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01-07-2015 | Uitgave 7/2015

Quality of Life Research 7/2015

Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation

Tijdschrift:
Quality of Life Research > Uitgave 7/2015
Auteurs:
Luca Neri, Paul Maurice Conway, Guido Basilisco, Laxative Inadequate Relief Survey (LIRS) Group
Belangrijke opmerkingen

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11136-014-0886-2) contains supplementary material, which is available to authorized users.
Members of the LIRS Study Group are listed in Electronic Supplementary Material and should be regarded as collaborators for indexing purposes.

Abstract

Background and aim

PAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation.

Methods

We enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference.

Results

Only a minority of patients reported any rectal tearing (38 %). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (r = 0.28–0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (β = −0.49; ω 2 = 0.25). M:PAC-SYM minimal clinically important difference was 0.24.

Conclusion

Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers.

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Extra materiaal
Supplementary material 1 (DOCX 233 kb)
11136_2014_886_MOESM1_ESM.docx
Supplementary material 2 (DOCX 37 kb)
11136_2014_886_MOESM2_ESM.docx
Literatuur
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