Johannessen Hege Hølmo, Norderval Stig, Stordahl Arvid, Falk Ragnhild Sørum, Wibe Arne
Department of Physiotherapy, Østfold Hospital Trust, Sarpsborg, Norway.
Department of Research, Østfold Hospital Trust, P.O. Box 300, 1714, Grålum, Norway.
Int Urogynecol J. 2018 May;29(5):667-671. doi: 10.1007/s00192-017-3363-y. Epub 2017 May 25.
St Mark's incontinence score (SMIS) was originally designed and validated for use in an interview setting (iSMIS), and there is conflicting evidence for the validity of the self-administered SMIS (sSMIS). Our objective was to compare self-administered and interview-based reports of anal incontinence (AI) symptoms.
A total of 147 women reported symptoms of AI on a sSMIS before inclusion in a clinical study investigating the effect of conservative treatment for AI 1 year after delivery. After clinical investigations, an iSMIS was completed by one of two consultant surgeons blinded to the sSMIS results. The correlation and agreement among the individual items of the iSMIS and the sSMIS were assessed using Spearman's rho and weighted kappa statistics, respectively.
The mean iSMIS and sSMIS reported was 4.0 (SD: 3.6) and 4.3 (SD: 4.0), respectively. Spearman's rho showed a strong relationship between the two total SMIS scores (r = 0.769, n = 147, p < 0.001), and explained variance was 59% (r=0.591). Except for the individual item about gas incontinence, women reported more frequent AI symptoms on the sSMIS than on the iSMIS. The assessment of consistency among the individual items of the iSMIS and sSMIS showed substantial agreement (κ ≥ 0.60) for all items except for fair agreement for the item about formed stool incontinence (κ = 0.22), and moderate for the item about any change in lifestyle (κ = 0.5).
The level of consistency between the two methods of reporting anal incontinence symptoms suggests that the St Mark's score may be used as both an interview-based and a self-administered incontinence score.
圣马克失禁评分（SMIS）最初是为访谈环境设计并验证的（iSMIS），而关于自我管理的SMIS（sSMIS）有效性的证据存在冲突。我们的目的是比较肛门失禁（AI）症状的自我管理报告和基于访谈的报告。
共有147名女性在纳入一项临床研究之前，通过sSMIS报告了AI症状，该临床研究旨在调查产后1年AI保守治疗的效果。临床检查后，由两名对sSMIS结果不知情的顾问外科医生之一完成iSMIS。分别使用Spearman等级相关系数和加权kappa统计量评估iSMIS和sSMIS各项目之间的相关性和一致性。
报告的iSMIS和sSMIS的平均值分别为4.0（标准差：3.6）和4.3（标准差：4.0）。Spearman等级相关系数显示，两个SMIS总分之间存在很强的相关性（r = 0.769，n = 147，p < 0.001），解释方差为59%（r = 0.591）。除了关于气体失禁的单项外，女性在sSMIS上报告的AI症状比在iSMIS上更频繁。对iSMIS和sSMIS各项目一致性的评估显示，除了关于成形大便失禁的项目一致性一般（κ = 0.22），以及关于生活方式任何变化的项目一致性中等（κ = 0.5）外，所有项目的一致性都很高（κ≥0.60）。
两种报告肛门失禁症状方法之间的一致性水平表明，圣马克评分既可以用作基于访谈的失禁评分，也可以用作自我管理的失禁评分。
