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Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina
Maryellen S Kelly1, Margaret Hannan2, Brenda Cassidy2
1University of California Irvine, Urology Center, CHOC Children's Hospital, Orange, California.
Insights
A new questionnaire reliably monitors neurogenic bowel symptoms in children, accurately distinguishing between affected and healthy individuals. Further validation in larger studies is recommended.
Area of Science:
- Pediatric Gastroenterology
- Clinical Assessment Tools
- Neurogenic Bowel Dysfunction
Background:
- Neurogenic bowel symptoms significantly impact children's quality of life.
- Accurate monitoring tools are essential for effective management.
- Existing assessment methods may lack reliability and validity.
Purpose of the Study:
- To develop and validate a questionnaire for monitoring neurogenic bowel symptoms in pediatric patients.
- To establish the reliability and validity of the developed questionnaire.
- To differentiate between children with and without neurogenic bowel.
Main Methods:
- A questionnaire was developed by an expert panel and refined through interviews.
- Intra-rater reliability was assessed using Cohen's Kappa (k) and paired t-tests.
- Inter-rater reliability, construct validity, and discriminate validity were evaluated using k, Spearman correlations, and ROC curves.
Main Results:
- High intra-rater reliability (85% with k >0.6) and inter-rater reliability (97% with k >0.6) were achieved.
- Strong positive correlation (rs = 0.943) between patient/caregiver and nurse scores.
- The questionnaire demonstrated high accuracy in differentiating neurogenic bowel patients (AUC=0.9, sensitivity=94%, specificity=87% at score 8.5).
Conclusions:
- The developed questionnaire is reliable and valid for assessing pediatric neurogenic bowel symptoms.
- The tool effectively distinguishes between neurogenic and normal bowel function in children.
- Further validation in larger cohorts is recommended to confirm findings.
Objective:
To develop a reliable and valid questionnaire to monitor neurogenic bowel symptoms in children.
Patients:
Thirty-four children aged 6-18 with neurogenic bowel and their caregivers. Eighteen control patients.
Methods:
An expert panel generated a domain of observables and formative/reflective content. Response options were scaled following Likert-type items. Key informant interviews revised the measures. A final questionnaire was given to patients twice to calculate intra-rater reliability using Cohen's Kappa Coefficient (k) and paired t-test. Blinded interviews were conducted after physical examination and health assessment and questionnaires completed by a nurse to determine construct validity and inter-rater reliability using k and Spearman's rank-order correlation. Control patients completed the questionnaire once, their results were used to determine discriminate validity and a receiver operating characteristic (ROC) curve.
Results:
Intra-rater reliability showed 85% of the questionnaires having k >0.6. Paired t-test results of t(33) = 1.997, P = 0.054, d = 0.53, confirmed there was not a significant difference between the scores of the two completed questionnaires. Inter-rater reliability showed 97% of the questionnaires having k >0.6 between the nurse and the patient/caregiver responses. Scores had a strong positive correlation at rs (32) = 0.943, P < 0.0005. Mean score with neurogenic bowel was 15.18(STD ± 5.77) and control group 4.68(STD ± 2.98). ROC analysis showed an area under the curve of 0.9. A score of 8.5 correlated with presence of neurogenic bowel with sensitivity of 94% and specificity of 87%.
Conclusion:
The questionnaire shows positive reliability and validity when used for pediatric neurogenic bowel patients. The questionnaire differentiates between normal and neurogenic patients. Larger studies are necessary to conduct further validation.
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