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Tsunoda A, Kusanagi H. Annual long-term functional outcomes after transanal repair for symptomatic rectocele. Ann Coloproctol 2022:ac.2022.00283.0040. [PMID: 36377333 DOI: 10.3393/ac.2022.00283.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose This study was performed to assess the long-term annual functional outcomes and quality of life (QOL) after transanal rectocele repair. Methods We evaluated retrospectively collected data from patients who underwent transanal repair for symptomatic rectocele between February 2012 and December 2018. The Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI), and several QOL questionnaires (e.g., the Patient Assessment of Constipation-QOL [PAC-QOL], Fecal Incontinence QOL, and the 36-Item Short Form Survey [SF-36]) were administered before surgery and annually after surgery. Additionally, physiological assessments and defecography were performed before and after surgery. Substantial symptom improvement, indicated by at least a 50% reduction in the CSS or FISI score, was evaluated postoperatively. All postoperative follow-up results were compared with the preoperative data. Results Thirty-two patients were included in the study. The median follow-up period was 5 years (range, 0.5-7 years). Postoperative defecography showed that the rectocele size significantly decreased (P<0.0001). However, the physiological assessment did not reveal postoperative changes. The CSS score 1 year after surgery was significantly lower than the preoperative score (P<0.0001) and remained significantly low until the long-term follow-up. Constipation improved by more than 80% 2 to 5 years postoperatively, and fecal incontinence improved in 2/3 of the patients after 5 years. The PAC-QOL scores significantly improved (all P<0.05) over time until the 3-year and long-term follow-ups, and 6 of the 8 SF-36 scores significantly improved at specific points postoperatively. Conclusion Transanal rectocele repair provides long-term improvement for constipation and constipation-specific QOL.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
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Tsunoda A, Takahashi T. The Minimal Important Difference of the Fecal Incontinence Quality of Life (FIQL) Questionnaire for Patients with Posterior Compartment Prolapse: A Prospective Cohort Study. J Anus Rectum Colon 2022; 6:16-23. [PMID: 35128133 PMCID: PMC8801248 DOI: 10.23922/jarc.2021-035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/15/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: The minimally important difference (MID) of the Fecal Incontinence Quality of Life (FIQL) scale has never been determined. Thus, in this study, we aimed to estimate the MID of the Japanese FIQL for patients with posterior compartment prolapse (PCP). Methods: For 3-months after surgery, we followed a prospective cohort of 136 patients with PCP combined with fecal incontinence (FI) who had undergone ventral rectopexy between 2012 and 2018. Usable data from 114 patients were analyzed. Patients have both completed the FIQL and the 36-Item Short Forum Health Survey (SF-36) before and after surgery. Distribution-based MID values were estimated at 1/2 SD and the standard error of measurement (SEM) for domain and total scores across time points. Changes in the domain scores anchored to changes in a SF-36 overall health assessment question were used to estimate anchor-based MID. To be interpreted as true change, the median, anchor-based MID values that were greater than the corresponding SEM were proposed as estimates of the MID for the FIQL. Results: Distribution-based MID of 1/2 SD for each domain and total score ranged between 0.3 and 0.4, whereas SEM ranges were between 0.2 and 0.3. The anchor-based approach resulted in the median MID estimates of 0.4 to 1.0. Final estimates of MID for each FIQL and total score were as follows: lifestyle (0.6-1.1), coping/behavior (0.8-1.4), depression/self-perception (0.4-0.8), embarrassment (1.0-1.6), and total score (0.7-1.1). Conclusions: The results provide a basis for clinically important differences in FIQL scores after surgery for patients with PCP and FI.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center
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Yukimoto R, Miyoshi N, Fujino S, Mori R, Ogino T, Takahashi H, Uemura M, Mizushima T, Doki Y, Eguchi H. Usefulness of An Anal Sphincter Injury Mouse Model by Means of a Balloon Catheter and a New Method of Evaluating Anal Sphincter Function. Ann Gastroenterol Surg 2021; 6:282-287. [PMID: 35261954 PMCID: PMC8889860 DOI: 10.1002/ags3.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/05/2021] [Accepted: 10/23/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ryohei Yukimoto
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Norikatsu Miyoshi
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Shiki Fujino
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Ryota Mori
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Takayuki Ogino
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Hidekazu Takahashi
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Mamoru Uemura
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Tsunekazu Mizushima
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Yuichiro Doki
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
| | - Hidetoshi Eguchi
- Department of Surgery Gastroenterological Surgery Osaka University, Graduate School of Medicine Suita Japan
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Long-term annual functional outcome after laparoscopic ventral rectopexy for rectoanal intussusception and/or rectocele: evaluation of sustained improvement. Tech Coloproctol 2021; 25:1281-1289. [PMID: 34633567 DOI: 10.1007/s10151-021-02499-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the long-term annual functional results and quality of life (QOL) after laparoscopic ventral rectopexy (LVR) for rectoanal intussusception (RAI) and/or rectocele. METHODS This study was a retrospective analysis of prospectively collected data. The study was conducted on patients who underwent LVR for RAI and/or rectocele at our institution between February 2012 and July 2015. The Fecal Incontinence Severity Index (FISI), Constipation Scoring System (CSS), and QOL instruments (i.e., 36-item Short-form Health Survey [SF-36], Patient Assessment of Constipation-QOL [PAC-QOL] scale, and Fecal Incontinence-QOL [FIQL]) were administered before and annually after surgery. The sustainability of substantial symptom improvement (reduction of at least 50% in CSS or FISI scores) postoperatively was evaluated. RESULTS Fifty-one patients (median age 76 [range 60-93] years, 48 women [94%]) were analyzed. No mortality or major morbidity occurred. After a median follow-up of 60 months (range 12-84 months), no mesh-related complications occurred. The median CSS and FISI scores were significantly reduced at 1 year and remained significantly reduced for 7 years. In patients who reported symptom scores ≥ 3 times postoperatively, sustained improvement of constipation and fecal incontinence was found in about 50% (18/38) and 75% (26/35) of relevant patients, respectively. All PAC-QOL and FIQL scales significantly improved over time for 5 years. Of the SF-36 scales, four showed significant improvement at 1 year but none was significantly improved after 3 years, except for the social functioning scale. CONCLUSIONS LVR for RAI and/or rectocele was associated with low morbidity and long-term improvement in symptom-specific QOL. The sustainability of postoperative improvement in fecal incontinence was satisfactory, and that in constipation was fair.
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Maeda K, Yamana T, Takao Y, Mimura T, Katsuno H, Seki M, Tsunoda A, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version. J Anus Rectum Colon 2021; 5:52-66. [PMID: 33537501 PMCID: PMC7843140 DOI: 10.23922/jarc.2020-057] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
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Nakano K, Takahashi T, Tsunoda A, Shimizu Y. Effects of Dietary Guidance without Dietary Fiber Supplements on the Symptoms, Quality of Life, and Dietary Intake in Patients with Fecal Incontinence. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:128-136. [PMID: 32743115 PMCID: PMC7390611 DOI: 10.23922/jarc.2020-008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
Objectives Dietary fiber (DF) supplements improve fecal incontinence (FI). Here, we investigated the effects of dietary guidance without DF supplements in patients with FI. Methods This was an interventional study on the nutritional guidance alone by a dietitian where outcomes were compared before and one month after the guidance. In this study, participants attended a one 20-min dietary guidance session and received individual guidance on dietary management according to the 2017 Japanese FI guidelines, between January 2016 and March 2019. The main assessment items used were as follows: (i) the Fecal Incontinence Severity Index (FISI) to assess symptoms, (ii) the Fecal Incontinence Quality of Life Scale (FIQL) to assess the quality of life, and (iii) the dietary intake per day. Results Out of 61 patients who participated in this study, 50 (82%) completed the entire study and 29 (48%) continued a self-controlled diet therapy without drug treatment. Of the 50 patients, the FISI and FIQL scores were significantly improved after the guidance (FISI: 19 before vs. 10.5 after, P < 0.001; FIQL: 2.9 before vs. 3.2 after, P < 0.001). There was no statistically significant difference in the overall DF intake before and after the dietary guidance. However, foods containing DF changed significantly after the guidance. The intake of rice was significantly increased, whilst that of fruits, dairy products, and confectioneries was significantly reduced after the guidance. Conclusions Individual dietary guidance without DF supplements was effective. These results suggested that increasing rice consumption and restricting some foods had positive effects on improving FI.
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Affiliation(s)
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
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Tsunoda A, Takahashi T, Kusanagi H. Transanal repair of rectocele: prospective assessment of functional outcome and quality of life. Colorectal Dis 2020; 22:178-186. [PMID: 31454453 DOI: 10.1111/codi.14833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to assess the functional outcome of transanal repair of rectocele using patient symptom scores and quality of life (QOL) instruments. METHOD Patients who underwent transanal repair for symptomatic rectocele between February 2012 and August 2017 were included. This study was a retrospective analysis of prospectively collected data. A standard questionnaire including the Constipation Scoring System (CSS), the Fecal Incontinence Severity Index (FISI) and QOL instruments [Patient Assessment of Constipation (PAC)-QOL, Fecal Incontinence QOL Scale, Short-Form 36 Health Survey (SF-36)] was administered before and after the operation. Physiological assessment and proctography were performed before and after the operation. RESULTS Thirty patients were included. The median follow-up was 36 (6-72) months. Postoperative proctography showed a reduction in rectocele size [34 mm (14-52 mm) vs 10 mm (0-28 mm), P < 0.0001]. Physiological assessment showed no significant postoperative changes. Constipation was improved in 15/21 patients (71%) at 1 year and 14/20 patients (70%) at the mid-term follow-up. The CSS score reduced at 3 months [12 (8-12) vs 6 (1-12), P < 0.0001] and remained significantly reduced over time until the mid-term follow-up. Faecal incontinence was improved in two-thirds patients at 1 year. Four patients developed new-onset faecal incontinence. All the PAC-QOL scale scores significantly improved over time until 1 year, while two of the eight SF-36 scale scores showed significant postoperative improvement. CONCLUSION Transanal repair for rectocele improves constipation and constipation-specific QOL.
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Affiliation(s)
- A Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - H Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Tsunoda A, Takahashi T, Matsuda S, Oka N, Kusanagi H. Midterm functional outcome after laparoscopic ventral rectopexy for external rectal prolapse. Asian J Endosc Surg 2020; 13:25-32. [PMID: 30920167 PMCID: PMC6972686 DOI: 10.1111/ases.12701] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/03/2019] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Although long-term crude outcomes of laparoscopic ventral rectopexy for external rectal prolapse (ERP) have been documented, repetitive functional and quality of life (QOL) assessments are scarce. This study assessed midterm annual functional results and QOL after laparoscopic ventral rectopexy for ERP. METHODS This study consisted of 58 patients and was a retrospective analysis of prospectively collected data. The Fecal Incontinence Severity Index, the Constipation Scoring System, and QOL instruments (ie 36-item Short-Form Health Survey and Fecal Incontinence Quality of Life scale) were administered before and after operation. RESULTS There was no mortality or major morbidity. After a median follow-up of 49 months (6-92 months), recurrence of ERP was noted in one patient (2%). There were no mesh-related complications. The median Fecal Incontinence Severity Index score was significantly reduced at 3 months (34 [10-61] vs 12 [0-50], P < 0.0001) and remained significantly reduced for 5 years. The median Constipation Scoring System score was significantly reduced at 3 months (14 [9-20] vs 7 [0-16], P < 0.0001) and remained significantly reduced for 4 years. No patients developed new-onset constipation. All of the Fecal Incontinence Quality of Life scales significantly improved overtime for 4 years. All of the 36-item Short-Form Health Survey scales were significantly improved at 3 and 6 months, but none of the scales significantly improved after 2 years. CONCLUSION Laparoscopic ventral rectopexy for ERP was associated with low morbidity, low recurrence, and a midterm improvement in function and fecal incontinence-specific QOL.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical CenterKamogawaJapan
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical CenterKamogawaJapan
| | - Satoshi Matsuda
- Department of Pediatric Surgery, Kameda Medical CenterKamogawaJapan
| | - Naoki Oka
- Department of Gastroenterological Surgery, Kameda Medical CenterKamogawaJapan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical CenterKamogawaJapan
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Akizuki E, Matsuno H, Satoyoshi T, Ishii M, Usui A, Ueki T, Nishidate T, Okita K, Mizushima T, Mori M, Takemasa I. Validation of the Japanese Version of the Low Anterior Resection Syndrome Score. World J Surg 2018; 42:2660-2667. [PMID: 29450698 PMCID: PMC6060820 DOI: 10.1007/s00268-018-4519-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The low anterior resection syndrome (LARS) score is a patient-reported outcome measure to evaluate the severity of bowel dysfunction after rectal cancer surgery by scoring the major symptoms of LARS. The aim of this study was to translate the English version of the LARS score into Japanese and to investigate the validity and reliability of the LARS score. METHODS The LARS score was translated in Japanese following current international recommendations. A total of 149 rectal cancer patients completed the LARS score questionnaire and were also asked a single question assessing the impact of bowel function on quality of life (QoL). A total of 136 patients answered the LARS score questionnaire twice. RESULTS The Japanese LARS score showed high convergent validity, based on its good correlation between the LARS score and QoL (p < 0.001). The LARS score was able to discriminate between patients according to the tumor distance to anal verge (p < 0.001), type of surgery (p < 0.001), and time since surgery (p = 0.001). Patients after ultra-low anterior resection and intersphincteric resection showed especially high scores. The score also had high test-retest reliability (intraclass correlation coefficient: 0.87). CONCLUSION The Japanese LARS score is a valid and reliable tool for measuring LARS. The LARS score is appropriate for assessments in postoperative bowel function and international comparison. Using this score, patient-reported outcome measures of LARS in Japanese patients can be shared internationally. Additional validation reports from non-English speaking countries can support the LARS score as a worldwide assessment tool for postoperative bowel dysfunction.
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Affiliation(s)
- Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Matsuno
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuta Satoyoshi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Akihiro Usui
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Tomomi Ueki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
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Peterson AC, Sutherland JM, Liu G, Crump RT, Karimuddin AA. Evaluation of the Fecal Incontinence Quality of Life Scale (FIQL) using item response theory reveals limitations and suggests revisions. Qual Life Res 2018; 27:1613-1623. [PMID: 29504056 DOI: 10.1007/s11136-018-1826-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The Fecal Incontinence Quality of Life Scale (FIQL) is a commonly used patient-reported outcome measure for fecal incontinence, often used in clinical trials, yet has not been validated in English since its initial development. This study uses modern methods to thoroughly evaluate the psychometric characteristics of the FIQL and its potential for differential functioning by gender. METHODS This study analyzed prospectively collected patient-reported outcome data from a sample of patients prior to colorectal surgery. Patients were recruited from 14 general and colorectal surgeons in Vancouver Coastal Health hospitals in Vancouver, Canada. Confirmatory factor analysis was used to assess construct validity. Item response theory was used to evaluate test reliability, describe item-level characteristics, identify local item dependence, and test for differential functioning by gender. RESULTS 236 patients were included for analysis, with mean age 58 and approximately half female. Factor analysis failed to identify the lifestyle, coping, depression, and embarrassment domains, suggesting lack of construct validity. Items demonstrated low difficulty, indicating that the test has the highest reliability among individuals who have low quality of life. Five items are suggested for removal or replacement. Differential test functioning was minimal. CONCLUSIONS This study has identified specific improvements that can be made to each domain of the Fecal Incontinence Quality of Life Scale and to the instrument overall. Formatting, scoring, and instructions may be simplified, and items with higher difficulty developed. The lifestyle domain can be used as is. The embarrassment domain should be significantly revised before use.
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Affiliation(s)
- Alexander C Peterson
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - R Trafford Crump
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ahmer A Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
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Tsunoda A, Takahashi T, Ohta T, Kusanagi H. Quality of life after laparoscopic ventral rectopexy. Colorectal Dis 2016; 18:O301-10. [PMID: 26709009 DOI: 10.1111/codi.13247] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/10/2015] [Indexed: 12/15/2022]
Abstract
AIM This study evaluated continence, constipation and quality of life (QOL) before and after laparoscopic ventral rectopexy (LVR) METHOD: Between February 2012 and July 2014, patients who underwent LVR for external rectal prolapse (ERP) and/or rectoanal intussusception (RAI) were prospectively included. A standard questionnaire including the Fecal Incontinence Severity Index (FISI), the Constipation Scoring System (CSS) and QOL instruments (Short-Form 36 Health Survey, Fecal Incontinence QOL scale, Patient Assessment of Constipation-QOL) were administered before and after operation. Psychiatric patients and those with dementia were excluded from the study. Defaecography was performed 6 months postoperatively. RESULTS Fifty-nine patients were included in the study period and 44 (19 with ERP, 25 with RAI) completed the follow-up questionnaire and were reviewed after a median of 26 (range 12-42) months. There was no recurrent ERP. Postoperative defaecography showed new-onset RAI in 6 and persistent RAI in 1. One year after surgery, incontinence was improved in 30/39 patients (77%) and constipation in 19/32 (59%). The FISI scores reduced between preoperative status and 1 year after surgery [32 (13-61) vs 11 (0-33), P < 0.0001]. The CSS scores also reduced [preoperative 12 (5-18) vs 1 year 5 (1-12), P < 0.0001]. Compared with the preoperative scores, almost all of the scale scores on the three kinds of QOL instruments significantly improved over time. The presence of new-onset or persistent RAI did not have an adverse effect on the improvement of QOL. CONCLUSION LVR improves both generic and symptom-specific QOL with good functional results.
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Affiliation(s)
- A Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - T Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - T Ohta
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - H Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan
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Hsu LF, Hung CL, Kuo LJ, Tsai PS. An abbreviated Faecal Incontinence Quality of Life Scale for Chinese-speaking population with colorectal cancer after surgery: cultural adaptation and item reduction. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 12/28/2022]
Affiliation(s)
- L.-F. Hsu
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - C.-L. Hung
- Department of Radiation Oncology; Cardinal Tien Hospital; New Taipei City Taiwan
| | - L.-J. Kuo
- Division of Colorectal Surgery; Department of Surgery; Taipei Medical University Hospital; Taipei Taiwan
| | - P.-S. Tsai
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
- Department of Nursing; Taipei Medical University-Municipal Wan Fang Hospital; Taipei Taiwan
- Sleep Science Center; Taipei Medical University Hospital; Taipei Taiwan
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13
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Mak TWC, Leung WW, Ngo DKY, Lee JFY, Hon SSF, Ng SSM. Translation and validation of the traditional Chinese version of the faecal incontinence quality of life scale. Int J Colorectal Dis 2016; 31:445-50. [PMID: 26662463 DOI: 10.1007/s00384-015-2462-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Psychometric evaluation with tools such as the faecal incontinence quality of life scale is an essential component of clinical assessment. Currently, there is no translated Traditional Chinese version of the scale. A validated translated version may help to improve the quality of healthcare received in countries with Chinese minorities (0.5, 1.2 and 4.0% of the UK, USA and Australian population, respectively) as well as local population of Hong Kong. The purpose of this study is to validate the Traditional Chinese version of the faecal incontinence quality of life scale (FIQL). METHODS The FIQL questionnaire was translated into Traditional Chinese Language followed by linguistic validation. It was then tested on 55 patients with faecal incontinence and 93 controls in the colorectal outpatients clinic. Faecal incontinence severity index was also used for the assessment of disease severity. RESULTS Internal consistency was good/excellent for all scales (Cronbach's alpha >0.70, between 0.71 and 0.93). The intra-class correlation indicated a high stability over time with coefficients ranging between 0.78 and 0.90. Test and retest of all four scales found no significant differences of mean scores between baseline and retest. The mean faecal incontinence quality of life scale scores of all four domains improved significantly after treatment of 10 patients whose faecal incontinence severity index scores decreased by 50 % of their pre-treatment scores, hence indicating good sensitivity. CONCLUSIONS This study demonstrates the linguistic and psychometric validity of the traditional Chinese version of the faecal incontinence quality of life scale.
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Affiliation(s)
- Tony W C Mak
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R.
| | - Wing Wa Leung
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R
| | - Dennis K Y Ngo
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R
| | - Janet F Y Lee
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R
| | - Sophie S F Hon
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R
| | - Simon S M Ng
- Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, S.A.R.
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Tsunoda A, Takahashi T, Ohta T, Fujii W, Kusanagi H. New-onset rectoanal intussusception may not result in symptomatic improvement after laparoscopic ventral rectopexy for external rectal prolapse. Tech Coloproctol 2015; 20:101-7. [PMID: 26589950 DOI: 10.1007/s10151-015-1395-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/15/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study was designed to assess defecatory function in patients who underwent laparoscopic ventral rectopexy (LVR) for external rectal prolapse (ERP). METHODS Thirty-one patients who underwent evacuation proctography 6 months postoperatively were assessed. Preoperative proctography had been performed in 21 patients of these patients. Defecatory function was evaluated using the constipation scoring system (CSS) and fecal incontinence severity index (FISI). RESULTS The findings of postoperative proctography revealed no full-thickness ERP in any patient, although in 10 patients the ERP was replaced by rectoanal intussusception (RAI). Of the 31 patients, 30 presented with fecal incontinence preoperatively. Ten of 30 had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in the FISI score of the patients with new-onset RAI tended to be significantly smaller than in the patients without RAI (6/10 vs. 18/20, p = 0.141). Seventeen patients presented with obstructed defecation preoperatively. Seven of them had new-onset RAI. Six months postoperatively, a reduction of at least 50 % in their CSS score in the patients with new-onset RAI was significantly smaller than in patients without RAI (0/7 vs. 8/10, p = 0.002). CONCLUSIONS Evacuation proctography showed new-onset RAI in some patients with ERP who underwent LVR, which was associated with a lack of symptomatic improvement.
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Affiliation(s)
- A Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
| | - T Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - T Ohta
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - W Fujii
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - H Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
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15
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Abstract
For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies.
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Affiliation(s)
- Avinoam Nevler
- Department of Surgery and Transplantation, the Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel (Affiliated to Sackler Medicine School)
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