Role of clinical pathway in improving the quality of care for patients with faecal incontinence: A randomised trial

Table 1 Demographic data of patients included in analysis

Pathway	No. of patients	BMI Median (IQR)	Age Median (IQR)	Sex
Standard care pathway	16	26.8 (23.0-31.9)	70.5 (60.0-76.0)	Female	14
				Male	2
IRAT	15	27.7 (22.8-35.8)	66.0 (59.0-77.0)	Female	12
				Male	3
P value		0.77	0.6	0.57

IRAT: Integrated Rapid Assessment and Treatment.

Table 2 Detailing obstetric history and concurrent urinary incontinence in patients included in analysis

Pathway	Vaginal delivery	Difficult labour	Perineal tear	Forceps delivery	Concurrent urinary incontinence	symptoms of global pelvic floor weakness
Standard care pathway	14/14	10	9	6	13	9
IRAT	12/14	9	8	4	9	6
P value	0.21	0.32	0.26	0.36	0.18	0.17

IRAT: Integrated Rapid Assessment and Treatment.

Table 3 detailing anorectal laboratory test results in patients included in the analysis

Anorectal physiology variables	IRAT pathway Median (IQR)	Standard care pathway Median (IQR)	P value
MMRP	46.0 (36.0-80.0)	55 (38.5-72)	0.96
MMSP	74.0 (57.0-89.0)	50.0 (37.0-72.0)	0.88
Resting victor volume	33308.0 (16559.2-54994.0)	51224.0 (29444.0-77663.0)	0.17
Squeeze victor volume	61168.0 (44393.0-165403.0)	81303 (51751.0-118808.5)	0.79
Squeeze asymmetry	29.7 (11.7-27.1)	14.4 (8.4-16.9)	0.07
Resting asymmetry	20.9 (13.5-31.0)	17.9 (11.2-27.1)	0.41
USS-IAS	2 abnormal	2 abnormal	1.00
USS-EAS	2 abnormal	1 abnormal	0.59
Resting vectrogram	4 abnormal	5 abnormal	0.94
Squeeze vectrogram	3 abnormal	5 abnormal	0.43
TRV	85 (50-100)	80 (50-95)	0.85
MRV	140 (100-195)	140 (100-195)	0.94
AME (high)	6.5 ( 5.2-10.6)	7.1 (5.5-11.3)	0.93
AME (mid)	5.3 (3.6-7.5)	5.9 (4.6-7.7)	0.89
AME (low)	4.7 (2.8-6.6)	5.1 (3.0-6.5)	0.85

MRV: Maximum rectal volume; TRV: Threshold rectal volume; MMRP: Maximum mean resting pressure.

Table 4 Comparison between baseline rockwood faecal incontinence quality of life scales of both study groups

Baseline	FIQoLS 1 Median (IQR)	FIQoLS 2 Median (IQR)	FIQoLS 3 Median (IQR)	FIQoLS 4 Median (IQR)
IRAT pathway	3.6 (2.0.2-4)	2.7 (1.4-3.4)	3.7 (2.3-4.1)	2.7 (1.3-3.8)
Standard care pathway	3.5 (2.3-3.7)	2.4 (1.6-3.0)	3.1 (2.0-3.7)	2.0 (1.3-2.7)
P value	0.44	0.94	0.11	0.22

IRAT: Integrated Rapid Assessment and Treatment; FIQoLS: Faecal Incontinence Quality of Life Scale.

Table 5 Comparison between baseline St. marks incontinence score and cleveland clinic incontinence score of both study groups

Baseline	CCIS Median (IQR)	SMIS Median (IQR)
IRAT pathway	8.0 (33.5-11.5)	13.0 (5.5-13.0)
Standard care pathway	9.5 (5.0-15.0)	12.0 (7.0-16.0)
P value	0.11	0.18

IRAT: Integrated Rapid Assessment and Treatment; CCIS: Cleveland clinic incontinence score; SMIS: St. marks incontinence score.

Table 6 Comparison between Rockwood Faecal Incontinence Quality of Life Scales of both study groups after completion of management

After completion of management	FIQoLS 1 Median (IQR)	FIQoLS 2 Median (IQR)	FIQoLS 3 Median (IQR)	FIQoLS 4 Median (IQR)
IRAT pathway	3.9 (2.2- 4.0)	2.9 (1.8 3.8)	3.9 (2.3-4.1)	3.0 (1.8-3.8)
Standard care pathway	3.6 (2.4-4.0)	3.8 (1.7-4.0)	3.5 (2.1-3.9)	2.3 (1.6-3.7)
P value	0.51	0.92	0.18	0.87

IRAT: Integrated Rapid Assessment and Treatment; FIQoLS: Faecal Incontinence Quality of Life Scale.

Table 7 Comparison between St. marks incontinence score and cleveland clinic incontinence score of both study groups after completion of management

After completion of management	CCIS Median (IQR)	SMIS Median (IQR)
IRAT pathway	6.0 (1.5 -11.5)	7.0 (30-15.5)
Standard care pathway	7.5 (3.0-12.0)	9.5 (4.0-11.0)
P value	0.37	0.85

IRAT: Integrated Rapid Assessment and Treatment; CCIS: Cleveland clinic incontinence score; SMIS: St. marks incontinence score.

Table 8 Comparison of patient satisfaction score between the integrated rapid assessment and treatment and the standard care pathways

Please rate your degree of satisfaction with each of the following aspect	Standard care pathway median (IQR)	IRAT pathway median (IQR)	P value
The waiting time from seeing your GP until been seen at York hospital was acceptable	4 (3-4)	4 (4-5)	0.07
The waiting time from being seen at York Hospital until completing your treatment was acceptable	4 (3-4)	4 (4-5)	0.03
The questions you were asked to complete were relevant to your problem?	4 (4-4)	4 (4-5)	0.24
The questions you were asked to complete were clear and easy to answer?	4 (4-4)	4 (4-5)	0.28
The questions you were asked to complete covered all aspect of your problem?	4 (3-4)	4 (4-5)	0.01
You were supported and given clear advices/instructions throughout management	4 (4-4)	4 (4-5)	0.08
You were given enough time to explain your problem/concerns	4 (4-4)	4 (4-5)	0.08
Your privacy and dignity were respected throughout management	4 (4-5)	4 (4-5)	0.43
The over all quality of care you received was high	4.5 (4-5)	4 (4-5)	0.85

IRAT: Integrated Rapid Assessment and Treatment.