title: Crohn's disease: systematic review of assessment of disease severity and its relevance to surgery.
abstract: BACKGROUND
  The aims of treatments for Crohn's disease are symptom control by medical or surgical means and improvement in health-related quality of life (HRQOL). A wide number of classification systems, instruments of disease activity measurement (DAM) and HRQOL are available, but few are used in routine surgical practice.
  
  
  OBJECTIVE
  To review the validity of DAM and HRQOL instruments and their applicability to surgically treated patients.
  
  
  METHODS
  A systematic literature search was undertaken to identify these instruments. Qualifying articles were used to determine the construct, content and criterion validity of the instruments identified with respect to surgically treated patients.
  
  
  RESULTS
  Thirteen disease activity indices and 11 HRQOL assessment tools were identified. Construct validity was demonstrated throughout but concerns of content and criterion validity were noted.
  
  
  CONCLUSIONS
  None of the current disease activity or HRQOL tools can be used without potential bias in a trial of surgical vs medical therapy as the items included favour the outcomes experienced following medical therapy. A more balanced assessment tool in the setting of a multidisciplinary trial is needed.
authors.affiliation: Department of Colorectal Surgery, Cardiff and Vale NHS Trust.
authors.forename: P K Dhruva
authors.initials: PK
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Davies
authors.forename: P E
authors.initials: PE
authors.lastname: Price
authors.forename: J
authors.initials: J
authors.lastname: Torkington
mesh_terms: D003424:Crohn Disease / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011788:Quality of Life; D012720:Severity of Illness Index