Responsiveness of the Persian version of the patient assessment of constipation quality of life and Wexner constipation scoring system questionnaires in individuals with dyssynergia defecation following physiotherapy intervention
Gastroenterology and Hepatology from Bed to Bench,
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2 March 2026
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Page 1-12 (e11)
https://doi.org/10.22037/ghfbb.v19i01.3213
Abstract
Aim: To investigate the responsiveness of the Persian version of the Patient Assessment of Constipation Quality Of Life (PAC-QOL) and Wexner questionnaires in individuals with dyssynergia defecation (DD) following physiotherapy intervention.
Background: Dyssynergic defecation, a common functional disorder, impairs quality of life. While PAC-QOL and Wexner questionnaires are standard outcome measures, their responsiveness in Persian-speaking individuals with this condition remains unevaluated.
Methods: The responsiveness of the PAC-QOL and Wexner questionnaires were evaluated in 95 patients with dyssynergic defecation following physiotherapy intervention. All participants in the study were evaluated through quality of life outcome tools in the first physiotherapy session and again after 5 weeks of physiotherapy treatment (at least fifteen sessions, every other day). The Patient Assessment of Constipation Quality of Life (PAC-QOL) and Wexner constipation scoring system were selected as treatment outcomes measuring before and after sessions 15. Responsiveness was examined using anchor-based (Global Rating of Change [GRC]) and distribution-based indices, including the area under the ROC curve (AUC), minimal clinically important change (MIC), effect size (ES), standardized response mean (SRM), and Guyatt’s responsiveness index (GRI).
Results: Both questionnaires showed excellent responsiveness. The PAC-QOL achieved an AUC = 0.92 (95 % CI 0.87–0.99) and the Wexner an AUC = 0.97 (95 % CI 0.94–0.99). The corresponding MICs were 34.5 and 3.5. Internal responsiveness indices were large (PAC-QOL ES = 2.19; SRM = 1.63; GRI = 1.45 / Wexner ES = 2.03; SRM = 1.85; GRI = 1.60).
Conclusion: The Persian PAC-QOL and Wexner questionnaires are highly responsive and capable of detecting clinically meaningful changes in DD after physiotherapy. These tools can reliably monitor treatment outcomes in Persian speaking populations and inform clinical and research practice in Persian-speaking populations.
- PAC-QOL
- Wexner
- responsiveness
- physiotherapy
- Dyssynergic defecation
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