title: The Danish anal sphincter rupture questionnaire: validity and reliability.
abstract: OBJECTIVE
  To revise, validate and test for reliability an anal sphincter rupture questionnaire in relation to construct, content and face validity. SETTING AND BACKGROUND: Since 1996 women with anal sphincter rupture (ASR) at one of the public university hospitals in Copenhagen, Denmark have been offered pelvic floor muscle examination and instruction by a specialist physiotherapist. In relation to that, a non-validated questionnaire about anal and urinary incontinence was to be answered six months after childbirth.
  
  
  METHODS
  The original questionnaire was revised and a pilot test was performed among health care personnel, followed by an expert panel discussion. Ten women were interviewed about their understanding and attitude toward answering the questionnaire and it was pre-tested on 52 women with ASR. The questionnaire was revised five times during the validation process. The final version was test-retested among 20 women with ASR.
  
  
  RESULTS
  The questionnaire revealed typical problems after ASR. The length, use of language, and the way the questionnaire was constructed, was deemed appropriate. The reliability test showed good to very good correlation (Kappa values from 0.733 to 0.923) in all main questions but one. Two questions needed further explanation. Seven women made minor errors.
  
  
  CONCLUSIONS
  The validated Danish questionnaire has a good construct, content and face validity. It is a well accepted, reliable, simple and clinically relevant screening tool. It reveals physical problems including sexual problems, impact on quality of life and need for treatment among women 6-8 months after ASR.
authors.affiliation: Department of Physiotherapy, Hvidovre Hospital, Hvidovre, Denmark. ulla.due@hvh.regionh.dk
authors.forename: Ulla
authors.initials: U
authors.lastname: Due
authors.forename: Marianne
authors.initials: M
authors.lastname: Ottesen
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D015331:Cohort Studies; D003718:Denmark; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D011336:Probability; D011788:Quality of Life; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous / Q000150:complications / Q000523:psychology; D018434:Sickness Impact Profile; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult