Development and Psychometric Testing of the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS)

Mariette Bengtsson; Bodil Ohlsson; Kerstin Ulander


BMC Gastroenterol 

In This Article

Abstract and Introduction

Background: The aim of this study was to develop and psychometrically test a short, patient-reported questionnaire to be used in clinical practice for patients with Irritable Bowel Syndrome (IBS). The Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS) questionnaire was designed to measure the treatment response of symptoms and well-being in patients suffering from IBS.
Methods: The VAS-IBS was psychometrically tested for content and criterion validity, scale acceptability, item-reduction, internal reliability consistency, simplicity, and speed. Two samples were used. One expert panel (five physicians and four registered nurses), who gave their opinion on the content validity, and one of 71 patients with IBS (mean age 38 years SD +13, range 19–65), who completed the VAS-IBS, as well as the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being Index for criterion validity.
Results: The items in the VAS-IBS capture the main physical concerns women with IBS might present and the psychometric testing confirmed that the VAS-IBS is an acceptable homogeneous patient-reported questionnaire indicated by Cronbach's alpha internal consistency reliability coefficient, with a value of 0.85. All correlations to test the criterion validity performed by using Pearson's correlation test, were statistically significant (p < 0.0001) and in the expected directions. The VAS-IBS is easy to complete and unproblematic to calculate.
Conclusion: The VAS-IBS appears to be reliable and user-friendly, for patients as well as for health professionals. The final version of the VAS-IBS including nine items needs to be further tested in clinical practice cross-culturally in women as well as in men.

Irritable Bowel Syndrome (IBS) is a common, global, functional, gastrointestinal disorder, affecting a significant number of people, predominantly women.[1,2] Etiology and pathophysiology is insufficiently understood, but it is generally accepted that the symptoms of IBS are multidetermined, and can be explained as a biopsychosocial model.[3] Early life factors can later in life influence the patient's psychosocial experience and physiological function, and generate gastrointestinal symptoms in a vulnerable patient. The inter-relationship between the patient's psychosocial status and physiology will affect how the patient experiences the symptoms, the patient's reaction, as well as the clinical outcome.[3] IBS has traditionally been considered as a diagnosis of exclusion rather than a primary diagnosis, since there are no observable biochemical and/or structural abnormalities to be found.[4,5] The diagnosis IBS is based on the Rome criteria and a third version has been presented during spring 2006[3,6] ( Table 1 ). Abdominal pain and bloating are the dominant symptoms of IBS,[7,8,9] and also the most troublesome.[8,10]

It is difficult in clinical practice to estimate the symptomatic changes occurring in patients having IBS based on to their description, as well as comparing the effect of different treatments. There is a need to translate the patients' perception of their symptoms and their subjective well-being into numbers. A patient-reported, short (less than 10 items) and reliable measuring questionnaire could be of help. It is important that the questionnaire is straightforward to calculate and easy to understand for patients as well as for health professionals, to maintain a high adherence from both groups. This questionnaire should serve as a complement to the anamnesis and measure the response to treatment of symptoms related to IBS as well as the general well-being of the patient. A search in Medline and Cinahl in 2001 did not show the existence of a questionnaire that fulfilled these criteria. The identified questionnaires showed reasonable psychometric and methodological qualities,[11,12,13] but not one of the questionnaires identified is optimal in all aspects.[13] The identified questionnaires have too many (more than 10) or inadequate questions (often only focus on pain) to assess outcomes of interventions in daily clinical practise, and are therefore not suitable to be used.

The aim of this study was therefore to develop and psychometrically test a short, patient-reported questionnaire to be used in clinical practice by different health care professionals to assess the status over time for patients with established IBS.


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