# A comprehensive scoring system for defecation disorders derived by merging various validated patient-reported outcome measures for fecal incontinence, chronic constipation, and obstructed defecation

## TL;DR

This study creates a new scoring system to assess defecation disorders by combining existing patient-reported outcome measures into a shorter, more efficient tool.

## Contribution

The novel contribution is the development of a concise Defecation Disorders Scoring System (DDSS) by merging validated PROMs.

## Key findings

- A final DDSS with 19 items was developed, covering five core components of defecation disorders.
- The DDSS showed satisfactory internal consistency and reduced redundancy from existing PROMs.
- The system could be used electronically to streamline clinical assessments.

## Abstract

Currently, too many Patient-Reported Outcome Measures (PROMs) with redundant and repetitive domains are adopted to assess defecation disorders, resulting in more extended clinical visits and increased patient burden. The aim of this study was to develop a new comprehensive Defecation Disorders Scoring System (DDSS) by incorporating all items of the most commonly used and validated PROMs.

This is a prospective observational study on patients waiting for rectal prolapse and defecation disorders surgery. Preoperatively, each patient completed seven different authoritative PROMs, two questionnaires assessing constipation, two questionnaires for obstructed defecation, two questionnaires to evaluate fecal incontinence, and one questionnaire aiming to assess both. Spearman’s correlation and Principal Component Analysis with varimax rotation were applied. Internal consistency was evaluated using Cronbach’s α.

A total of 127 female patients completed all 57 items across the seven validated PROMs and were included. Several items highly correlated with others expressing the same concept were reconsidered and excluded. A final set of 19 items was identified and arranged into DDSS, encompassing five core components regarding specific aspects of incontinence, bowel movements/defecation frequency, evacuation effort and duration, type of assistance, and abdominal discomfort. Regarding internal consistency, the derived DDSS and its five components demonstrated satisfactory results.

This study highlights the potential for reducing item redundancy across existing PROMs for defecation disorders. Despite some limitations, the proposed DDSS could potentially provide a concise, comprehensive tool for assessing multiple aspects of defecation disorders, potentially available in electronic format. Future studies will be required to further evaluate and validate DDSS across different patient populations.