The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation
BACKGROUND: The patient perspective on fecal incontinence can only be captured through the use of participant-reported measures. There are few psychometric evaluations of such measures, and these evaluations have reported some problems with existing measures. OBJECTIVE: This study clinically evaluated the new Revised Faecal Incontinence Scale which was developed to provide a short, psychometrically sound measure for epidemiological and evaluative research. DESIGN: A sample of consecutive patients was recruited and administered a questionnaire pre and posttreatment (Continence Advising, Physiotherapy and Surgery). SETTINGS: The study was conducted at 6 incontinence clinics across Australia. PATIENTS: The sample included 61 people with fecal incontinence at baseline and 38 at follow-up. MAIN OUTCOME MEASURES: Measures included the Revised Faecal Incontinence Scale, the Wexner Continence Scale, and the St Mark's Incontinence Score. Additionally, patient and clinician ratings of severity and improvement were collected. RESULTS: The internal reliability of the Revised Faecal Incontinence Scale had a Cronbach's = 0.78 compared with 0.65 for both the Wexner and St Mark's scales. Test-retest reliabilities were 0.80, 0.74, and 0.68. All 3 instruments were similarly responsive to change at follow-up. Correlations with other fecal incontinence measures were high and significant. LIMITATIONS: The small sample size, particularly at posttreatment, provides limitations concerning generalizability and subanalyses that could be undertaken. CONCLUSIONS: The Revised Faecal Incontinence Scale possessed evaluative discrimination between different levels of incontinence severity. In this sample it had superior internal consistency and test-retest reliability to the Wexner and St Mark's Incontinence Scales. It was at least as responsive as the Wexner and St Mark's in detecting change in incontinence status following treatment. Although ongoing clinical validation is required, these findings suggest it is a short, reliable, and valid scale that could be considered for use by researchers, epidemiologists, and clinicians.