low anterior or intersphincteric resection: a prospective cohort study.

Haksal M, Akin M, Karagoz E, Kocak M, Korkut E, Shahhosseini R Tech Coloproctol. 2024; 28(1):109.

PMID: 39143419 PMC: 11324693. DOI: 10.1007/s10151-024-02989-1.

Long-Term Functional Outcome After Early vs. Late Stoma Closure in Rectal Cancer Surgery: Sub-analysis of the Multicenter FORCE Trial.

Meyer V, Bosch N, van der Heijden J, Kalkdijk-Dijkstra A, Pierie J, Beets G J Gastrointest Cancer. 2024; 55(3):1266-1273.

PMID: 38922517 PMC: 11347459. DOI: 10.1007/s12029-024-01062-2.

Pelvic Floor Rehabilitation After Rectal Cancer Surgery One-year follow-up of a Multicenter Randomized Clinical Trial (FORCE trial).

Bosch N, Kalkdijk-Dijkstra A, van Westreenen H, Broens P, Pierie J, van der Heijden J Ann Surg. 2024; .

PMID: 38899475 PMC: 11723484. DOI: 10.1097/SLA.0000000000006402.

Anal incontinence after obstetrical anal sphincter injury significantly impacts quality of life for women: a cohort study.

Rebmann E, Hamel J, Helbert C, Lemasson F, Legendre G, Venara A Langenbecks Arch Surg. 2024; 409(1):67.

PMID: 38368278 DOI: 10.1007/s00423-024-03257-4.

Multi-national observational study to assess quality of life and treatment preferences in patients with Crohn's perianal fistulas.

Karki C, Athavale A, Abilash V, Hantsbarger G, Geransar P, Lee K World J Gastrointest Surg. 2023; 15(11):2537-2552.

PMID: 38111766 PMC: 10725550. DOI: 10.4240/wjgs.v15.i11.2537.

References

Revicki D, Hays R, Cella D, Sloan J . Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008; 61(2):102-9. DOI: 10.1016/j.jclinepi.2007.03.012. View

Cotterill N, Norton C, Avery K, Abrams P, Donovan J . Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: the ICIQ-B. Dis Colon Rectum. 2011; 54(10):1235-50. DOI: 10.1097/DCR.0b013e3182272128. View

Dunivan G, Heymen S, Palsson O, Von Korff M, Turner M, Melville J . Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol. 2010; 202(5):493.e1-6. PMC: 3855440. DOI: 10.1016/j.ajog.2010.01.018. View

JORGE J, Wexner S . Etiology and management of fecal incontinence. Dis Colon Rectum. 1993; 36(1):77-97. DOI: 10.1007/BF02050307. View

Haylen B, Ridder D, Freeman R, Swift S, Berghmans B, Lee J . An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2009; 21(1):5-26. DOI: 10.1007/s00192-009-0976-9. View

Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm M . Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology. 2003; 125(5):1320-9. DOI: 10.1016/j.gastro.2003.09.039. View

de Vet H, Terwee C, Ostelo R, Beckerman H, Knol D, Bouter L . Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes. 2006; 4:54. PMC: 1560110. DOI: 10.1186/1477-7525-4-54. View

Bols E, Berghmans B, Hendriks E, de Bie R, Melenhorst J, van Gemert W . A randomized physiotherapy trial in patients with fecal incontinence: design of the PhysioFIT-study. BMC Public Health. 2007; 7:355. PMC: 2234416. DOI: 10.1186/1471-2458-7-355. View

Terwee C, Bot S, de Boer M, van der Windt D, Knol D, Dekker J . Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2006; 60(1):34-42. DOI: 10.1016/j.jclinepi.2006.03.012. View

10.

Salter K, Jutai J, Teasell R, Foley N, Bitensky J, Bayley M . Issues for selection of outcome measures in stroke rehabilitation: ICF Participation. Disabil Rehabil. 2005; 27(9):507-28. DOI: 10.1080/0963828040008552. View

11.

Maeda Y, Pares D, Norton C, Vaizey C, Kamm M . Does the St. Mark's incontinence score reflect patients' perceptions? A review of 390 patients. Dis Colon Rectum. 2008; 51(4):436-42. DOI: 10.1007/s10350-007-9157-4. View

12.

Schafer J . Multiple imputation: a primer. Stat Methods Med Res. 1999; 8(1):3-15. DOI: 10.1177/096228029900800102. View

13.

Avery K, Bosch J, Gotoh M, Naughton M, Jackson S, Radley S . Questionnaires to assess urinary and anal incontinence: review and recommendations. J Urol. 2006; 177(1):39-49. DOI: 10.1016/j.juro.2006.08.075. View

14.

Browning G, Parks A . Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg. 1983; 70(2):101-4. DOI: 10.1002/bjs.1800700216. View

15.

Bakx R, Sprangers M, Oort F, van Tets W, Bemelman W, Slors J . Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis. 2004; 20(2):126-36. DOI: 10.1007/s00384-004-0638-9. View

16.

Vaizey C, Carapeti E, Cahill J, Kamm M . Prospective comparison of faecal incontinence grading systems. Gut. 1998; 44(1):77-80. PMC: 1760067. DOI: 10.1136/gut.44.1.77. View

17.

Hendriks E, Bernards A, Berghmans B, de Bie R . The psychometric properties of the PRAFAB-questionnaire: a brief assessment questionnaire to evaluate severity of urinary incontinence in women. Neurourol Urodyn. 2007; 26(7):998-1007. DOI: 10.1002/nau.20450. View

18.

Mokkink L, Terwee C, Patrick D, Alonso J, Stratford P, Knol D . The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010; 63(7):737-45. DOI: 10.1016/j.jclinepi.2010.02.006. View

19.

Bug G, Kiff E, Hosker G . A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG. 2001; 108(10):1057-67. DOI: 10.1111/j.1471-0528.2001.00245.x. View

20.

Deutekom M, Terra M, Dobben A, Dijkgraaf M, Felt-Bersma R, Stoker J . Selecting an outcome measure for evaluating treatment in fecal incontinence. Dis Colon Rectum. 2006; 48(12):2294-301. DOI: 10.1007/s10350-005-0162-1. View