Validation of a Novel Fecal Incontinence Scale: The Rapid Assessment Fecal Incontinence Score (RAFIS)

J Clin Gastroenterol. 2020 Apr 14. doi: 10.1097/MCG.0000000000001342. Online ahead of print.

Fernando de la Portilla 1, Irene Ramallo 1, Maria V Maestre 1, José V Roig 2, Manuel Devesa 3, Francisco J Padillo 1


Author information

1Coloproctology Unit, Clinical Management Unit of General and Gastrointestinal Surgery, Division Seville, Biomedical Research Institute (BIS), University Hospital Virgen del Rocio/CSIC University of Seville, Seville.

2Coloproctology Unit, Unit of General and Gastrointestinal Surgery, Division Hospital Nisa 9 de Octubre, Valencia.

3Coloproctology Unit, Ruber International Hospital, Madrid, Spain.

PMID: 32301835

DOI: 10.1097/MCG.0000000000001342


Objective: The development and validation of a new version of the fecal incontinence (FI) scale "Rapid Assessment Fecal Incontinence Score" (RAFIS) incorporating domains for severity, type of stool loss, and global perception of the effect of incontinence on quality of life (QoL).

Background: FI negatively impacts on QoL. Currently used incontinence questionnaires have outstanding limitations on the global assessment of the impact of the disease on QoL that patients perceive. We developed a new version of RAFIS with a more complete questionnaire.

Materials and methods: A 3-phase study was performed to evaluate the applicability and reliability of our questionnaire as a tool for assessing FI. Our score was completed by 98 patients (78 women; mean age: 57±13 y) who presented with FI and who were referred from 4 colorectal surgery centers. The RAFIS was assessed for internal consistency, test-retest reliability, and sensitivity to change. A multivariate analysis was performed. Comparisons were made with the Wexner Cleveland Clinic Incontinence Score and the Fecal Incontinence Quality of Life Scale.

Results: The RAFIS showed good internal consistency and test-retest reliability, differentiating the severity of incontinence but not the etiology. There was a moderate-high correlation between the new scale and the reference scales. Sensitivity to change, compared with the Wexner Score, was moderate. Comparison with established QoL instruments showed a moderate negative correlation. Logistic regression of the RAFIS discriminated between mild and moderate-severe impact on QoL. No correlation was detected with the new score to the presence of an anal sphincter defect or sphincter hypotonia.

ConclusionThe RAFIS scale is easy to administer and compares well with other validated incontinence instruments.

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