Skip to main content

Advertisement

SpringerLink
Log in

Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence: a secondary analysis from a randomized controlled trial

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

MIC:

Minimally important change

FIQL:

Fecal Incontinence Quality of Life Scale

FI:

Fecal incontinence

SRM:

Standardized response mean

QOL:

Quality of life

PRO:

Patient-reported outcome

SD:

Standard deviation

GPE:

Global perceived effect

References

  1. Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26

    Article  PubMed  Google Scholar 

  2. Dunivan GC, Heymen S, Palsson OS et al (2010) Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol 202(5):493.e1–493.e6

    Article  Google Scholar 

  3. Deutekom M, Terra MP, Dobben AC et al (2005) Selecting an outcome measure for evaluating treatment in fecal incontinence. Dis Colon Rectum 48:2294–2301

    Article  PubMed  Google Scholar 

  4. Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415

    Article  PubMed  CAS  Google Scholar 

  5. Browning GG, Parks AG (1983) Postanal repair for neuropathic faecal incontinence: correlation of clinical result and anal canal pressures. Br J Surg 70:101–104

    Article  PubMed  CAS  Google Scholar 

  6. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  7. Vaizey CJ, Carapeti E, Cahill JA et al (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80

    Article  PubMed  CAS  Google Scholar 

  8. Bols EMJ, Berghmans LCM, Hendriks HJM et al (2008) Physiotherapy and surgery in fecal incontinence: an overview. Phys Ther Rev 13:1–20

    Article  Google Scholar 

  9. Davis KJ, Kumar D, Poloniecki J (2004) Adjuvant biofeedback following anal sphincter repair: a randomized study. Aliment Pharmacol Ther 20:539–549

    Article  PubMed  CAS  Google Scholar 

  10. Norton C, Chelvanayagam S, Wilson-Barnett J et al (2003) Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology 125:1320–1329

    Article  PubMed  Google Scholar 

  11. Avery KN, Bosch JL, Gotoh M et al (2007) Questionnaires to assess urinary and anal incontinence: review and recommendations. J Urol 177:39–49

    Article  PubMed  CAS  Google Scholar 

  12. Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16, discussion 16-17

    Article  PubMed  CAS  Google Scholar 

  13. Bols EM, Hendriks EJ, Deutekom M et al (2010) Inconclusive psychometric properties of the Vaizey score in fecally incontinent patients: a prospective cohort study. Neurourol Urodyn 29:370–377

    PubMed  Google Scholar 

  14. Bols EM, Berghmans BC, Hendriks EJ et al (2007) A randomized physiotherapy trial in patients with fecal incontinence: design of the PhysioFIT-study. BMC Public Health 7:355

    Article  PubMed  Google Scholar 

  15. Morkved S (2007) Physical therapy for fecal incontinence. In: Bo K, Berghmans B, Morkved S, Van Kampen M (eds) Evidence-based physical therapy for the pelvic floor. Elsevier, London, pp 309–315

    Google Scholar 

  16. Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745

    Article  PubMed  Google Scholar 

  17. Husted JA, Cook RJ, Farewell VT et al (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468

    Article  PubMed  CAS  Google Scholar 

  18. Crosby RD, Kolotkin RL, Williams GR (2003) Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 56:395–407

    Article  PubMed  Google Scholar 

  19. Terwee CB, Bot SD, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42

    Article  PubMed  Google Scholar 

  20. Salter K, Jutai JW, Teasell R et al (2005) Issues for selection of outcome measures in stroke rehabilitation: ICF Participation. Disabil Rehabil 27:507–528

    Article  PubMed  CAS  Google Scholar 

  21. Hendriks EJ, Bernards AT, Berghmans BC et al (2007) The psychometric properties of the PRAFAB-questionnaire: a brief assessment questionnaire to evaluate severity of urinary incontinence in women. Neurourol Urodyn 26:998–1007

    Article  PubMed  Google Scholar 

  22. Terwee CB, Roorda LD, Dekker J et al (2010) Mind the MIC: large variation among populations and methods. J Clin Epidemiol 63:524–534

    Article  PubMed  Google Scholar 

  23. de Vet HC, Terwee CB, Ostelo RW et al (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 4:54

    Article  PubMed  Google Scholar 

  24. Schafer JL (1999) Multiple imputation: a primer. Stat Methods Med Res 8:3–15

    Article  PubMed  CAS  Google Scholar 

  25. Terwee CB, Mokkink LB, Knol DL et al (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 21:659–670

    Article  PubMed  Google Scholar 

  26. Revicki D, Hays RD, Cella D et al (2008) Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 61:102–109

    Article  PubMed  Google Scholar 

  27. Maeda Y, Parés D, Norton C et al (2008) Does the St. Mark’s incontinence score reflect patients’ perceptions? A review of 390 patients. Dis Colon Rectum 51:436–442

    Article  PubMed  Google Scholar 

  28. Bakx R, Sprangers MA, Oort FJ et al (2005) Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis 20:126–136

    Article  PubMed  Google Scholar 

  29. Olopade FA, Norman A, Blake P et al (2005) A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy. Br J Cancer 92:1663–1670

    Article  PubMed  CAS  Google Scholar 

  30. Bug GJ, Kiff ES, Hosker G (2001) A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. BJOG 108:1057–1067

    PubMed  CAS  Google Scholar 

  31. Rockwood TH (2004) Incontinence severity and QOL scales for fecal incontinence. Gastroenterology 126(1 Suppl 1):S106–S113

    Article  PubMed  Google Scholar 

  32. de Vet HC, Terluin B, Knol DL et al (2010) Three ways to quantify uncertainty in individually applied “minimally important change” values. J Clin Epidemiol 63:37–45

    Article  PubMed  Google Scholar 

  33. Gardener N, Avery K, Abrams P et al (2005) Methods of development of a symptom and quality of life assessment for bowel symptoms including anal incontinence-ICIQ-BS. Proceedings from the International Continence Society meeting, Montreal, Canada (abstract). Neurourol Urodyn 24:558–559

    Google Scholar 

  34. Cotterill N, Norton C, Avery KN et al (2011) 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 54:1235–1250

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD, Maastricht, The Netherlands

    E. M. J. Bols, H. J. M. Hendriks & R. A. de Bie

  2. Centre for Evidence Based Physiotherapy, MUMC+, PO Box 616, 6200 MD, Maastricht, The Netherlands

    E. M. J. Bols, H. J. M. Hendriks & R. A. de Bie

  3. Pelvic care Center Maastricht, MUMC+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    L. C. M. Berghmans

  4. Department of Surgery, MUMC+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    C. G. M. I. Baeten

Authors
  1. E. M. J. Bols
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. J. M. Hendriks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. C. M. Berghmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. G. M. I. Baeten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. A. de Bie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. M. J. Bols.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bols, E.M.J., Hendriks, H.J.M., Berghmans, L.C.M. et al. Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence: a secondary analysis from a randomized controlled trial. Int Urogynecol J 24, 469–478 (2013). https://doi.org/10.1007/s00192-012-1886-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-012-1886-9

Keywords

Search

Navigation