Reproducibility, feasibility and validity of the Groningen Defecation and Fecal Continence questionnaires

<b>Objectives:</b> Current questionnaires on defecation disorders are often brief and fail to include questions considering causative factors. Furthermore, adult and pediatric questionnaires differ, which makes it impossible to monitor defecation disorders during the transition from childhood to adulthood. With these points in mind, we developed the Groningen Defecation and Fecal Continence (DeFeC) questionnaire and its pediatric equivalent, the P-DeFeC. The aim of this paper is to introduce the questionnaires and to assess their feasibility, reproducibility and validity. <b>Materials and methods:</b> Various Rome IV criteria and scoring tools for constipation and fecal incontinence were incorporated, resulting in nine categories. Feasibility and reproducibility were assessed by performing a test–retest survey in 100 adult participants. Concurrent validity was assessed in 27 patients and 18 healthy volunteers by comparing questionnaire-based diagnoses of constipation and fecal incontinence to final diagnoses based on anorectal function tests. <b>Results:</b> There were no remarks on the understandability of any questions. The Cohen’s kappa coefficient of all main questions ranged from 0.26 to 1.00, with an average of 0.57. All but one category showed moderate agreement or higher. The sensitivity of the questionnaire-based diagnosis of constipation was 75%; specificity was 100%. The sensitivity of the questionnaire-based diagnosis of fecal incontinence was 77%; specificity was 94%. <b>Conclusions:</b> Overall reproducibility of the Groningen DeFeC questionnaire is acceptable and its validity is good. This makes it a feasible screening tool for defecation disorders and, equally important, with these questionnaires defecation disorders can now be monitored during the transition from childhood to adulthood.

**研究目的**：当前针对排便障碍的调查问卷往往较为简略，且未纳入针对致病因素的相关问题。此外，成人与儿科调查问卷存在差异，导致无法对儿童向成年过渡阶段的排便障碍情况进行持续监测。基于上述问题，本研究开发了格罗宁根排便与控便问卷（Groningen Defecation and Fecal Continence, DeFeC）及其儿科版本P-DeFeC。本研究旨在介绍上述两款问卷，并评估其可行性、重测信度与效度。
**材料与方法**：本问卷整合了多项罗马IV标准（Rome IV criteria）及便秘、大便失禁相关评分工具，最终涵盖9个类别。通过对100名成年受试者开展重测调查，评估问卷的可行性与重测信度；通过将基于问卷的便秘、大便失禁诊断结果与肛门直肠功能检查得出的最终诊断进行对比，在27例患者与18名健康志愿者中评估其同时效度。
**研究结果**：所有问卷题目均未出现理解性反馈意见。所有核心题目的科恩kappa系数（Cohen’s kappa coefficient）区间为0.26至1.00，平均分为0.57。除1个类别外，其余所有类别的一致性均达到中等及以上水平。基于问卷的便秘诊断灵敏度为75%，特异度为100%；基于问卷的大便失禁诊断灵敏度为77%，特异度为94%。
**研究结论**：格罗宁根DeFeC问卷整体重测信度良好，效度优异。这使其可作为排便障碍的可行筛查工具；同等重要的是，借助这两款问卷，如今可对儿童向成年过渡阶段的排便障碍情况开展持续监测。