Quality of Life in Women with Defecatory Dysfunctions: Systematic Review of Questionnaires Validated in the Portuguese Language

Vasconcelos, José Ananias; Vasconcelos, Camila Teixeira Moreira; Karbage, Sara Arcanjo Lino; Farias, Hérdeny Di Cárlly de Almeida Rocha; Machado, Stéffany Gadelha de Macêdo; Saboia, Dayana Maia

doi:10.1055/s-0039-1678592

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 41 (3) • Mar 2019 • https://doi.org/10.1055/s-0039-1678592 copy

Quality of Life in Women with Defecatory Dysfunctions: Systematic Review of Questionnaires Validated in the Portuguese Language

Qualidade de vida em mulheres com disfunções defecatórias: revisão sistemática de questionários validados para a língua portuguesa

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify the quality of life (QoL) assessment instruments related to the health of women with fecal incontinence (FI) or anal incontinence (AI).

Data Sources

Systematic review conducted in the Virtual Health Library (VHL), PubMed and Cochrane Library databases. The descriptors used were: Questionnaire, Questionnaires, Quality of life, validation, validation Studies, anal incontinence, fecal incontinence and constipation. The search was performed between December 26, 2017 and the beginning of January 2018. The limits used were female gender.

Selection of Studies

Initially, 5,143 articles were obtained in the search. The articles of validation for Portuguese of questionnaires for the evaluation of the impact of FI/AI on the QoL of women were considered eligible.

Data Collection

The article search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines.

Data Synthesis

Of the 5,143 articles, only 2 fulfilled the inclusion and exclusion criteria: Fecal Incontinence Quality of Life (FIQL) and the Wexner scale (WS). The FIQL evaluates the QoL related to FI, not covering flatus incontinence. The WS assesses flatus incontinence and the severity of the AI. The WS obtained an interclass correlation coefficient (ICC) of 0.932 and a Cronbach α coefficient > 0.90. The FIQL obtained intraexaminer and interexaminer reproducibility ranging from 0.929 to 0.957 and from 0.944 to 0.969, respectively.

Conclusions

The WS and the FIQL have satisfactory reliability and validity for use during gynecological consultations.

Keywords:
fecal incontinence; quality of life; validation studies; surveys and questionnaires; review

	Definition	Descriptors	Limits
Patient	Brazilian women with anal incontinence or constipation	Anal incontinenceORFecal IncontinenceORConstipation	Women
AND
Intervention	Anal incontinence or constipation questionnaire	Questionnaire OR Questionnaires
OR
Comparison	No other questionnaire or other evaluation questionnaire
Outcome	Validation, reliability	Validation OR Validation Studies OR Quality of life

Authors	Questionnaire	Number of questions	Items/ Domains	Questions	Score variation	Time	Application
Fonseca et al (2016) ⁸8 Fonseca AM, Meinberg MF, Lucas DV, et al. Cultural adaptation and validation of the Wexner scale inpatients with anal incontinence in a Brazilian population. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27(06):959-963. Doi: 10.1007/s00192-015-2927-y https://doi.org/10.1007/s00192-015-2927-...	Wexner Scale	5 questions	SolidLiquidGasUse of protectorsAlteration of the lifestyle	12345	0–40–40–40–40–4	Not found	Interview
Yusuf et al (2004) ⁹9 Yusuf SA, Jorge JM, Habr-Gama A, Kiss DR, Gama Rodrigues J. Avaliação da qualidade de vida na incontinência anal: validação do questionário FIQL (Fecal Incontinence Quality of Life). Arq Gastroenterol 2004;41(03):202-208. Doi: 10.1590/S0004-28032 004000300013 https://doi.org/10.1590/S0004-28032...	Fecal incontinence quality of life (FIQL)	4 questions (Total of 29 items):Q1: 1 itemQ2: 13 itemsQ3: 14 itemsQ4: 1 item	Lifestyle	10 questions: Q2 (items a, b, c, d, e, g, h)Q3 (items b, l, m)	1–41–41–41–41–51–41–61–41–4	Average time: 13 minutes	Interview
			Behavior	9 questions: Q2 (items f, I, j, k, m)Q3 (items c, h, j, n)
			Depression	7 questions: Q1Q3 (items d, f, g, i, k);Q4
			Embarrassment	3 questions: Q2 (Item l)Q3 (items a, e)

Authors	Target population	Sample	Age (mean)
Fonseca et al ⁸8 Fonseca AM, Meinberg MF, Lucas DV, et al. Cultural adaptation and validation of the Wexner scale inpatients with anal incontinence in a Brazilian population. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27(06):959-963. Doi: 10.1007/s00192-015-2927-y https://doi.org/10.1007/s00192-015-2927-...	Patients from the urogynecology outpatient clinic	20 patients with AI for the cultural translation and adaptation50 patients with AI for the validation	57.5 years old
Yusuf et al ⁹9 Yusuf SA, Jorge JM, Habr-Gama A, Kiss DR, Gama Rodrigues J. Avaliação da qualidade de vida na incontinência anal: validação do questionário FIQL (Fecal Incontinence Quality of Life). Arq Gastroenterol 2004;41(03):202-208. Doi: 10.1590/S0004-28032 004000300013 https://doi.org/10.1590/S0004-28032...	Patients with AI from the physiology of the colon, rectum, and anus outpatient clinic	40 patients with AI for the cultural adaptation; 50 patients with AI for the reproducibility and construct validity; 30 patients with constipation and 30 healthy patients for the discriminative validityTotal: 150 patients	52.8 years old
Authors	Reliability	Validity	Limitation
Fonseca et al ⁸8 Fonseca AM, Meinberg MF, Lucas DV, et al. Cultural adaptation and validation of the Wexner scale inpatients with anal incontinence in a Brazilian population. Int Urogynecol J Pelvic Floor Dysfunct 2016; 27(06):959-963. Doi: 10.1007/s00192-015-2927-y https://doi.org/10.1007/s00192-015-2927-...	Cronbachs α = 0.932	Convergent validity and discriminant validity	The authors did not verify whether the order of application of the face-to-face interview/telephone interview affected the results.Lack of evidence of sensitivity to change.7.2% of the patients were illiterate (could be considered a bias in favor of successful results.)
Yusuf et al ⁹9 Yusuf SA, Jorge JM, Habr-Gama A, Kiss DR, Gama Rodrigues J. Avaliação da qualidade de vida na incontinência anal: validação do questionário FIQL (Fecal Incontinence Quality of Life). Arq Gastroenterol 2004;41(03):202-208. Doi: 10.1590/S0004-28032 004000300013 https://doi.org/10.1590/S0004-28032...	Intraexaminer and interexaminer reproducibility ranged from 0.929 to 0.957 and from 0.944 to 0.969, respectively (ICC)	Construct validity and discriminatory validity	In 22% of the cases, there were no results of the AII corresponding to the quality of life index (10% with a slight impact on the quality of life despite high AI/12% with moderate or mild AI), with great repercussions on QoL).26% of the population was composed by men.

Variable (WS)	Cronbach α coefficient
Solid	0.799
Liquid	0.768
Gas	0.765
Use of protectors	0.896
Alteration of the lifestyle	0.865
Total score	0.932
Variables (FIQL)	Intraexaminer ICC	Interexaminer ICC
Lifestyle	0.934	0.944
Behavior	0.938	0.973
Depression	0.957	0.957
Embarrassment	0.929	0.969

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[1] Address for correspondence
José Ananias Vasconcelos Neto, Departamento de Uroginecologia, Hospital Geral de Fortaleza, Rua Ávila Goulart, 900, Papicu, Fortaleza, CE, Brazil (e-mail: dr.ananiasvasconcelos@gmail.com).