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Development and validation of a modified fecal incontinence quality of life scale for Japanese patients after intersphincteric resection for very low rectal cancer

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Abstract

Purpose

Fecal incontinence is a frequently observed symptom after lower rectal surgery with sphincter manipulation. The aim of this study was to evaluate a proposed modification to the fecal incontinence quality of life (FIQL) scale for the assessment of the quality of life among patients with very low rectal cancer who have undergone intersphincteric resection.

Methods

A single 14-item composite scale was prepared that was derived from items in the “Lifestyle” and “Coping” subscales of the original FIQL. The scale was tested with a convenience sample of 152 postoperative patients. In addition to classic psychometric evaluation, newer statistical techniques, such as a multiple correspondence analysis and partial credit model, were performed to evaluate the item response patterns.

Results

The proposed scale exhibited an item-rest correlation of 0.66–0.84 and a Cronbach’s alpha of 0.96, and was correlated with concurrently measured Social Functioning subscale of the Medical Outcomes Study Short Form 36 (−0.70), physical role limitation (−0.61), and Wexner continence grading scale (−0.61). Multiple correspondence analysis supported a uni-dimensional construct, and the partial credit model showed a varying yet overlapping range of item response thresholds across items. Several items, such as “Locating bathroom whenever going out”, reflected more a serious condition than items such as “Avoiding eating-out.” Weighted item scores based on estimated thresholds provided results comparable with those based on non-weighted scores.

Conclusions

The proposed modification to the FIQL scale exhibited high internal consistency and satisfactory concurrent and convergence validity. The modified scale is practical to administer and is sensitive to a range of functional problems associated with fecal incontinence among patients who have undergone intersphincteric resection.

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References

  1. Grumann MM, Noack EM, Hoffmann IA, Schlag PM. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg. 2001;233:149–56.

    Article  CAS  PubMed  Google Scholar 

  2. Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, et al. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg. 2007;246:916–21.

    Article  PubMed  Google Scholar 

  3. Saito N, Moriya Y, Shirouzu K, Maeda K, Mochizuki H, Koda, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49:S13–22.

  4. Cotterill N, Norton C, Avery KN, Abrams P, Donovan JL. A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon Rectum. 2008;51:82–7.

    Article  PubMed  Google Scholar 

  5. Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S. Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis. 2008;10:273–9.

    Article  CAS  PubMed  Google Scholar 

  6. Rockwood TH. Incontinence severity and QOL scales for fecal incontinence. Gastroenterol. 2004;126:S106–13.

    Article  Google Scholar 

  7. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43:9–16.

    Article  CAS  PubMed  Google Scholar 

  8. Bretagnol F, Rullier E, Laurent C, Zerbib F, Gontier R, Saric J. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum. 2004;47:832–8.

    Article  PubMed  Google Scholar 

  9. Rullier E, Zerbib F, Marrel A, Amouretti M, Lehur PA. Validation of the French version of the Fecal Incontinence Quality-of-Life (FIQL) scale. Gastroenterol Clin Biol. 2004;28:562–8.

    Article  PubMed  Google Scholar 

  10. Yusuf SA, Jorge JM, Habr-Gama A, Kiss DR, Gama Rodrigues J. Evaluation of quality of life in anal incontinence: validation of the questionnaire FIQL (Fecal Incontinence Quality of Life). Arq Gastroenterol. 2004;41:202–8.

    Article  PubMed  Google Scholar 

  11. Altomare DF, Rinaldi M, Giardiello GG, Donelli A, Petrolino M, Villani RD, et al. Italian translation and prospective validation of fecal incontinence quality of life (FIQL) index. Chir Ital. 2005;57:153–8.

    PubMed  Google Scholar 

  12. Minguez M, Garrigues V, Soria MJ, Andreu M, Mearin F, Clave P. Adaptation to Spanish language and validation of the fecal incontinence quality of life scale. Dis Colon Rectum. 2006;49:490–9.

    Article  PubMed  Google Scholar 

  13. Edelmann R, Iwawaki S. Self-reported expression and consequences of embarrassment in the United Kingdom and Japan. Int J Psychol Orient. 1987;30:205–16.

    Google Scholar 

  14. Zhong J, Wang A, Qian M, Zhang L, Gao J, Yang J, et al. Shame, personality, and social anxiety symptoms in Chinese and American nonclinical samples: a cross-cultural study. Depress Anxiety. 2008;25:449–60.

    Article  PubMed  Google Scholar 

  15. Hashimoto H, Green J, Iwao Y, Sakurai T, Hibi T, Fukuhara S. Reliability, validity, and responsiveness of the Japanese version of the Inflammatory Bowel Disease Questionnaire. J Gastroenterol. 2003;38:1138–43.

    Article  PubMed  Google Scholar 

  16. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol. 1998;51:1037–44.

    Article  CAS  PubMed  Google Scholar 

  17. Fukuhara S, Iwao Y, Wada S, Green J, Hashimoto H, Hibi N. Development and Psychometric test of the Japanese version of Inflammatory Bowel Disease Questionnaire. In: N. Fukuhara, editor. Annual Report in 1998 by Research Group on QOL in intractable disease patients. Research on Intractable Disease, Ministry of Health and Welfare; 1999. p. 15–23.

  18. Fukuhara S, Ware J Jr, Kosinski M, Wada S, Gandek B. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol. 1998;51:1045–53.

    Article  CAS  PubMed  Google Scholar 

  19. Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  CAS  PubMed  Google Scholar 

  20. Hatta H, Higashi A, Yashiro H, Ozawa K, Hayashi K, Kiyota K, et al. A validation of the hospital anxiety and depression scale [in Japanese]. Jpn J Psychosom Med. 1998;38:309–15.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  22. Everitt B, Dunn G. Applied multivariate data analysis. London: Arnold; 2001.

  23. Edelen MO, Reeve BB. Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement. Qual Life Res. 2007;16(Suppl 1):5–18.

    Article  PubMed  Google Scholar 

  24. Rabe-Hesketh S, Skrondal A, Pickles A. GLLAMM manual. U.C. Berkeley Division of Biostatistics Working Paper Series. 2004;93–108.

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Conflict of interest statement

The authors claim no conflict of interest.

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Authors and Affiliations

  1. Department of Health Economics and Epidemiology Research, School of Public Health, University of Tokyo, Bunkyo-ku, 7-3-1 Hongo, Tokyo, 113-0031, Japan

    Hideki Hashimoto

  2. Department of Gastroenterological Surgery (Omori), Toho University School of Medicine, Tokyo, Japan

    Hiroyuki Shiokawa, Kimihiko Funahashi & Tatsuo Teramoto

  3. Colorectal and Pelvic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Norio Saito

  4. Department of Surgery, Gunma Prefectural Cancer Center, Gunma, Japan

    Toshio Sawada

  5. Department of Surgery, Kurume University Faculty of Medicine, Kurume, Fukuoka, Japan

    Kazuo Shirouzu

  6. Department of Surgery, Coloproctology Center, Takano Hospital, Kumamoto, Japan

    Kazutaka Yamada

  7. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

  8. Department of Surgery, Teikyo University School of Medicine, Itabashi-Ku, Tokyo, Japan

    Toshiaki Watanabe

  9. Department of Surgery, Yokohama Municipal Hospital, Yokohama, Japan

    Akira Sugita

  10. Department of General Surgery, Kameda General Hospital, Chiba, Japan

    Akira Tsunoda

  11. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan

    Shigeki Yamaguchi

Authors
  1. Hideki Hashimoto
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  2. Hiroyuki Shiokawa
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  3. Kimihiko Funahashi
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  4. Norio Saito
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  5. Toshio Sawada
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  6. Kazuo Shirouzu
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  7. Kazutaka Yamada
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  8. Kenichi Sugihara
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  9. Toshiaki Watanabe
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  10. Akira Sugita
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  11. Akira Tsunoda
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  12. Shigeki Yamaguchi
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  13. Tatsuo Teramoto
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Corresponding author

Correspondence to Hideki Hashimoto.

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Hashimoto, H., Shiokawa, H., Funahashi, K. et al. Development and validation of a modified fecal incontinence quality of life scale for Japanese patients after intersphincteric resection for very low rectal cancer. J Gastroenterol 45, 928–935 (2010). https://doi.org/10.1007/s00535-010-0239-z

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  • DOI: https://doi.org/10.1007/s00535-010-0239-z

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