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P244. Development and initial validation of a new assessment tool for faecal incontinence in inflammatory bowel disease: the International Consultation on Incontinence Questionnaire: Inflammatory Bowel Disease (ICIQ-IBD)

L. Dibley1, C. Norton1, N. Cotterill2, P. Bassett3, 1King's College London, Florence Nightingale School of Nursing & Midwifery, London, United Kingdom, 2British Urological Institute, Southmead Hospital, Bristol, United Kingdom, 3Statsconsultancy, Medical Statistician, Amersham, United Kingdom

Background

Faecal incontinence (FI) in IBD is common and under-reported. In a prior study [1] an existing questionnaire [2] was found unsuitable for assessing FI in IBD due to inability to address fluctuating symptoms and IBD-related concerns. We aimed to develop a new psychometrically robust IBD-specific FI questionnaire.

Methods

Participants were purposefully sampled from a UK IBD charity's membership. The International Consultation on Incontinence Questionnaire [3] development and validation protocol was followed in a two phase study. Phase 1: we progressively developed content, terminology and format of the new tool from feedback in the original study [1] and four rounds of cognitive interviews. A modified Delphi survey of clinicians identified important clinical content. Phase 2: participants completed the final version of the ICIQ-IBD and a disease activity index twice, to evaluate validity of the questionnaire and consistency of assessment. A principal exploratory factor analysis identified underlying domains in the questionnaire.

Results

Phase 1: 24 respondents (female n = 18, 75%; age: mean 50 yrs, range 30–70; CD 12, 50%; UC 9, 37.5%; Crohn's Colitis 2, 8.3%; Proctitis 1, 4.1%) participated in cognitive interviews. Ten clinicians (4 IBD nurse specialists, 3 gastroenterologists, 2 specialist dieticians, 1 physiotherapist) clarified clinical content.

Phase 2: 166/188 (88%) returned the first (test) questionnaire. 143 (86% [76% of total sample]) returned the second (retest) questionnaire 2–6 weeks later. Minimal missing data indicated that most questions were applicable and acceptable to most respondents. Response spread showed that the ICIQ-IBD discriminates between patients with and without FI, and between low and high disease activity and concern levels. 110 respondents returning test and retest data had stable disease activity; these data were analysed using weighted kappa to determine stability (test–retest reliability). 17/41 questions (41.5%) showed moderate (kappa 0.41–0.6) agreement; 19/41 questions (46%) showed good (kappa 0.61–0.8) agreement, suggesting the ICIQ-IBD is reasonably stable and reliable.

Two domains were identified: bowel symptoms and quality of life, consisting of eleven and fourteen items respectively. Factor analysis data indicates a simple additive score for each domain. Ten further stand-alone, unscored items are included to encompass assessment of issues considered to be important from the patient or clinical perspective.

Conclusion

The new ICIQ-IBD is valid and reliable. Further psychometric testing to evaluate sensitivity to change will be conducted in a forthcoming intervention study.

1. Norton C, Dibley L, Bassett, P., (2013), Faecal incontinence in inflammatory bowel disease (IBD): associations and effect on quality of life, Journal of Crohn's & Colitis, 7(8): e302–311.

2. Cotterill, N., Norton, C., Avery, K., Abrams, P., & Donovan, J., (2011), Psychometric evaluation of a new patient-completed questionnaire for evaluating anal incontinence symptoms and impact on quality of life: The ICIQ-B., Diseases of the Colon & Rectum, 54 (10) 1235–1250.

3. ICIQ, (2011), International Consultation on Incontinence Protocol, http://www.iciq.net/validationprotocol.htm