The revised faecal incontinence scale: a critical appraisal.

To the Editor—We read with interest the article authored by sansoni and coworkers. although the goals of their study were indeed laudable, their methodology and data interpretation unfortunately did not allow any clinically relevant and/or scientifically valid conclusions. numerous problems with this study include their very small sample size of a mere 61 people, only 38 of whom were available at follow-up and only 17 of whom underwent surgery. these shortcomings are, of course, exacerbated by additional ones, such as 1) no test was reported by which the homogeneity of the population among sites could be evaluated. moreover, the numbers of patients per site were also not enumerated. therefore, it is impossible to judge whether there was any selection bias by site. it is actually very unusual that a population-based questionnaire would include only 61 people when 6 separate community hospitals were used. Basically, a mean of only 10 patients per site were recruited, only 19 of whom completed a retest survey 2 to 3 weeks later. moreover, the average period of treatment was only 5.9 months. 2) the baseline evaluation of only 61 patients including follow-up in just over half of those patients meant that the weighted average of the missing 23 patients (38% of the total patients) might well be important. 3) anoVa for the demographic factors is missing. 4) the Cronbach α for probability cannot be used in cases of missing values. 5) the relatively high sD in the Revised faecal incontinence scale as shown in table 4 of their article may suggest a variety of intervals between outcome measurements. We would like to contrast this small, short-term incomplete follow-up study of heterogeneous patient inclusion and suboptimal statistical design with another, far larger demographic sample that, once again, validated the most commonly used fecal incontinence score. undoubtedly, similar conclusions could be reached for the Vaizey (st mark's) incontinence score. in stark contrast to the current small study of sansoni et al, a community-based survey of 5817 women was recently undertaken. Despite the criticisms of the incontinence score leveled in the study of 38 patients by sansoni and coworkers, our populationbased study of 5817 women included 1096 women with fecal incontinence. our recent study showed a statistically significant correlation among women seeking care for fecal incontinence based on a threshold of a incontinence score of 10. the women with incontinence with a mean score 10.7 sought care, whereas women with a mean score of 7.5 did not. this number is important given that Rothbarth and coworkers in the past had validated the incontinence score criticized by sansoni and associates and proved a statistically significant inverse correlation between quality of life and incontinence score; the score of 10 was the breakpoint. the multivariant model predicting care seeking in the study by Brown et al supported this fact. We certainly applaud sansoni et al for trying to improve upon the universally accepted and frequently validated incontinence scoring system. We urge them to continue their efforts in this regard, but would encourage them to significantly enlarge the size of their denominator, include longer and more complete follow-up, and more appropriately describe all of their statistical methods in their next attempt.