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Measurement of Constipation Using Self-Report Instruments: What the Literature Tells Us

Lindsay McCrea, MS, APRN, BC, WOCN, FNP1, Christine Miaskowski, RN, PhD, FAAN2, Stacey Hart, PhD3, Nancy Stotts, RN, EdD, FAAN2, and Madhulika Varma, MD4. (1) University of California, San Francisco, PhD Student, San Francisco, CA 94143, (2) University of California, San Francisco, Professor, (3) University of California, San Francisco, Assistant Adjunct Professor, (4) University of California, San Francisco, Assistant Professor in Residence

Constipation is a common symptom that affects between 2% to 27% of the population. The symptom experience can range from a mild acute event to a chronic condition that requires frequent intervention with mixed, if not unsatisfactory results. Little is known about how best to measure this condition. Valid methods to assess constipation are essential to guide treatment and measure outcomes.

Purpose: The purpose of this study is to identify and evaluate existing self-report instruments that assess constipation in adults.

Methods: Four databases, Medline, CINAHL, Cochrane, Web of Science, were searched to identify constipation assessment instruments combining constipation with instrument, questionnaire, inventory, scale, or assessment. Inclusion criteria were: published self-report instrument with psychometric analyses measuring only the symptom of constipation, adults in any health care and/or community settings, and English language. Exclusion criteria included children and instruments measuring symptoms not related to constipation. Identified instruments meeting inclusion criteria were analyzed systematically regarding content, contextual issues, and psychometric properties.

Statistics: Descriptive

Results: Seven instruments met the inclusion criteria. Sample sizes per instrument ranged from 32 to 349. Six of the instruments had 12 items or less (range 4-21). The instruments have not been widely tested; few have been used in more than one population. Most common symptoms measured were: stool frequency 100%, stool consistency 85%, associated symptoms 85%, and medications/foods 71%. Evaluation of instrument psychometric properties reveals incomplete statistical analyses were reported in more than half of the instruments.

Conclusion: Constipation is a significant problem for many people. This review highlights the need for further research to establish clinically relevant, psychometrically sound assessment instruments in order to evaluate the symptom of constipation and its treatment outcomes.


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