Strong agreement between interview-obtained and self-administered Wexner and St. Mark’s scores using a single questionnaire

  • Stig NordervalEmail author
  • Mona Birgitte Rydningen
  • Ragnhild Sørum Falk
  • Arvid Stordahl
  • Hege Hølmo Johannessen
Original Article


Introduction and hypothesis

St Mark’s incontinence score (SMIS) and the Wexner score have been constructed and validated as interview-based scoring systems. We developed a single questionnaire from which a separate SMIS or Wexner score could be derived. This study aimed to demonstrate the level of agreement between self-administered (sSMIS and sWexner) and interview-based (iSMIS and iWexner) scores using this questionnaire.


One hundred five consecutive patients (30 male) seen in the incontinence outpatient clinics at the Østfold Hospital Trust, Sarpsborg, and University Hospital of North Norway, Tromsø, completed the self-administered incontinence questionnaire prior to the appointment. Following clinical investigation, the patients were interviewed about their symptoms according to the SMIS and Wexner scores, with the interviewers blinded to the results from self-reported questionnaire. Agreement between total scores and between subscores of the various items were determined using interclass correlation coefficient (ICC) and kappa statistics, respectively.


The self-administered questionnaire was incomplete in six cases (5.7%) and the interview-based was incomplete in two cases. Agreement was almost perfect between the iSMIS and sSMIS and between the iWexner score and sWexner score (ICC 0.90 and 0.92, respectively). Agreement was substantial to almost perfect for all items in both scoring systems, with kappa values ranging from 0.64–0.94. Mean iSMIS was 9.48 versus 9.53 for sSMIS (p = 0.90) and 8.26 versus 8.44 for the iWexner and sWexner score, respectively (p = 0.42).


The SMIS and Wexner scores can be completed by the patients using a single questionnaire, and the derived SMIS and Wexner scores are highly consistent with scores obtained by interview.


Fecal incontinence Anal incontinence Wexner score St Mark’s score Scoring systems 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Conference presentation

Poster presentation at the International Continence Society 48th annual meeting, Philadelphia, USA, 28–31 August 2018.


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal SurgeryUniversity Hospital of North NorwayTromsøNorway
  2. 2.Gastrosurgical Research Group, Department of Clinical MedicineUiT the Arctic University of NorwayTromsøNorway
  3. 3.Oslo Centre of Biostatistics and EpidemiologyOslo University HospitalOsloNorway
  4. 4.Department of SurgeryØstfold Hospital TrustSarpsborgNorway
  5. 5.Department of Physical Medicine and RehabilitationØstfold Hospital TrustSarpsborgNorway

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