title: Quality-of-life measures in fecal incontinence: is validation valid?
abstract: BACKGROUND
  Multiple health measurement scales have been used to study patients with fecal incontinence, but none have met the needs for clinical use and research perfectly. These include severity scales and generic and condition-specific quality-of-life scales. Several different approaches have been used to develop and evaluate the internal and external validity of these scales.
  
  
  OBJECTIVE
  As a step toward an improved quality-of-life instrument for fecal incontinence, the present study aimed to provide a critical review of the psychometric methodology of existing generic and condition-specific quality-of-life scales by using a standard measurement model.
  
  
  METHODS
  This study is a retrospective review.
  
  
  METHODS
  Two investigators experienced in psychometric methodology reviewed source articles from frequently used fecal incontinence quality-of-life scales.
  
  
  METHODS
  Patients with fecal incontinence were identified.
  
  
  METHODS
  The primary outcome measured was the demonstration of at least 1 reliability criterion, content validity, construct validity, and either criterion validity or discriminative validity.
  
  
  RESULTS
  A total of 12 scales were identified. The reported methodology varied considerably. Most scales demonstrated convergent validity and test-retest reliability, whereas very few scales demonstrated internal consistency or predictive validity. Generic scales were found to be reliable and valid, but not responsive to condition severity. There was a wide range of methodology used in scale development and a wide diversity in the psychometric rigor.
  
  
  CONCLUSIONS
  Variations in scale construction, data reporting, and validity testing made the evaluation of fecal incontinence quality-of -life scales by using a standardized measurement model difficult.
  
  
  CONCLUSIONS
  Identifying deficiencies in validity testing and reporting of existing scales is vital for future creation of a useful validated instrument to measure quality of life in patients with fecal incontinence.
authors: 1 Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2 Division of Health Policy and Public Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors: Janet T
authors: JT
authors: Lee
authors: Robert D
authors: RD
authors: Madoff
authors: Todd H
authors: TH
authors: Rockwood
mesh_terms: D005242:Fecal Incontinence / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics / Q000379:methods / Q000592:standards; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index