Original ArticleReliability and Validity of a Modified Bristol Stool Form Scale for Children
Section snippets
Methods
As described previously, the original BSFS was adapted by decreasing the number of stool categories from 7 to 5.18 This reduces the discriminations children are required to make, with the goal of maintaining scale usefulness while increasing accuracy of classification by young children who may have more difficulty attending to and discriminating between the original 7 categories. Reducing response categories for self-report scale use by children is common practice.19, 20, 21
The 5 categories
Inter-Observer Reliability with Unread Stool Form Descriptors
When stool form descriptors were not read to the children (n = 119; 48.7% female), the single measures intra-class correlation coefficient for the total sample was 0.62 (95% CI, 0.44 to 0.85; P < .001). Inter-observer reliability did not reach acceptable standards (ie, >0.70) until the children were 8 to 10 years of age, with the youngest children evidencing extremely low reliability (Table II). As previously mentioned, this led us to evaluate reliability and validity of the mBSFS-C in a second
Discussion
Despite the usefulness of assessing stool form in clinical practice and research, few have attempted to validate stool form scales, and such a scale has not been validated for use in children. We present the mBSFS-C as a stool form rating scale with pictorial representations and short descriptors that requires fewer discriminations than the standard BSFS, while still capturing clinically relevant differentiations. We anticipate that the mBSFS-C can be effectively used in clinical and research
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Supported by an investigator-initiated grant from Takeda Pharmaceuticals. Funding was independent of: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. Salary support to one or more of the authors during the conduct of this study has been provided by the National Institutes of Health (R01 NR05337, UH2 DK083990, and RC2 NR011959), the Daffy’s Foundation, and the USDA/ARS (under Cooperative Agreement 6250-51000-043 and P30 DK56338), which funds the Texas Medical Center Digestive Disease Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The contents do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors declare no conflicts of interest.