PTU-100 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)

Abstract

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 IBDrelated 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 ICIQIBD 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. Conclusions: The new ICIQ-IBD is valid and reliable. Further psychometric testing to evaluate sensitivity to change will be conducted in a forthcoming intervention study. (Table Presented).