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. 2024 Apr;26(4):716-725.
doi: 10.1111/codi.16917. Epub 2024 Feb 16.

The development of a cryptoglandular anal fistula quality of life scale (AF-QoL)

Nusrat Iqbal  1   2 , Laith Alrubaiy  2   3 , Ailsa Hart  2 , Rachel Siviter  4 , Lynsay Wilson  4 , Phil Tozer  2
Affiliations

The development of a cryptoglandular anal fistula quality of life scale (AF-QoL)

Nusrat Iqbal et al. Colorectal Dis. 2024 Apr.

Abstract

Aim: Quality of life (QoL) is a crucial and core outcome in assessing the effectiveness of treatments for cryptoglandular anal fistula. Despite its extensive impact, there is a lack of patient-centred, disease-specific QoL measurement instruments of adequate quality. The aim of this study is to develop a disease-specific measurement instrument that can accurately measure QoL for patients with cryptoglandular anal fistula.

Method: Semi-structured qualitative patient interviews and a systematic review of current instruments were used to generate items for the draft instrument. This underwent successive rounds of cognitive interviews to refine its wording and structure. Individual item and overall scale content validity were determined by asking experts to rate the relevance of each item and those deemed irrelevant were removed. The final instrument then underwent psychometric testing and test-retest analysis to determine its sensitivity and stability.

Results: A total of 148 patients were involved in item generation, scale development and psychometric testing. A 22-item measurement instrument has been developed; it is scored on a scale of 0-100, where 0 indicates the worst QoL and 100 demonstrates perfect QoL. The scale demonstrates excellent internal consistency (Cronbach-α = 0.927), strong content and construct validity [correlation with Perianal Disease Activity Index = -0.713, Hospital Anxiety and Depression Anxiety (-0.659) and Depression (-0.673) subscales and Short Form-12 physical (0.609) and mental (0.589) component scales] and strong reliability and responsiveness.

Conclusion: We have developed a cryptoglandular Anal Fistula Quality of Life scale (AF-QoL), a comprehensive, disease-specific patient reported outcome measure assessing QoL in patients with cryptoglandular anal fistula.

Keywords: PROM; QoL; anal fistula; patient reported outcome measures; proctology; quality of life.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Histogram of anal fistula quality of life scale (AF‐QoL) score distribution.
See this image and copyright information in PMC

References

    1. Iqbal N, Machielsen AJHM, Breukink SO, Woodcock R, Kane G, Alrubaiy L, et al. Living with cryptoglandular anal fistula: a qualitative investigation of the patient's experience through semi‐structured patient interviews. Qual Life Res. 2022;31:2505–2518. - PMC - PubMed
    1. Iqbal N, Machielsen AJHM, Kimman ML, Kane G, Woodcock R, Grossi U, et al. AFCOS: the development of a cryptoglandular anal fistula core outcome set. Ann Surg. 2022;277:e1045–e1050. - PMC - PubMed
    1. Machielsen AJHM, Iqbal N, Kimman ML, Sahnan K, Adegbola SO, Kane G, et al. Heterogeneity in outcome selection, definition and measurement in studies assessing the treatment of cryptoglandular anal fistula: findings from a systematic review. Tech Coloproctol. 2021;25:761–830. doi: 10.1007/s10151-021-02452-5 - DOI - PMC - PubMed
    1. Owen HA, Buchanan GN, Schizas A, Cohen R, Williams AB. Quality of life with anal fistula. Ann R Coll Surg. 2016;98(5):334–338. - PMC - PubMed
    1. Visscher AP, Schuur D, Roos R, Van der Mijnsbrugge GJH, Meijerink WJHJ, Felt‐Bersma RJF. Long‐term follow‐up after surgery for simple and complex cryptoglandular fistulas: fecal incontinence and impact on quality of life. Dis Colon Rectum. 2015;58(5):533–539. - PubMed

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