title: Quantifying patient improvement following sacral neuromodulation: is it time for a new scoring system for fecal incontinence?
abstract: BACKGROUND
  The Cleveland Clinic Florida Fecal Incontinence score is widely used to assess the severity of fecal incontinence.
  
  
  OBJECTIVE
  We hypothesized that the Cleveland Clinic Fecal Florida Incontinence score is useful at establishing baseline disease severity, but it may underestimate the response to treatment following sacral neuromodulation because of the large number of patients who still wear a pad despite improved continence, as well as the inability to track improvements in urgency.
  
  
  METHODS
  Data were obtained from prospectively maintained database of patients treated with sacral neuromodulation for fecal incontinence at 2 institutions beginning in 2011.
  
  
  METHODS
  A retrospective review of the individual components of Cleveland Clinic Fecal Florida Incontinence scores in response to treatment with sacral neuromodulation was performed.
  
  
  METHODS
  The study was conducted at 1 academic medical center and 1 community medical center.
  
  
  METHODS
  One hundred twenty-one consecutive patients were treated with sacral neuromodulation for fecal incontinence.
  
  
  METHODS
  No interventions occurred.
  
  
  METHODS
  Individual components of posttreatment Cleveland Clinic Florida Fecal Incontinence scores and subjective improvement in fecal urgency were the primary outcomes measured.
  
  
  RESULTS
  The median preoperative Cleveland Clinic Fecal Florida Incontinence score of 14 decreased to 3 (interquartile range, 2-4) at 12 months. Of the patients, 66.1% reported still wearing a pad after the procedure. The reason for wearing a pad was residual fecal incontinence (41%), habit despite normal continence (35.3%), and urinary incontinence with complete fecal continence (23.5%). Of patients who report wearing a pad, 59% have falsely elevated Cleveland Clinic Fecal Florida Incontinence scores owing to wearing a pad despite complete fecal continence. Additionally, 96.3% of patients reported improvement in fecal urgency.
  
  
  CONCLUSIONS
  This retrospective study did not include a comparison with an alternative scoring system.
  
  
  CONCLUSIONS
  Although the Cleveland Clinic Fecal Florida Incontinence score is a validated scale, which is simple to use for baseline disease severity, it may underestimate patient response to treatment. Additionally, it does not capture improvement in urgency. The ideal scoring system would be easy to use in clinical practice, and would account for improvement in fecal urgency.
authors.affiliation: 1Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 2Adirondack Surgical Group, Saranac Lake, New York 3Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Cincinnati, Ohio.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.forename: Adam
authors.initials: A
authors.lastname: Abodeely
authors.forename: Bobby L
authors.initials: BL
authors.lastname: Johnson
authors.forename: Janice F
authors.initials: JF
authors.lastname: Rafferty
mesh_terms: D000368:Aged; D003672:Defecation; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D016496:Incontinence Pads / Q000706:statistics & numerical data*; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome