Psychometric properties of a questionnaire (HEMO‐FISS‐QoL) to evaluate the burden associated with haemorrhoidal disease and anal fissures

• Published in: Colorectal disease Vol. 21; no. 1; pp. 48 - 58
• Main Authors: Abramowitz, L., Bouchard, D., Siproudhis, L., Trompette, M., Pillant, H., Bord, C., Senejoux, C. A., Favreau‐Weltzer, C., Berdeaux, G., Zkik, A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2019; Wiley; John Wiley and Sons Inc
• Subjects: Adult; anal fissures; Clinical trials; Component reliability; Construction standards; Correlation coefficient; Correlation coefficients; Cost of Illness; Female; Fissure in Ano - complications; Fissure in Ano - physiopathology; Fissure in Ano - psychology; Gastrointestinal Hemorrhage - physiopathology; Gastrointestinal Hemorrhage - psychology; Haemorrhoids; Hemorrhoids; Hemorrhoids - complications; Hemorrhoids - physiopathology; Hemorrhoids - psychology; Human health and pathology; Humans; Hépatology and Gastroenterology; Itching; Life Sciences; Male; Middle Aged; Original; Original Aticle; Pain; Pain - physiopathology; Pain - psychology; Patients; patient‐related outcomes; Principal Component Analysis; Principal components analysis; Pruritus; Pruritus - physiopathology; Pruritus - psychology; Psychometrics; quality of life; Quantitative psychology; Questionnaires; Sexuality; Surveys and Questionnaires; Validation studies; Validity; Haemorrhoids; patient-related outcomes; anal fissures; quality of life
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.14393

Aim
Current questionnaires designed to evaluate the burden of haemorrhoidal disease ignore symptoms such as bleeding, pain and itching. A specific questionnaire is needed to evaluate the global impact of anal disorders on patients’ daily lives.
Method
We developed a questionnaire (HEMO‐FISS‐QoL) to assess the symptom burden of anal disorders and administered it to 256 patients (mean age 46.2 years; men 60.4%) with haemorrhoidal disease (67.2%), anal fissure (29.3%) or both (3.5%). Psychometric properties were evaluated by testing the acceptability, construct validity and reliability of the questionnaire. Principal components and multi‐trait analyses were used to identify dimensions and to assess construct validity. Backward Cronbach alpha curves and a graded response model were used to reduce the number of items and modalities. External validity was evaluated against SF‐12 and the Psychological Global Well‐Being Index (PGWBI) using Spearman's correlation coefficient.
Results
Principal component analysis defined four dimensions: physical disorders, psychology, defaecation and sexuality. The number of questions was reduced from 38 to 23. The HEMO‐FISS‐QoL scores correlated well with those of the SF‐12 and PGWBI (P < 0.001). Cronbach's coefficients (all > 0.7) reflected good internal reliability of the different dimensions. The total score increased with the severity of the anal disorders and with their consequences (days off work and personal spending related to the disease).
Conclusion
The HEMO‐FISS‐QoL questionnaire reliably evaluates the global impact of haemorrhoids and anal fissures on patients’ daily lives. This simple tool may prove useful for treatment evaluation in clinical trials and daily practice.