Purpose
The aim of this study was to perform a psychometric evaluation of the Fecal Incontinence Quality of Life Scale in the Spanish language.
Methods
Eleven hospitals in Spain participated in the study, which included 118 patients with active fecal incontinence. All the patients filled out a questionnaire on the severity of their incontinence, a general questionnaire of health (Medical Outcomes Survey Short Form), and a Spanish translation of the Fecal Incontinence Quality of Life Scale (Cuestionario de Calidad de Vida de Incontinencia Anal), which consists of 29 items in four domains: lifestyle, behavior, depression, and embarrassment. On a second visit, patients repeated the Fecal Incontinence Quality of Life Scale. For each domain, an evaluation was made of temporal reliability, internal reliability, the convergent validity with the generic questionnaire of health, and the discriminant validity correlating the domains of Cuestionario de Calidad de Vida de Incontinencia Anal with the severity of fecal incontinence.
Results
For cultural adaptation, the answer alternatives for 14 items were modified. A total of 111 patients (94 percent) completed the study adequately. Temporal reliability (test–retest) was good for all domains except for embarrassment, which showed significant differences (P < 0.02). Internal reliability was good/excellent for all domains (Cronbach alpha >0.80, between 0.84 and 0.96). The four domains of Cuestionario de Calidad de Vida de Incontinencia Anal significantly correlated with the domains of the generic questionnaire on health (P < 0.01) and with the scale of severity of fecal incontinence (P < 0.001). All domains of Cuestionario de Calidad de Vida de Incontinencia Anal correlated negatively with the need to wear pads (P < 0.01) and with the presence of complete fecal incontinence.
Conclusions
The Cuestionario de Calidad de Vida de Incontinencia Anal incorporates sufficient requirements of reliability and validity to be applied to patients with fecal incontinence.
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Supported in part by a grant from the Instituto de Salud Carlos III (Grant 03/02).
Appendices
Appendix 1: Fecal Incontinence Quality of Life Scale
Cuestionario de Calidad de Vida de Incontinencia Anal
Instructions
The next questions refer to what you think about your health and the limitations in your daily habitual activities in the last month due to accidental bowel leakage. Answer every question as it is indicated. Please do not hesitate to ask if you are not sure of what to answer.
Instrucciones
Las preguntas que siguen se refieren a lo que usted piensa sobre su salud, y las limitaciones que le produce su forma de contener las heces o gases en sus actividades habituales en el último mes. Conteste cada pregunta tal como se le indica. Si no está seguro/a de cómo responder a una pregunta, por favor no dude en preguntar.
Clarification
ANAL INCONTINENCE is the loss of capacity to control voluntarily the expulsion of flatus or stools by your anus.
Aclaraciones:
INCONTINENCIA ANAL es la perdida de la capacidad de controlar voluntariamente la expulsión de gases o heces por el ano. Es decir que a una persona cuando se le escapan (sin poder evitarlo) los gases o las heces por el ano se considera que tiene una incontinencia anal.
Please Do Not Leave a Question without an Answer.
Mark Only One Answer
Make a cross in the answer that it is next to your situation
No Deje Ninguna Pregunta Sin Responder Marque Una Sola Respuesta
Tache con una cruz la respuesta que considere adecuada a su situación
Q1: In general, would you say your health is:
En general, usted diría que su salud es:
-
1
□ Excellent (Excelente)
-
2
□ Very good (Muy Buena)
-
3
□ Good (Bien)
-
4
□ Fair (Regular)
-
5
□ Poor (Mal)
Q2–Q3: In the following text you will find a list of situations and behaviors that can be related to an anal incontinence episode. Please indicate how much of the time the issue is a concern for you due to accidental bowel leakage. If it is a concern for you for reasons other than accidental bowel leakage then mark a cross in no proceed.
Q2–Q3: A continuación encontrará un listado de situaciones y de comportamientos que se pueden relacionar con un episodio de incontinencia anal. Por favor indique con qué frecuencia le ocurren en relación a la posibilidad de que usted tenga un episodio de incontinencia anal. En el supuesto de que esta situación se produzca por motivos diferentes a la incontinencia, marque como respuesta válida no procede.
DUE TO ACCIDENTAL EPISODES OF ANAL INCONTINENCE
DEBIDO A LOS EPISODIOS DE INCONTINENCIA ANAL
Q2:
| Most of the time | Some of the time | A little of the time | None of the time | No proceed |
Muchas veces | Bastantes veces | Alguna vez | Nunca | No procede | |
a) I am afraid to leave home | 1 | 2 | 3 | 4 | 5 |
Tengo miedo (temor) a salir fuera de casa | |||||
b) I avoid visiting friends | 1 | 2 | 3 | 4 | 5 |
Evito hacer visitas a mis amigos | |||||
c) I avoid staying overnight away from home | 1 | 2 | 3 | 4 | 5 |
Evito pasar la noche fuera de casa | |||||
d) It's difficult for me to leave home and do things like going to a movie or to church | 1 | 2 | 3 | 4 | 5 |
Me resulta difícil salir de casa para ir aalgunos sitios, como el cine o la iglesia | |||||
e) I eat less (reduce the quantityof my meals) before leaving home | 1 | 2 | 3 | 4 | 5 |
Si tengo que salir de casa reduzco la cantidad de comida | |||||
f) Whenever I am away from home, I try to stay near a restroom as much as possible | 1 | 2 | 3 | 4 | 5 |
Cuando estoy fuera de casa intento estar siempre lo mas cerca posible de un retrete público | |||||
g) It is fundamental for me to organize my daily activities according to when and how often I need to go to the toilet | 1 | 2 | 3 | 4 | 5 |
Para mi es fundamental organizar las actividades diarias en función de cuándo y cuantas veces necesite ir al retrete | |||||
h) I avoid travelling | 1 | 2 | 3 | 4 | 5 |
Evito viajar | |||||
i) It worries me not be able to reach a toilet in time | 1 | 2 | 3 | 4 | 5 |
Me preocupa no ser capaz de llegar al retrete a tiempo | |||||
j) I feel I have no control over my bowels | 1 | 2 | 3 | 4 | 5 |
Me parece que no soy capaz de controlar mi defecación | |||||
k) I can't hold my bowel movement long enough to get to the bathroom | 1 | 2 | 3 | 4 | 5 |
Soy incapaz de aguantar las heces hasta llegar al retrete | |||||
l) I leak stool without even knowing it | 1 | 2 | 3 | 4 | 5 |
Se me escapan las heces sin darme cuenta | |||||
m) I try to prevent bowel accidents by staying very near a bathroom | 1 | 2 | 3 | 4 | 5 |
Intento prevenir los episodios de incontinencia situándome cerca de un cuarto de baño. |
Q3:
Most of the time | Some of the time | A little of the time | None of the time | No proceed | |
Muchas veces | Bastantes veces | Alguna vez | Nunca | No procede | |
a) I feel ashamed | 1 | 2 | 3 | 4 | 5 |
Me siento avergonzada/o | |||||
b) I can not do many of things I want to do | 1 | 2 | 3 | 4 | 5 |
No hago muchas de las cosas que me gustaria hacer | |||||
c) I worry about bowel accidents | 1 | 2 | 3 | 4 | 5 |
Estoy preocupado porque se me escapan las heces | |||||
d) I feel depressed | 1 | 2 | 3 | 4 | 5 |
Me siento deprimido | |||||
e) I worry about others smelling stool on me | 1 | 2 | 3 | 4 | 5 |
Me preocupa que otras personas puedan oler mis heces | |||||
f) I feel like I am not a healthy person | 1 | 2 | 3 | 4 | 5 |
Siento que no soy una persona sana | |||||
g) I enjoy life less | 1 | 2 | 3 | 4 | 5 |
Disfruto menos de la vida | |||||
h) I have sex less often than I would like to | 1 | 2 | 3 | 4 | 5 |
Tengo menos relaciones sexuales de las que desearía | |||||
i) I feel different from other people | 1 | 2 | 3 | 4 | 5 |
Me siento diferente del resto de la gente | |||||
j) The possibility of bowel accidents is always on my mind | 1 | 2 | 3 | 4 | 5 |
En mi cabeza esta siempre presente la posibilidad de tener un episodio de incontinencia | |||||
k) I am afraid to have sex | 1 | 2 | 3 | 4 | 5 |
Tengo miedo al acto sexual | |||||
l) I avoid traveling on public transport (trains, planes, buses, subway, etc.) | 1 | 2 | 3 | 4 | 5 |
Evito hacer viajes en transportes públicos (tren, avión, autobús, metro etc.) | |||||
m) I avoid eating out | 1 | 2 | 3 | 4 | 5 |
Evito comer fuera de casa | |||||
n) When I go to a new place, I always try to know where the toilet is | 1 | 2 | 3 | 4 | 5 |
Cuando voy a un lugar nuevo intento siempre saber dónde está el retrete |
Q4: During the last month, have you felt sad, discouraged, hopeless, or had many problems that you wondered if anything was worthwhile?
Durante el mes pasado, se ha sentido usted tan triste, desanimado, desesperanzado que le parecía que la vida no tenia sentido?
-
1
□ Extremely So—To the point that I have just about given up (siempre—hasta el punto de abandonarlo todo)
-
2
□ Very Much So (muchas veces)
-
3
□ Quite a Bit (pocas veces)
-
4
□ Some—Enough to bother me (alguna vez, pero suficiente para sentirme molesto)
-
5
□ A Little Bit (muy poco)
-
6
□ Not At All (nunca)
The Fecal Incontinence Quality of Life Scale is composed of 29 items; these items form four scales:
-
1.
Lifestyle (10 items)
-
2.
Coping/Behavior (9 items)
-
3.
Depression/Self-Perception (7 items)
-
4.
Embarrassment (3 items)
El cuestionario de calidad de vida de incontinencia anal tiene 29 preguntas que evaluan cuatro dominios:
-
1.
Estilo de vida (10 preguntas)
-
2.
Conducta (9 preguntas)
-
3.
Depresión/Percepción de uno mismo (7 preguntas)
-
4.
Verguenza (3 preguntas)
Scales range from 1 to 5, with a 1 indicating a lower functional status of quality of life. Scale scores are the mean to all items in the scale. No proceed is coded as missing value in the analysis for all questions.
Se establece un rango del 1 al 5 para cada item. El 1 indica un estado funcional bajo de calidad devida. La puntuación para cada apartado se calculacomo la media de los items que conforman cadaapartado (suma de todos los puntos de cada item dividido por elnúmero de items). La respuestaNoprocede se considera como valor perdido.
-
1)
Lifestile, ten items: Q2a, Q2b, Q2c, Q2d, Q2e, Q2g, Q2h, Q3b, Q3l, Q3m
-
2)
Coping/Behavior, nine items: Q2f, Q2i, Q2j, Q2k, Q2m, Q3d, Q3h, Q3j, Q3n
-
3)
Depression/Self-Perception, seven items: Q1 (is reverse code), Q3d, Q3f, Q3g, Q3i, Q3k, Q4
-
4)
Embarrassment, 3 items: Q2l, Q3a, Q3e
-
1)
Estilo de vida: Lo configuran los items: Q2a, Q2b, Q2c, Q2d, Q2e, Q2g, Q2h, Q3b, Q3l, Q3m
-
2)
Conducta: Los items: Q2: Q2f, Q2i, Q2j, Q2k, Q2m, Q3d, Q3h, Q3j, Q3n
-
3)
Depresión, autopercepción: Q1 (se codifica al revés), Q3d, Q3f, Q3g, Q3i, Q3k, Q4
-
4)
Verguenza: Q2l, Q3a, Q3e
Appendix 2: Collaborating Investigators and Centers
Institution | Investigator |
Hospital Universitario N.S. de la Candelaria, Santa Cruz de Tenerife, Tenerife, Spain | Juan Salvador Baudet, M.D. |
Hospital Clinic, IDIBAPS, Barcelona, Spain | Gloria Lacima, M.D. |
Hospital Universitario Vall d'Hebrón, Barcelona, Spain | Jose Luis Fernández-Fraga, M.D. |
Hospital General de Albacete, Albacete, Spain | Pedro Cascales M.D. |
Hospital Clínico San Carlos, Madrid, Spain | Antonio Ruiz de Leon, M.D. |
Hospital Clinico Universitario, Valencia, Spain | Adolfo Benages, MD. |
Centro Medico Teknon, Barcelona, Spain | Cristina Puigdellivol, MD. |
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Minguez, M., Garrigues, V., Soria, M.J. et al. Adaptation to Spanish Language and Validation of the Fecal Incontinence Quality of Life Scale. Dis Colon Rectum 49, 490–499 (2006). https://doi.org/10.1007/s10350-006-0514-5
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DOI: https://doi.org/10.1007/s10350-006-0514-5