Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation

Eleonora Gaetani, Antonio Gasbarrini, Rino Cannizzaro, Carlo Maria Cicala, Rosa Cuomo, Fulvio De Giorgi, Mariachiara Fortuna, Mario Groppo, Luca Neri, Paul Maurice Conway, Guido Basilisco, Donato Francesco Altomare, Vito Annese, Danilo Badiali, Gabrio Bassotti, Edda Battaglia, Gabriele Bazzocchi, Massimo Bellini, Emanuele Bendia, Luigi BeniniGiuseppe Biscaglia, Ivano Biviano, Renato Bocchini, Leonilde Bonfrate, Sebastiano Bonventre, Fabrizio Bossa, Giovanni Brandimarte, Renato Cannizzaro, Michele Cicala, Virgilio Clara, Rosanna Cogliandro, Giulia Comandini, Sergio Crotta, Rosario Cuomo, Lucia D'Alba, Francesco De Giorgi, Michela Di Fonzo, Francesco Di Mario, Michele Di Stefano, Vittorio D'Onofrio, Kostantinos Efthymakis, Pierluigi Fiore, Manuela Fortuna, Walter Fries, Francesca Galeazzi, Andrea Geccherle, Francesco Giangregorio, Lisa Girardi, Mario Grassini, Marzia Groppo, Giovanni Guarnieri, Paola Iovino, Massimiliano Lo Cascio, Roberto Lolli, Francesco Luzza, Giampiero Macarri, Maria Marino, Stefania Miraglia, Santo Monastra, Maria Cristina Neri, Matteo Neri, Roberto Antonio Noris, Silvia Orselli, Sandro Passaretti, Alberto Paviotti, Paolo Pazzi, Alberto Pilotto, Piero Portincasa, Nunzio Ranaldo, Paolo Ravelli, Francesca Rogai, Renato Sablich, Vincenzo Savarino, Giancarlo Spinzi, Vincenzo Stanghellini, Leonardo Tammaro, Francesco Torresan, Paolo Usai Satta, Claudio Valle

Risultato della ricerca: Contributo in rivistaArticolo in rivista

20 Citazioni (Scopus)

Abstract

Background and aim: PAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation. Methods: We enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference. Results: Only a minority of patients reported any rectal tearing (38 %). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (r = 0.28-0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (β = -0.49; ω2 = 0.25). M:PAC-SYM minimal clinically important difference was 0.24. Conclusion: Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers.
Lingua originaleEnglish
pagine (da-a)1597-1605
Numero di pagine9
RivistaQuality of Life Research
Volume24
DOI
Stato di pubblicazionePubblicato - 2015

Keywords

  • Chronic constipation
  • Chronic non-organic constipation
  • Constipation severity
  • Quality of life

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