Cultural adaptation and validation of the Wexner scale in patients with anal incontinence in a Brazilian population.

Abstract

Jorge and Wexner devised a questionnaire for anal incontinence (AI), known as the Wexner scale (WS). Specific validated questionnaires are essential for the assessment of symptom severity. The objective was to accomplish the cultural adaptation and validation of the Portuguese version of the WS. The WS was validated according to the international criteria. A Brazilian version was tested, including the item "I do not understand" at the end of each question. If this answer was reported at a rate higher than 15%, the item would be considered difficult to understand and would thus be modified. The final version of the WS and the Fecal Incontinence Quality of Life (FIQL) were completed by 50 women. Convergent validity was assessed by comparing the data from the first interview of the WS with the FIQL using Spearman's test. Reproducibility was assessed by means of a 2-week test-retest procedure using Cronbach's alpha coefficient. In the initial version of the questionnaire, we did not obtain a response of "I do not understand" at a rate greater than 15% and this version was considered definitive. A significant negative relationship (r = -0.63) was found between the FIQL total score and the WS. The answers obtained on the "test-re-est" questionnaires showed a significant correlation according to the intraclass correlation coefficient (ICC). A high level of internal consistency was found, as demonstrated by a Cronbach's alpha of 0.932. The Brazilian Portuguese version of the WS is a reliable, consistent, and valid instrument.