Abstract
Background
After colorectal surgery, patients often experience impaired functional outcome. Faecal incontinence grading systems and self-assessment questionnaires are frequently used to assess these complaints. The available faecal incontinence grading systems have been validated, but have a limited focus, while more comprehensive questionnaires, which have been developed, have not been validated.
Aims
To investigate the reliability and validity of a newly developed, colorectal functional outcome (COREFO) questionnaire and of Dutch translations of the Hallböök questionnaire and an adapted version of the Vaizey questionnaire.
Patient/methods
Two hundred fifty-seven patients with and without impaired functional outcome after (colorectal) surgery received a booklet containing the three questionnaires in random order by mail. One hundred seventy-nine (70%) completed them, and 160 patients (90%) completed a retest within, on average, 18 days.
Results/findings
Reliability and validity were adequate for the COREFO and Hallböök questionnaire, with slight differences in the psychometric analyses in favour of the COREFO questionnaire. Significantly more patients found the COREFO questionnaire to reflect their problems best. The reliability of the Vaizey questionnaire was not sufficient.
Interpretation/conclusions
The newly developed COREFO questionnaire and the previously unvalidated Hallböök questionnaire are both suitable instruments to evaluate functional outcome after colorectal surgery. The psychometric analyses showed a slight difference in favour of the COREFO questionnaire and significantly more patients preferred the COREFO questionnaire to the other questionnaires. Therefore, we prefer to use the COREFO questionnaire in future research.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF (1999) Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 230:648–654
Slors FJ, van Zuijlen PP, van Dijk GJ (2000) Sexual and bladder dysfunction after total mesorectal excision for benign diseases. Scand J Gastroenterol Suppl 232:48–51
Van Duijvendijk P, Slors JF, Taat CW, Van Tets WF, Van Tienhoven G, Obertop H, Boeckxstaens GE (2002) Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 97:2282–2289
Johanson JF, Lafferty J (1996) Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol 91:33–36
Kirwan WO, Turnbull RB Jr, Fazio VW, Weakley FL (1978) Pullthrough operation with delayed anastomosis for rectal cancer. Br J Surg 65:695–698
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35:482–487
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80
Hallböök O, Sjodahl R (2000) Surgical approaches to obtaining optimal bowel function. Semin Surg Oncol 18:249–258
Shibata D, Guillem JG, Lanoutte N, Paty P, Minsky B, Harrison L, Wong WD, Cohen A (2000) Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation. Dis Colon Rectum 43:752–758
Olagne E, Ballieux J, de la Roche R, Adham M, Berthoux N, Bourdeix O, Gerard JP, Ducerf C (2000) Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer. J Am Coll Surg 191:643–649
Hida J, Yasutomi M, Fuijmoto K, Okuno K, Idea S, Machidera N, Kubo R, Shindo K, Koh K (1996) Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 39:986–991
Fayers PM, Machin D (2000) Scores and measurements: validity, reliability, sensitivity. In: Quality of life; assessment, analysis and interpretation. Wiley, Chichester, pp 45–71
Hallböök O, Pahlman L, Krog M, Wexner SD, Sjodahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224:58–65
Reilly WT, Talley NJ, Pemberton JH, Zinsmeister AR (2000) Validation of a questionnaire to assess fecal incontinence and associated risk factors: fecal incontinence questionnaire. Dis Colon Rectum 43:146–153
Fayers PM, Machin D (2000) Questionnaire development and scoring. In: Quality of life; assessment, analysis and interpretation. Wiley, Chichester, pp 135–153
Cronbach LJ (1951) Coefficient alpha and internal structure of tests. Psychometrika 16:297–334
Nunnally JC, Bernstein IH (1994) Psychometric theory. McGraw-Hill, New York
Kerlinger FN (1973) Foundations of behavioral research. Holt, Rinehart and Winston, New York
Cohen J (1980) Statistical power analysis for behavioral sciences. Erlbaum, Hillsdale, NJ
Machado M, Nygren J, Goldman S, Ljungqvist O (2003) Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 238:214–220
Heah SM, Seow-Choen F, Eu KW, Ho YH, Tang CL (2002) Prospective, randomized trial comparing sigmoid vs descending colonic J-pouch after total rectal excision. Dis Colon Rectum 45:322–328
Ho YH, Seow-Choen F, Tan M (2001) Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial. World J Surg 25:876–881
Ho YH, Brown S, Heah SM, Tsang C, Seow-Cheon F, Eu KW, Tang CL (2002) Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 236:49–55
Dehni N, Tiret R, Singland JD, Cunningham C, Schlegel RD, Guiguet M, Parc R (1998) Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 41:817–822
Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD (1998) Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum 41:740–746
Kim NK, Lim DJ, Yun SH, Sohn SK, Min JS (2001) Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis 16:234–237
Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S (1997) Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 40:1409–1413
Oya M, Komatsu J, Takase Y, Nakamura T, Ishikawa H (2002) Comparison of defecatory function after colonic J-pouch anastomosis and straight anastomosis for stapled low anterior resection: results of a prospective randomized trial. Surg Today 32:104–110
Acknowledgements
We would like to thank Dr A.G.E.M. de Boer and Dr P. Bundock for the forward–backward translation of the COREFO questionnaire. This study was partly funded by “Dutch Digestive Diseases Foundation”.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Bakx, R., Sprangers, M.A.G., Oort, F.J. et al. Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis 20, 126–136 (2005). https://doi.org/10.1007/s00384-004-0638-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-004-0638-9