Selecting an outcome measure for evaluating treatment in fecal incontinence.
OBJECTIVE
Various outcome measures exist to evaluate treatment in fecal incontinence, including descriptive, severity (fecal incontinence scoring systems), and impact (quality-of-life questionnaires) and diagnostic measures. We studied associations between changes after treatment for a number of outcome measures and compared them to patients' subjective perception of relief.


METHODS
We analyzed data of 66 patients (92 percent female; mean age, 62 years) (Vaizey score, Wexner score, two impact scales, utility, resting pressure, and maximal incremental squeeze pressure) at baseline and after physiotherapy. In a standardized interview by phone, we asked patients to compare their situation before and after treatment. Correlations between changes in outcome measures were calculated. These changes were compared with patients' subjective perception.


RESULTS
There was a high correlation between the changes in the Vaizey and the Wexner scores (r = 0.94, P < 0.01). Changes in Vaizey and Wexner scores correlated moderately with changes in maximum incremental squeeze pressure (r = -0.29, -0.30, both P < 0.05). Changes in utility and resting pressure were not correlated with changes in any of the other measurements (all r values between -0.086 and 0.18). Average severity scores (Vaizey and Wexner) were 1 point lower for patients who rated their situation as worse or equal (62 percent), 4 points lower for patients who reported their situation to be better (21 percent), and 9 points lower in patients who rated their situation much better (17 percent) (P < .05).


CONCLUSIONS
Severity measures are best related to patients' subjective perception of relief.
Deutekom
Marije
M
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands. m.deutekom@amc.uva.nl
Terra
Maaike P
MP
Dobben
Annette C
AC
Dijkgraaf
Marcel G W
MG
Felt-Bersma
Richelle J F
RJ
Stoker
Jaap
J
Bossuyt
Patrick M M
PM
D000368:Aged; D023381:Endpoint Determination; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011312:Pressure; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome