Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome

Abstract

Background In functional gastrointestinal disorders, patient recall of symptoms drives diagnostic decisions and evaluation of treatment response, as well as research conclusions about potential treatments. In pediatrics, parent report also impacts assessment and care. Hence, identifying methods for accurately capturing patient and parent report of Irritable Bowel Syndrome (IBS) symptoms is important. This study evaluated correspondence between retrospective questionnaire (parent and child report) and prospective diary data for children and adolescents with IBS. Methods Participants included 50 children/adolescents with IBS per Rome III criteria. Children completed a two-week pain and stool diary. Children and parents subsequently completed a two-week recall questionnaire, reporting number of pain days, maximum pain, days without bowel movement, and days with diarrhea during the diary interval. Intraclass correlation coefficients and Bland-Altman plots assessed agreement. Key Results For pain and days without bowel movement, overall agreement between child recall questionnaire and child diary was strong, though under conditions likely to facilitate agreement and with individual variation observed. Parent recall and child diary were less concordant, and agreement about diarrhea was poor for parent and child. Age did not significantly correlate with agreement. Conclusions & Inferences Child questionnaire with short recall interval may be a reasonable approximation for diary data, though this varies by individual and replication/investigation of lengthier recall are needed. Relying on parent questionnaire does not appear a suitable proxy, and recall of stool form by both parent and child appears more problematic. These results combined with existing literature support use of diary data whenever possible.

Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations

“…We used a retrospective cross-sectional recall by the children to cover the last 2 weeks. While a retrospective recall might be biased, a recent study in children and adolescents aged 8–18 years suffering irritable bowel syndrome did not find significant differences between retroversus prospective diary approaches for pain assessment [44]. Nonetheless, our retrospective approach of pain assessment has to be seen as limitation.…”

Using a worst pain intensity measure in children and adolescents

“…By comparing pain ratings during the day with end of the day worst pain intensity ratings or worst pain intensity ratings of the following morning, retrospective worst pain ratings were lower than the maximum observed pain intensity rating during the day (Liu & Aitkenhead 1991, Stone et al 2010. Looking for a long-time interval, retrospective worst pain intensities were found to be higher compared with maximum pain intensity ratings of the previous 2 days (Jensen et al 2012) and similar compared with maximum pain intensity ratings of the previous one or 2 weeks (Bolton et al 2010, Self et al 2015.…”

Is caregiver refusal of analgesics a barrier to pediatric emergency pain management? A cross-sectional study in two Canadian centres

“…63 There is also good agreement between the pain questionnaires with a short recall interval (14 days) and prospective pain diaries. 64 Global measures of confidence managing pain and satisfaction with ED care were likely dependent on factors not directly measured, such as previous experience with health care and wait time. Although others have used similar scales to measure caregiver perceptions in the context of pain, 54 the results of these outcomes should be interpreted cautiously.…”