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A new patient-centered validated measure of accidental bowel leakage symptoms in women
Rogers, R. G., Sung, V. W., Lukacz, E. S., Fairchild, P., Arya, L. A., Barber, M. D., Markland, A. D., Siddiqui, N. Y., & Bann, C. M. (2020). Accidental bowel leakage evaluation: A new patient-centered validated measure of accidental bowel leakage symptoms in women. Diseases of the Colon and Rectum, 63(5), 668-677. https://doi.org/10.1097/dcr.0000000000001596, https://doi.org/10.1097/DCR.0000000000001596
BACKGROUND: Questionnaires assessing accidental bowel leakage lack important patient-centered symptoms.OBJECTIVE: We aimed to create a valid measure of accidental bowel leakage symptoms.DESIGN: We previously created a conceptual framework capturing patient-centered accidental bowel leakage symptoms. The framework included bowel leakage type, severity and bother, and ancillary bowel symptoms, including predictability, awareness, leakage control, emptying disorders, and discomfort. SETTINGS: The study was conducted in outpatient clinics.PATIENTS: Women with at least monthly accidental bowel leakage were included.INTERVENTIONS: Participants completed the Accidental Bowel Leakage Evaluation at baseline and 12 and 24 weeks, as well as bowel diaries and other validated pelvic floor questionnaires. A subset completed items twice before treatment. Final item selection was based on psychometric properties and clinical importance.MAIN OUTCOME MEASURES: Psychometric analyses included Cronbach alpha, confirmatory factor, and item response theory analyses. Construct validity was based on correlations with measures of similar constructs.RESULTS: A total of 296 women completed baseline items, and 70 provided test-retest data. The cohort was predominately white (79%) and middle aged (64 +/- 11 y). Confirmatory factor analyses supported the conceptual framework. The final 18-item scale demonstrated good internal consistency (Cronbach alpha = 0.77-0.90) and test-retest reliability (intraclass correlation = 0.80). Construct validity was demonstrated with baseline and 12- and 24-week scale scores, which correlated with the Vaizey (r = 0.52, 0.68, and 0.69), Colorectal Anal Distress Inventory (r = 0.54, 0.65, 0.71), Colorectal Anal Impact Questionnaire (r = 0.48, 0.53, 0.53), and hygiene (r = 0.39, 0.43, 0.49) and avoidance subscales scores of the adaptive index (r = 0.45, 0.44, 0.43) and average number of pad changes per day on bowel diaries (r = 0.35, 0.38, 0.31; all p < 0.001).LIMITATIONS: The study was limited by nature of involving validation in a care-seeking population.CONCLUSIONS: The Accidental Bowel Leakage Evaluation instrument is a reliable, patient-centered measure with good validity properties. This instrument improves on currently available measures by adding patient-important domains of predictability, awareness, control, emptying, and discomfort. See Video Abstract at http://links.lww.com/DCR/B172.
