Case Control Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World Journal of Gastrointestinal Surgery. Sep 27, 2015; 7(9): 203-207
Published online Sep 27, 2015. doi: 10.4240/wjgs.v7.i9.203
Validation of a new scoring system: Rapid assessment faecal incontinence score
Fernando de la Portilla, Arantxa Calero-Lillo, Rosa M Jiménez-Rodríguez, Maria L Reyes, Manuela Segovia-González, María Victoria Maestre, Ana M García-Cabrera
Fernando de la Portilla, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd), Instituto de Salud Carlos III, 08036 Barcelona, Spain
Fernando de la Portilla, Arantxa Calero-Lillo, Rosa M Jiménez-Rodríguez, Maria L Reyes, María Victoria Maestre, Ana M García-Cabrera, Department of General and Digestive Surgery, Colorrectal Surgery Unit, “Virgen del Rocío” University Hospital/IBiS/CSIC/University of Seville, 41013 Seville, Spain
Manuela Segovia-González, Department of Economics, Quantitative Methods, University Pablo Olavide of Seville, 41013 Seville, Spain
Author contributions: de la Portilla F was responsible for the conception and design of the study, he acquired, analyzed and interpreted the data and drafted the manuscript and was responsible for revising the manuscript critically for important intellectual content; Calero-Lillo A, Jiménez-Rodríguez RM, Reyes ML, Segovia-González M and García-Cabrera AM contributed to the establishment of the methods and the development of the study.
Institutional review board statement: This study was approved by the Institutional Review Board of our hospital.
Informed consent statement: All patients gave their informed consent to take part in the study.
Conflict-of-interest statement: Drs. Fernando de la Portilla, Rosa M Jiménez-Rodríguez, Ana M García-Cabrera, Maria L Reyes and Manuela Segovia-González have no conflicts of interest or financial ties to disclose. Dr. Calero-Lillo received a grant from the Spanish Association of Coloproctology (Asociación Española de Coloproctología - AECP) to do research for a period of 3 mo at our institution, the University Hospital Virgen del Rocío in Seville.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at fportilla@us.es. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fernando de la Portilla, MD, PhD, EBSQ-c, MAECP, Department of General and Digestive Surgery, Colorrectal Surgery Unit, “Virgen del Rocío” University Hospital/IBiS/CSIC/University of Seville, Avda. Manuel Siurot s/n, 41013 Seville, Spain. fportilla@us.es
Telephone: +34-95-5012292 Fax: +34-95-5012292
Received: March 26, 2015
Peer-review started: March 28, 2015
First decision: May 13, 2015
Revised: June 6, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: September 27, 2015
Processing time: 187 Days and 7.8 Hours
Abstract

AIM: To implement a quick and simple test - rapid assessment faecal incontinence score (RAFIS) and show its reliability and validity.

METHODS: From March 2008 through March 2010, we evaluated a total of 261 consecutive patients, including 53 patients with faecal incontinence. Demographic and comorbidity information was collected. In a single visit, patients were administered the RAFIS. The results obtained with the new score were compared with those of both Wexner score and faecal incontinence quality of life scale (FIQL) questionnaire. The patient without influence of the surgeon completed the test. The role of surgeon was explaining the meaning of each section and how he had to fill. Reliability of the RAFIS score was measured using intra-observer agreement and Cronbach’s alpha (internal consistency) coefficient. Multivariate analysis of the main components within the different scores was performed in order to determine whether all the scores measured the same factor and to conclude whether the information could be encompassed in a single factor. A sample size of 50 patients with faecal incontinence was estimated to be enough to detect a correlation of 0.55 or better at 5% level of significance with 80% power.

RESULTS: We analysed the results obtained by 53 consecutive patients with faecal incontinence (median age 61.55 ± 12.49 years) in the three scoring systems. A total of 208 healthy volunteers (median age 58.41 ± 18.41 years) without faecal incontinence were included in the study as negative controls. Pearson’s correlation coefficient between “state” and “leaks” was excellent (r = 0.92, P < 0.005). Internal consistency in the comparison of “state” and “leaks” yielded also excellent correlation (Cronbach’s α = 0.93). Results in each score were compared using regression analysis and a correlation value of r = 0.98 was obtained with Wexner score. As regards FIQL questionnaire, the values of “r” for the different subscales of the questionnaire were: “lifestyle”r = -0.87, “coping/behaviour”r = -0.91, “depression”r = -0.36 and “embarrassment”r = -0.90, (P < 0.01). A multivariate analysis showed that all the scoring systems measured the same factor. A single factor may explain 80.84% of the variability of FI, so all the scoring systems measure the same factor. Patient’s continence improves when RAFIS and Jorge-Wexner scores show low values and when the values obtained in the FIQL questionnaire are high.

CONCLUSION: RAFIS is a valid and reliable tool to assess Faecal Incontinence.

Keywords: Faecal incontinence; Measure; Score; Test; Faecal incontinence quality of life scale questionnaire

Core tip: There are different scales for measuring the severity and impact of faecal incontinence (FI), but no together. The authors recommend the combined use of them to get a complete evaluation of FI. The aim of the present study is to implement a quick and simple test to assess faecal incontinence - the rapid assessment faecal incontinence score - and show its reliability and validity. Its validity and reliability has been proved when compared with other widely used scores.