Patient-Reported Outcome Measures (PROMs) are an interesting tool to assess constipation, obstructed defecation and fecal incontinence severity. However, too many different PROMs are currently used, investigating redundant and repetitive items. The aim of this study was to compare all items of the most frequently adopted PROMs for Defecation Disorders (DDs) in order to create a comprehensive “super-score” for DDs.

This is a prospective observational study conducted at a tertiary academic center on patients with rectal prolapse who underwent traditional and robot-assisted Ventral Mesh Rectopexy. Preoperatively, each patient was asked to complete 7 different authoritative PROMs: 4 questionnaires for constipation/obstructed defecation (Altomare and Longo ODS score, Cleveland Clinic Constipation Scoring System, PAC-SYM), 2 questionnaires for fecal incontinence (Cleveland Clinic Fecal Incontinence and St. Marks’ Incontinence Score), and 1 questionnaire for both (Symptom Severity Score). Spearman’s correlation and Principal Component Analysis (PCA) with varimax rotation were conducted to compare all items of the PROMS and reconsider unnecessary ones. The assumptions of PCA were checked by Bartlett’s Test of Sphericity and Kaiser-Meyer-Olkin Measure of Sampling Adequacy. We also performed reliability analyses using Cronbach α to measure the internal consistency.

Finally, among a total of 159 patients, 127 (80%) subjects completed all 59 items of the 7 validated PROMs. After Spearman’s correlation and PCA, it was possible to reconsider and exclude items of each PROM highly correlated with other one that express the same concept in an equal way or did not show a statistical correlation to the other components grouped by similar content. In particular, 6 components were identified by the final analysis regarding fecal incontinence aspects, evacuation effort and time, abdominal discomfort, type of assistance, bowel movements and attempt per day, and incomplete emptying. The remaining 21 items were arranged in a final, novel DDs “super-score” (Figure 1), that could be considered a proposal for a comprehensive, ideal PROM for DDs, including symptoms of constipation, obstructed defecation and fecal incontinence. Cronbach α showed satisfactory results for reliability analyses.

This study demonstrated that a reduction in the number of items of several PROMs for DDs is promising.

The following step will be the validation of the novel DDs “super-score” in future studies in order to reduce PROMs redundancy and adopt selected, targeted questions in a single, comprehensive questionnaire.