Adaptation to Spanish Language and
Validation of the Fecal Incontinence
Quality of Life Scale
Miguel Minguez, M.D.,1 Vicente Garrigues, M.D.,2 Maria Jose Soria, M.D.,3
Montserrat Andreu, M.D.,4 Fermin Mearin, M.D.,5 Pere Clave, M.D.6
1
2
3
4
5
6
Department
Department
Department
Department
Department
Department
of
of
of
of
of
of
Gastroenterology,
Gastroenterology,
Gastroenterology,
Gastroenterology,
Gastroenterology,
Gastroenterology,
Hospital Clinico Universitario, Valencia, Spain
Hospital La Fe, Valencia, Spain
Hospital Universitario Puerta del Mar, Cadiz, Spain
Hospital del Mar, Barcelona, Spain
Centro Medico Teknon, Barcelona, Spain
Institut Guttmann, Barcelona, Spain
retest) was good for all domains except for embarrassment,
which showed significant differences (P < 0.02). Internal
reliability was good/excellent for all domains (Cronbach
alpha >0.80, between 0.84 and 0.96). The four domains of
Cuestionario de Calidad de Vida de Incontinencia Anal
significantly correlated with the domains of the generic
questionnaire on health (P < 0.01) and with the scale of
severity of fecal incontinence (P < 0.001). All domains of
Cuestionario de Calidad de Vida de Incontinencia Anal
correlated negatively with the need to wear pads (P < 0.01)
and with the presence of complete fecal incontinence.
CONCLUSIONS: The Cuestionario de Calidad de Vida de
Incontinencia Anal incorporates sufficient requirements of
reliability and validity to be applied to patients with fecal
incontinence. [Key words: Fecal incontinence; Quality-oflife scale; Cultural adaptation]
PURPOSE: The aim of this study was to perform a psychometric evaluation of the Fecal Incontinence Quality of Life
Scale in the Spanish language. METHODS: Eleven hospitals
in Spain participated in the study, which included 118 patients with active fecal incontinence. All the patients filled
out a questionnaire on the severity of their incontinence, a
general questionnaire of health (Medical Outcomes Survey
Short Form), and a Spanish translation of the Fecal Incontinence Quality of Life Scale (Cuestionario de Calidad de
Vida de Incontinencia Anal), which consists of 29 items in
four domains: lifestyle, behavior, depression, and embarrassment. On a second visit, patients repeated the Fecal
Incontinence Quality of Life Scale. For each domain, an
evaluation was made of temporal reliability, internal reliability, the convergent validity with the generic questionnaire of health, and the discriminant validity correlating the
domains of Cuestionario de Calidad de Vida de Incontinencia Anal with the severity of fecal incontinence. RESULTS:
For cultural adaptation, the answer alternatives for 14 items
were modified. A total of 111 patients (94 percent) completed the study adequately. Temporal reliability (test–
F
ecal incontinence (FI) produces, according to
doctors and patients, important alterations in the
general dynamics of life from the moment it occurs.
Its effect on the quality of life must be evaluated
following standard forms of measurement. Generic
scales that are useful for assessing the perception of
the general state of health, such as the SF-36 which
fundamentally evaluates the functional state and
emotional well-being, may be used, or specific questionnaires that attempt to evaluate the impact that a
determined illness has on the quality of life, in this
case the presence of fecal incontinence (FI), can also
be administered.
Supported in part by a grant from the Instituto de Salud Carlos
III (Grant 03/02).
Presented at the meeting of the Asociación Española de Gastroenterologı́a, Madrid, Spain, March 1 to 2, 2002.
Correspondence to: Miguel Minguez, M.D., Department of
Gastroentology, Hospital Clı́nico, Valencia, Av Blasco Ibañez 17,
Valencia 46010, Spain, e-mail: [email protected]
Dis Colon Rectum 2006; 49: 490–499
DOI: 10.1007/s10350-006-0514-5
* The American Society of Colon and Rectal Surgeons
Published online: 08 March 2006
490
Vol. 49, No. 4
SPANISH FECAL INCONTINENCE QUESTIONNAIRE
In 2000, Rockwood et al.1 first published a survey
on the quality of life specifically for patients with FI,
which was validated in English: the Fecal Incontinence Quality of Life Scale (FIQL). This questionnaire, developed after meticulous screening, consists
of 29 items that evaluate four scales (lifestyle,
behavior, depression, and embarrassment) and was
psychometrically assessed, complying with the criteria of reliability and validation sufficiently to evaluate
the quality of life specifically in patients with FI. The
reception of the mailed questionnaire was very low;
only 9 of 55 patients completed the test–retest.
Therefore, it was necessary to repeat the study by
means of telephone interviews with 61 patients, of
which only 47 (77 percent) finished.
The convergent validation was performed using
the generic questionnaire SF-36. This questionnaire
has been widely used to evaluate the changes in
quality of life in patients subjected to different types
of treatment: lateral internal sphincterotmy,2 treatment with heat controlled by radiofrequency,3,4
injection of substances to increase the volume
(microspheres) in the internal anal sphincter,5 artificial anal sphincter,6,7 overlapping anal sphincter
repair,8 and neurostimulation.9 However, the correlation between the severity of the incontinence and
the information obtained by the FIQL has not been
evaluated. Furthermore, validations in other languages have not been performed either.
The aim of this study was to translate and adapt
the FIQL to Spanish culture and to validate it
following usual psychometric tools. Also, the discriminant validity of the questionnaire according to
the severity of FI was evaluated.
PATIENTS AND METHODS
The study population was made up of 118 patients
over 18 years old. All suffered FI of diverse etiology
and were recruited between June and November
2001 in eleven hospitals in Spain. All patients presented active symptoms at the moment of inclusion
and had the intellectual capacity to understand and fill
in the questionnaire. Participation was voluntary.
Permission was obtained for the use of the original
questionnaire (Fecal Incontinence Quality of Life
Scale (FIQL)) from the authors of the English
validation.1 This questionnaire comprises of 29 items
that cover four dimensions of perceived health:
lifestyle (10 items), behavior (9 items), depression/
self-perception (7 items), and embarrassment (3
491
items). Each item has a range of 1 to 4, with 1 being
the lowest value for the state of quality of life. The
score for each scale is the average of all the items.
Cultural Adaptation
The translation to Spanish was performed by four
gastroenterologists accustomed to evaluating functional digestive pathology and a psychologist who
specializes in surveys on the quality of life, all with
sufficient knowledge of the English language. Once
translated and some expressions modified to adapt
them to the Spanish language and culture, the
questionnaire was back-translated from Spanish into
English by two native bilingual doctors, one from the
United States and the other from the United Kingdom. After consensus of the researchers, the translated version was administered to 14 subjects (12
women and 2 men, age = 56 T 12 years), 10 of them
patients with FI, to determine the difficulty and
degree of comprehension of the questionnaire (pilot
test of the adaptation). The final version, which was
called Cuestionario de Calidad de Vida de Incontinencia Anal (CCVIA), was approved by consensus
in a meeting of the Grupo Español de Motilidad
Digestiva (GEMD) (Appendix 1).
Study Design
All surveys were performed in each of the
participating hospitals (Appendix 2). The patients
themselves filled in the FI-specific quality-of-life
questionnaire (CCVIA), together with the Spanish
version of the generic questionnaire SF-36.10 Also, a
questionnaire to measure the severity of the incontinence (Wexner scale)11 was completed. Between
seven and ten days afterward, the patients again
completed the FI-specific questionnaire (CCVIA).
Patients were helped by medical personnel if they
had any questions when filling in the questionnaires.
Psychometric Properties
Internal Reliability. The internal consistency
of each scale was analyzed by means of the
Cronbach alpha coefficient, the result being considered acceptable (>0.7–0.8), good (>0.8–0.9), and
excellent (>0.9).12
Test–Retest Reliability. The temporal stability of the
questionnaire, repeated in an interval of seven to ten
days during which no change was expected to occur,
was evaluated by calculating the interclass cor-
MINGUEZ ET AL
492
relation coefficient (ICC) for each scale with the
corresponding 95 percent confidence interval (95
CI). Traditionally, it is accepted that the ICC is
adequate when the value is higher than 0.80.
Validity. The convergent validity of the questionnaire was analyzed by evaluating the correlation
between the four scales of the CCVIA and the
appropriate dimensions of the SF-36 (Pearson
correlation coefficient).
To analyze the divergent validity, the four scales of
the CCVIA were correlated to the Wexner scale of
incontinence severity (measuring it globally and
establishing a subgroup in which the score that
depended on lifestyle was excluded), severity of
incontinence depending on the use of pads, and
severity of incontinence depending on the existence
of total (gases, liquids, and solids) or partial incontinence (only gases and liquids).
Statistical Analysis
The descriptive analysis of each of the quantitative
variables of the questionnaire (specific and generic)
and of the Wexner scale was performed by means of
analysis of average values and standard deviation.
The analysis of internal validity was performed by
Cronbach alpha coefficients, whereas the test-retest
analysis was performed using the ICC. The analysis
of the validity of CCVIA with respect to SF-36 was
made using Pearson correlation coefficients. A P
value of less than 0.05 was considered significant.
RESULTS
Translation and Back-Translation
In the back-translation there were only minor inconsistencies in two items. Because of the cultural
adaptation, the answers in section Q3 of the original
questionnaire were modified after the pilot test and
discussion between the researchers about the best
possibilities. The original answers ‘‘strongly agree,’’
‘‘somewhat agree,’’ ‘‘somewhat disagree,’’ and ‘‘strongly
disagree’’ were replaced by ‘‘most of the time,’’ ‘‘some of
the time,’’ ‘‘a little of the time,’’ and ‘‘none of the time.’’
These answers were perfectly understood by the pilot
population; in contrast, those literally translated from
the original English were not completely understood
by the patients and help from hospital staff was
frequently needed to answer the questionnaire. In the
answers about having episodes of incontinence, ‘‘agree
or disagree’’ was changed to ‘‘frequency.’’
Dis Colon Rectum, April 2006
Patients
Of the 118 patients recruited in the study period,
111 (94 percent) completed all the questionnaires (92
women and 19 men; average age = 60 T 12 years).
With respect to education, 36 percent had less than
high school, 32 percent had finished high school, 19
percent had some college, and 10 percent had a B.S.,
B.A., or graduate degree. The average severity of
incontinence, according to the Wexner scale, was 12
T 4.8; 78 percent of the patients on some occasion
had used protective pads to avoid soiling undergarments; and 82 percent had complete incontinence
(gases, liquids, and solids).
Psychometric Analysis
Reliability. Table 1 gives the evaluation of temporal stability, which was optimal (ICC > 0.80) for the
scales related to lifestyle, behavior, and depression/
self-perception. However, the values were more
inferior than desired for the scale of embarrassment
(ICC = 0.74). The questions that constitute the four
scales of the CCVIA showed an acceptable internal
reliability (consistency), with alpha values over 0.70
in all cases (Table 1).
Convergent Validity. The correlation that exists
between the four scales of the CCVIA questionnaire
and the corresponding scales of the SF-36 was examined, making a total of ten comparisons (Table 2).
All were statistically significant, confirming that the
questionnaire analyzed possesses an adequate validity when compared with an instrument of proven
sensitivity such as the quality-of-life questionnaire
SF-36.
Divergent Validity. The correlation between the
severity of the incontinence and CCVIA was very
good, when taking into account the global results of
the score of the questionnaire of Wexner or the
partial results, excluding the score that corresponds
to the change in lifestyle (Table 3). The existence of
an inverse correlation is observed (the higher the
score in the Wexner scale, the lower it is in each
domain of CCVIA), i.e., the more severe the incontinence, the higher the repercussion on the perception of health for each of the domains.
With a cutoff point of 9 on the Wexner scale, significant differences between patients were observed
(Table 4).
The use of protective pads was related to a worse
perception of health in each domain of CCVIA
Vol. 49, No. 4
SPANISH FECAL INCONTINENCE QUESTIONNAIRE
493
Table 1.
Values Obtained by Means of Two Administrations for Each Scale of the Questionnaire on the Quality of Life for Fecal
Incontinence
Scale
Test
Lifestyle
Behavior
Depression self-perception
Embarrassment
2.86
2.31
3.12
2.37
Retest
(0.99)
(0.84)
(0.78)
(0.93)
2.87
2.36
3.20
2.53
ICC
(1.04)
(0.91)
(0.77)
(0.95)
0.92
0.90
0.85
0.74
Alpha
(0.89–0.94)
(0.86–0.93)
(0.80–0.90)
(0.64–0.81)
0.96
0.95
0.92
0.85
The values of test and retest are expressed as means (standard deviation) and the interclass correlation coefficient
(ICC) as coefficients and 95% confidence intervals.
Table 2.
Correlation of Scales of the Questionaire on the Quality of Life for Fecal Incontinence with the Scales Considered in the
Generic Questionnaire SF-36
Physical
Role
Lifestyle
Behavior
Depression self-perception
Embarrassment
General
Health
Vitality
0.43*
0.64*
0.23**
Social
Functioning
Emotional
Role
0.54*
0.38*
Mental
Health
0.47*
0.62*
0.25**
0.63*
0.37*
*P < 0.001; **P < 0.05.
Table 3.
Pearson’s Correlation Coefficient Between Scores of
Wexner Scale and Domains of CCVIA
without Score of
Change in Lifestyle
Lifestyle
Behavior
Depression
Embarrassment
0.49*
0.50*
0.47*
0.45*
Global
0.62*
0.82*
0.89*
0.58*
CCVIA = Cuestionario de Calidad de Vida de Incontinencia Anal.
*P < 0.01.
Table 4.
Comparison Between Different Groups of Patients with
Fecal Incontinence (FI) According to the Score of Severity
of Wexner Above or Below 9 and the Perception of the
Quality of Life by the Domains of CCVIA
Lifestyle
Behavior
Depression
Embarrassment
Wexner
<9 (29%)
Wexner
Q9 (70%)
3.5
2.9
3.5
2.8
2.6
2.0
2.6
2.1
±
±
±
±
0.7*
0.8*
0.8*
0.8*
±
±
±
±
0.9
0.7
0.9
0.9
CCCIA = Cuestionario de Calidad de Vida de Incontinencia Anal.
*P < 0.001.
(Table 5). Moreover, there were significant differences in ‘‘behavior,’’ ‘‘lifestyle,’’ and ‘‘embarrassment’’
between patients who suffer total FI and those who
present incontinence of liquid stool or gas (Table 6).
DISCUSSION
This study presents the results of the transcultural
adaptation and the validation of the Fecal Incontinence Quality of Life questionnaire (FIQL) for its use
in the Spanish population. CCVIA is the first specific
questionnaire that evaluates the quality of life of
patients with FI to be validated in the Spanish language. There is a need for measurements of quality
of life in Spanish given the large Spanish-speaking
population that exists in the world (i.e., 400 million
people; 40 million in the United States).
Historically, all study groups have recognized that
FI has a great impact on the quality of life of patients
and it has been empirically observed that the more
serious the incontinence, the higher the repercussion
on different social and personal events. However, it
has been only recently that objective forms of measurement, by means of generic or specific questionnaires, have begun to evaluate the effect that FI
(different types and degrees of severity) has on the
quality of life and the changes that patients undergo
after treatment. The form of measurement has been
different depending on the questionnaire used. The
simplest form asks about the influence that FI had on
the quality of life of a patient (none, some, much)
and/or frequency (from never to always). This type
of question is not capable of discriminating between
concrete aspects of life changed by the illness, so
clinical or specific studies on the repercussion of FI
MINGUEZ ET AL
494
Table 5.
Comparison Between Different Groups of Patients with
Fecal Incontinence (FI) with Respect to the Use of
Pads and the Perception of Quality of Life by Domains
of CCVIA
Use of Pads
(78%)
Lifestyle
Behavior
Depression
Embarrassment
2.7
2.2
2.7
2.1
±
±
±
±
0.9
0.8
0.9
0.8
No Pads
(22%)
3.5
2.8
3.5
3.0
±
±
±
±
0.8
0.8
0.8
0.8
CCVIA = Cuestionario de Calidad de Vida de Incontinencia Anal. P < 0.001 for all values.
Table 6.
Comparison Between Different Groups of Patients with
Fecal Incontinence (FI) with Respect to the Presence of
Incontinence of Gas and/or Liquid or Total Incontinence
(Gas, Liquid, and Solid) and the Perception of Quality of
Life by Domains of CCVIA
Incontinence of
Gas and/or
Liquid (18%)
Lifestyle
Behavoir
Depression
Embarrassment
3.3
2.7
3.2
2.8
±
±
±
±
0.8
0.9*
0.8
0.8*
Total
Incontinence
(82%)
2.8
2.2
2.8
2.2
±
±
±
±
0.9
0.8
0.9
0.9
CCVIA = Cuestionario de Calidad de Vida de Incontinencia Anal.
*P < 0.05.
have used questionnaires, validated or not, that
measure the state of health and the quality of life in
different domains (activity, social and physical function). The ideal questionnaire should comply with
several requisites: simplicity; capacity to evaluate different aspects of the direct impact of FI on the patient; differentiation between suffering FI or not;
discrimination according to the severity or type; and
sensitivity to any change after treatment. In 1993,
Jorge and Wexner10 proposed a system of scoring
(0–20) to evaluate the severity of FI. It included a
question about how the frequency of episodes of FI
changed lifestyle. This questionnaire, generally
known as the Wexner scale, has been widely used
because of its simplicity13 and has been used to evaluate the cutoff score that indicates changes in the
quality of life. A score equal to or greater than 9 is
associated with a low score of the gastrointestinal
quality-of-life index (<105),14 i.e., confined at home
and little social activity. In 2000, Rockwood et al.1
validated the first specific questionnaire on the
quality of life of patients with FI, the Fecal Incontinence Quality of Life Scale (FIQL), which consists of
Dis Colon Rectum, April 2006
29 questions that evaluate four domains of health
(lifestyle, behavior, depression/self-perception, and
embarrassment). Because this questionnaire is recommended by the American Society of Colon and
Rectal Surgeons, it was chosen by the GEMD to be
validated in Spanish.
The transcultural adaptation of FIQL was performed by means of translation/back-translation,
which is the most widely used method to ensure
the semantic and conceptual equivalence of a questionnaire written in another language.15 Our objective was to maintain a close correspondence between
the original version in United States English and the
version in the Spanish spoken in Spain. To this end,
several processes were performed: semantic translation of the original English to Spanish, revision of the
translation by consensus, and back-translation by
two bilingual natives. The last step was the administration of the questionnaire to a group of subjects to
evaluate the level of comprehension of the questions. In the final version, the original answers
‘‘strongly agree,’’ ‘‘somewhat agree,’’ ‘‘somewhat disagree,’’ and ‘‘strongly disagree’’ were replaced by
‘‘most of the time,’’ ‘‘some of the time,’’ ‘‘a little of the
time,’’ and ‘‘none of the time,’’ because these answers
were completely understood by the pilot population.
The original English questions were not completely
understood by the patients and help from hospital
staff was needed to answer them. In the answers
about having episodes of incontinence, the answer
‘‘agree or disagree’’ was changed.
In this study, the patients completed the questionnaire by themselves during a hospital visit, with
personnel on hand to help with any possible questions. We believe that this method is preferable to that
used by the authors of the original questionnaire
(mail or telephone interview) because it permits a
greater degree of intimacy, there is more collaboration to resolve questions, there is no time limit to
answer the questions, and consequently there is a
higher degree of participation. In this respect, 111
out of 118 patients (94 percent) completed the study
adequately, which is a much better response compared with that obtained by mail (16 percent) or by
telephone (77 percent), the two methods used in the
validation of the original version. The interval between the two administrations of the questionnaire—
seven to ten days—was similar although slightly
shorter than in the original publication by Rockwood
et al.1 (10–14 days). This shorter interval could
overstimate the test–retest reliability, but it minimizes
Vol. 49, No. 4
SPANISH FECAL INCONTINENCE QUESTIONNAIRE
the risk of a change in the clinical status of the patient (i.e., the severity of incontinence), which could
also modify the quality of life.
Our study has allowed the validation of the questionnaire using 111 patients, which is better than the
original number (47 patients), and using the face-toface self-administration method, which we consider
to be more adequate than a telephone interview.
The results of internal reliability of our study
demonstrate that the questionnaire possesses good
psychometric properties in the four domains, with
Cronbach alpha values similar or greater than those
obtained by Rockwood et al.1: lifestyle (0.96 vs. 0.96),
behavior (0.94 vs. 0.96), depression (0.92 vs. 0.88),
and embarrassment (0.84 vs.0.80). However, in temporal stability, significant differences exist with the
domain embarrassment. We believe that a change in
the severity of incontinence should not be the cause
of the change, because the other domains were
stable. We do not know if cultural differences could
account for instability of the domain. A possible
reason could be that this domain is constituted by
only three questions and changes in time in any of
them have greater impact on the whole domain.
Further studies should investigate this issue.
The convergent validation of this questionnaire,
when compared with the corresponding domains of
SF-36, demonstrates a significant correlation in all of
them, with similar results to those obtained in the
English version. We have demonstrated that this
questionnaire significantly correlates, for all its
domains, with the scale of severity of FI most used
in the literature (Wexner scale) in such a way that a
high score on this scale correlates to a worse quality
of life in any of the domains. Furthermore, we have
demonstrated that a score of 9 or more on the
Wexner scale significantly implies a worse quality of
life with respect to a score lower than 9. These data,
previously reported by Eypasch et al.14 using a
generic questionnaire on quality of life for gastrointestinal symptoms, are important given the specific
characteristics of CCVIA. The analysis of the discriminant capacity depending on the use of protective pads manifests that their use is associated with a
worse quality of life. However, only the domains of
behavior and embarrassment showed significant
differences between patients suffering incontinence
of gas or liquid stool and those with total FI (gases,
liquids, and solids).
In conclusion, we consider that the questionnaire
on the quality of life of those suffering from fecal
495
incontinence in its Spanish version (CCVIA) presents
sufficient psychometric requirements to be used as a
measure of health in patients with FI.
APPENDIX 1: FECAL INCONTINENCE
QUALITY OF LIFE SCALE
Cuestionario de Calidad de Vida de
Incontinencia Anal
Instructions
The next questions refer to what you think about
your health and the limitations in your daily habitual
activities in the last month due to accidental bowel
leakage. Answer every question as it is indicated.
Please do not hesitate to ask if you are not sure of
what to answer.
Instrucciones
Las preguntas que siguen se refieren a lo que usted
piensa sobre su salud, y las limitaciones que le produce su forma de contener las heces o gases en sus
actividades habituales en el último mes. Conteste
cada pregunta tal como se le indica. Si no está
seguro/a de cómo responder a una pregunta, por
favor no dude en preguntar.
Clarification
ANAL INCONTINENCE is the loss of capacity to
control voluntarily the expulsion of flatus or stools by
your anus.
Aclaraciones:
INCONTINENCIA ANAL es la perdida de la capacidad de controlar voluntariamente la expulsión de
gases o heces por el ano. Es decir que a una persona
cuando se le escapan (sin poder evitarlo) los gases o
las heces por el ano se considera que tiene una incontinencia anal.
Please Do Not Leave a Question without an Answer.
Mark Only One Answer
Make a cross in the answer that it is next to your
situation
No Deje Ninguna Pregunta Sin Responder Marque
Una Sola Respuesta
Tache con una cruz la respuesta que considere
adecuada a su situación
MINGUEZ ET AL
496
Q2–Q3: A continuación encontrará un listado de
situaciones y de comportamientos que se pueden
relacionar con un episodio de incontinencia anal.
Por favor indique con qué frecuencia le ocurren en
relación a la posibilidad de que usted tenga un
episodio de incontinencia anal. En el supuesto de
que esta situación se produzca por motivos diferentes a la incontinencia, marque como respuesta
válida no procede.
Q1: In general, would you say your health is:
En general, usted dirı́a que su salud es:
1
2
3
4
5
Ì
Ì
Ì
Ì
Ì
Excellent (Excelente)
Very good (Muy Buena)
Good (Bien)
Fair (Regular)
Poor (Mal)
Q2–Q3: In the following text you will find a list of
situations and behaviors that can be related to an
anal incontinence episode. Please indicate how
much of the time the issue is a concern for you due
to accidental bowel leakage. If it is a concern for you
for reasons other than accidental bowel leakage then
mark a cross in no proceed.
a) I am afraid to leave home
Tengo miedo (temor) a salir fuera de casa
b) I avoid visiting friends
Evito hacer visitas a mis amigos
c) I avoid staying overnight away from home
Evito pasar la noche fuera de casa
d) It’s difficult for me to leave home and do
things like going to a movie or to church
Me resulta difı́cil salir de casa para ir a algunos
sitios, como el cine o la iglesia
e) I eat less (reduce the quantity of my meals)
before leaving home
Si tengo que salir de casa reduzco
la cantidad de comida
f) Whenever I am away from home, I try to
stay near a restroom as much as possible
Cuando estoy fuera de casa intento estar siempre
lo mas cerca posible de un retrete público
g) It is fundamental for me to organize my
daily activities according to when and how
often I need to go to the toilet
Para mi es fundamental organizar las
actividades diarias en función de cuándo
y cuantas veces necesite ir al retrete
h) I avoid travelling
Evito viajar
i) It worries me not be able to reach a toilet in time
Me preocupa no ser capaz de llegar al
retrete a tiempo
j) I feel I have no control over my bowels
Me parece que no soy capaz de controlar
mi defecación
k) I can’t hold my bowel movement long
enough to get to the bathroom
Soy incapaz de aguantar las heces hasta
llegar al retrete
l) I leak stool without even knowing it
Se me escapan las heces sin darme cuenta
Dis Colon Rectum, April 2006
DUE TO ACCIDENTAL EPISODES OF ANAL
INCONTINENCE
DEBIDO A LOS EPISODIOS DE INCONTINENCIA
ANAL
Q2:
No
proceed
Most
of the
time
Some
of the time
A little
of
the time
None of
the
time
Muchas
veces
Bastantes
veces
Alguna
vez
Nunca
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
No
procede
Vol. 49, No. 4
SPANISH FECAL INCONTINENCE QUESTIONNAIRE
m) I try to prevent bowel accidents
by staying very near a bathroom
Intento prevenir los episodios de
incontinencia situándome cerca de un
cuarto de baño.
1
2
497
3
4
5
Q3:
Most of
the
time
Some of
the time
A little of
the
time
None of
the
time
No
proceed
Nunca
No
procede
Muchas
veces
Bastantes
veces
Alguna
vez
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
a) I feel ashamed
Me siento avergonzada/o
b) I can not do many of things I want to do
No hago muchas de las cosas que me
gustaria hacer
c) I worry about bowel accidents
Estoy preocupado porque se me escapan las heces
d) I feel depressed
Me siento deprimido
e) I worry about others smelling stool on me
Me preocupa que otras personas puedan
oler mis heces
f) I feel like I am not a healthy person
Siento que no soy una persona sana
g) I enjoy life less
Disfruto menos de la vida
h) I have sex less often than I would like to
Tengo menos relaciones sexuales de las
que desearı́a
i) I feel different from other people
Me siento diferente del resto de la gente
j) The possibility of bowel accidents is
always on my mind
En mi cabeza esta siempre presente la
posibilidad de tener un episodio de incontinencia
k) I am afraid to have sex
Tengo miedo al acto sexual
l) I avoid traveling on public transport
(trains, planes, buses, subway, etc.)
Evito hacer viajes en transportes públicos
(tren, avión, autobús, metro etc.)
m) I avoid eating out
Evito comer fuera de casa
n) When I go to a new place, I always
try to know where the toilet is
Cuando voy a un lugar nuevo intento
siempre saber dónde está el retrete
Q4: During the last month, have you felt sad,
discouraged, hopeless, or had many problems that
you wondered if anything was worthwhile?
Durante el mes pasado, se ha sentido usted tan
triste, desanimado, desesperanzado que le parecı́a
que la vida no tenia sentido?
1 Ì Extremely So—To the point that I have just
about given up (siempre—hasta el punto de
abandonarlo todo)
2 Ì Very Much So (muchas veces)
3 Ì Quite a Bit (pocas veces)
4 Ì Some—Enough to bother me (alguna vez,
pero suficiente para sentirme molesto)
5 Ì A Little Bit (muy poco)
6 Ì Not At All (nunca)
The Fecal Incontinence Quality of Life Scale is
composed of 29 items; these items form four scales:
1. Lifestyle (10 items)
2. Coping/Behavior (9 items)
MINGUEZ ET AL
498
3. Depression/Self-Perception (7 items)
4. Embarrassment (3 items)
El cuestionario de calidad de vida de incontinencia
anal tiene 29 preguntas que evaluan cuatro dominios:
1.
2.
3.
4.
Estilo de vida (10 preguntas)
Conducta (9 preguntas)
Depresión/Percepción de uno mismo (7 preguntas)
Verguenza (3 preguntas)
Scales range from 1 to 5, with a 1 indicating a lower
functional status of quality of life. Scale scores are the
mean to all items in the scale. No proceed is coded as
missing value in the analysis for all questions.
Se establece un rango del 1 al 5 para cada item. El 1
indica un estado funcional bajo de calidad de vida. La
puntuación para cada apartado se calcula como la
media de los items que conforman cada apartado
(suma de todos los puntos de cada item dividido por
el número de items). La respuesta No procede se
considera como valor perdido.
1) Lifestile, ten items: Q2a, Q2b, Q2c, Q2d, Q2e,
Q2g, Q2h, Q3b, Q3l, Q3m
2) Coping/Behavior, nine items: Q2f, Q2i, Q2j,
Q2k, Q2m, Q3d, Q3h, Q3j, Q3n
3) Depression/Self-Perception, seven items: Q1 (is
reverse code), Q3d, Q3f, Q3g, Q3i, Q3k, Q4
4) Embarrassment, 3 items: Q2l, Q3a, Q3e
1) Estilo de vida: Lo configuran los items: Q2a, Q2b,
Q2c, Q2d, Q2e, Q2g, Q2h, Q3b, Q3l, Q3m
APPENDIX 2: COLLABORATING
INVESTIGATORS AND CENTERS
Institution
Hospital Universitario N.S.
de la Candelaria, Santa Cruz
de Tenerife, Tenerife, Spain
Hospital Clinic, IDIBAPS,
Barcelona, Spain
Hospital Universitario Vall
d’Hebrón, Barcelona, Spain
Hospital General de Albacete,
Albacete, Spain
Hospital Clı́nico San Carlos,
Madrid, Spain
Hospital Clinico Universitario,
Valencia, Spain
Centro Medico Teknon,
Barcelona, Spain
Investigator
Juan Salvador
Baudet, M.D.
Gloria Lacima, M.D.
Jose Luis
Fernández-Fraga, M.D.
Pedro Cascales, M.D.
Antonio Ruiz
de Leon, M.D.
Adolfo Benages, MD.
Cristina Puigdellivol, MD.
Dis Colon Rectum, April 2006
2) Conducta: Los items: Q2: Q2f, Q2i, Q2j, Q2k,
Q2m, Q3d, Q3h, Q3j, Q3n
3) Depresión, autopercepción: Q1 (se codifica al
revés), Q3d, Q3f, Q3g, Q3i, Q3k, Q4
4) Verguenza: Q2l, Q3a, Q3e
REFERENCES
1. Rockwood TH, Church JM, Fleshman JW, et al. Fecal
Incontinence Quality of Life Scale, Quality of life
instrument for patients with fecal incontinence. Dis
Colon Rectum 2000;43:9 – 17.
2. Hyman N. Incontinence after lateral internal sphincterotomy: a prospective study and quality of life assessment. Dis Colon Rectum 2004;1:35 – 8.
3. Efron JE, Corman ML, Fleshman J, et al. Safety and
effectiveness of temperature-controlled radio-frequency energy delivery to the anal canal (Secca procedure)
for the treatment of fecal incontinence. Dis Colon
Rectum 2003;12:1606 – 16.
4. Takahashi T, Garcia-Osogobio S, Valdovinos MA,
Belmonte C, Barreto C, Velasco L. Extended two-year
results of radio-frequency energy delivery for the
treatment of fecal incontinence (the Secca procedure).
Dis Colon Rectum 2003;6:711 – 5.
5. Davis K, Kumar D, Poloniecki J. Preliminary
evaluation of an injectable anal sphincter bulking agent
(Durasphere) in the management of faecal incontinence. Aliment Pharmacol Ther 2003;18:237 – 43.
6. Devesa JM, Rey A, Hervas PL, et al. Artificial anal
sphincter: complications and functional results of a large
personal series. Dis Colon Rectum 2002;9:1154– 63.
7. Wong WD, Congliosi SM, Spencer MP, et al. The safety
and efficacy of the artificial bowel sphincter for fecal
incontinence: results from a multicenter cohort study.
Dis Colon Rectum 2002;9:1139 – 53.
8. Halverson AL, Hull TL. Long term outcome of overlapping anal sphincter repair. Dis Colon Rectum
2000;6:813 – 20.
9. Matzel KE, Stadelmaier U, Bittorf B, Hohenfellner M,
Hohenberger W. Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum
resection. Int J Colorectal Dis 2002;17:430 – 44.
10. Badia X, Salamero M, Alonso J. La Medición de la
Salud. Guia de escalas de medición en español.
Cuestionario de Salud SF-36. Barcelona: Edimac edit,
1999.
11. Jorge JM, Wexner SD. Etiology and management of
fecal incontinence. Dis Colon Rectum 1993;36:77 – 97.
12. Fayes PM, Machin D. Quality of Life: assessment,
analysis and interpretation. Chichester: John Wiley &
Sons, 2000.
Vol. 49, No. 4
SPANISH FECAL INCONTINENCE QUESTIONNAIRE
13. Rockwood TH. Incontinence severity and QOL scales for
fecal incontinence. Gastroenterology 2004;126(Suppl 1):
S106–13.
14. Eypasch E, Williams JI, Wood-Dauphinee S, et al.
Gastrointestinal Quality of Life Index: development,
499
validation and application of a new instrument. Br J
Surg 1995;82:216 – 22.
15. Sperber AD. Translation and validation of study instruments for cross-cultural research. Gastroenterology
2004;126(Suppl 1):S124 – 8.