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. 2022 May 7;20(1):75.
doi: 10.1186/s12955-022-01975-1.

Development and content validation of patient-reported outcomes tools for ulcerative colitis and Crohn's disease in adults with moderate-to-severe disease

Arpita Nag  1 , Beverly Romero  2
Affiliations

Development and content validation of patient-reported outcomes tools for ulcerative colitis and Crohn's disease in adults with moderate-to-severe disease

Arpita Nag et al. Health Qual Life Outcomes. .

Abstract

Background: Ulcerative colitis (UC) and Crohn's disease (CD) are associated with a range of symptoms that adversely affect health-related quality of life. This research aimed to develop and validate two patient-reported outcome (PRO) tools to assess signs and symptoms in patients with moderate-to-severe UC or CD.

Methods: PRO-UC and PRO-CD Diaries were developed in accordance with US Food and Drug Administration (FDA) recommendations. Data were collected from concept elicitation interviews (in which patients described their symptoms and experience of the disease) and further refined through cognitive interviews (in which patients assessed the relevance and clarity of questions in the tools).

Results: Interviews were conducted with 12 patients for each indication. Five symptoms (urgent bowel movements, abdominal pain, frequent bowel movements, bloody stools, diarrhea/watery stools) were reported by 83-100% of participants with UC and were included in the final 6-item PRO-UC Diary: stool frequency, rectal bleeding (2 items), diarrhea, rectal urgency, and abdominal pain. For CD, seven symptoms (abdominal pain, diarrhea/loose stools, urgent bowel movements, fatigue/tiredness/weakness, frequent bowel movements, bloody stools, nausea) were reported by 50-100% of participants. These, together with vomiting and incontinence (reported by 42% and 33% of participants, respectively), were included in the final 10-item PRO-CD Diary, covering abdominal pain (2 items), stool frequency, liquid/very soft stool frequency, rectal bleeding, rectal urgency, nausea, vomiting, bowel incontinence, and general well-being. Symptoms were consistently cited across both indications to have an impact on quality of life, with frequent complaints being the need to always be near a toilet and inability to leave home, as well as general pain, discomfort, and nausea. For both tools, questions were accurately interpreted, with at least 67% of participants in both indications stating that items were easy to answer/relevant to their condition and symptoms were easy to recall over the last 24 h.

Conclusions: Both the PRO-UC and PRO-CD Diaries were developed and validated in accordance with FDA recommendations, providing two new tools for use in clinical trials to assess response to treatment in patients with UC or CD. Psychometric analyses are warranted to fully evaluate their properties and value for use in clinical trials.

Keywords: Crohn’s disease; Health-related quality of life; Inflammatory bowel disease; Patient-reported outcomes; Ulcerative colitis.

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Conflict of interest statement

AN, currently employed at Sanofi, was an employee of Takeda Development Center Americas at the time of the study, and holds stock in Takeda. BR is a salaried employee of ICON, which received research funds from Shire, a Takeda company for conducting the study.

Figures

Fig. 1
Fig. 1
Relative importance of symptoms, as ranked by participants in the UC study (n = 11). UC, ulcerative colitis
Fig. 2
Fig. 2
Relative importance of symptoms, as ranked by participants in the CD study (n = 11). CD, Crohn’s disease
See this image and copyright information in PMC

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