Crohn's disease: systematic review of assessment of disease severity and its relevance to surgery

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Volume 9 Issue 8 Page 678-685, October 2007

To cite this article: P. K. Dhruva Rao, M. Davies, P. E. Price, J. Torkington (2007) Crohn's disease: systematic review of assessment of disease severity and its relevance to surgery Colorectal Disease 9 (8), 678–685. doi:10.1111/j.1463-1318.2007.01233.x

Review article

Crohn's disease: systematic review of assessment of disease severity and its relevance to surgery

P. K. Dhruva Rao**Department of Colorectal Surgery, Cardiff and Vale NHS Trust, M. Davies**Department of Colorectal Surgery, Cardiff and Vale NHS Trust, P. E. Price††Wound Healing Research Unit, Cardiff University, Cardiff, UK and J. Torkington**Department of Colorectal Surgery, Cardiff and Vale NHS Trust

*Department of Colorectal Surgery, Cardiff and Vale NHS Trust and †Wound Healing Research Unit, Cardiff University, Cardiff, UK

Mr Torkington, Llandough Hospital, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX, UK.E-mail: jared.torkington@...

Abstract

Background The aims of treatments for Crohn's disease are symptom control by medical or surgical means and improvement in health-related quality of life (HRQOL). A wide number of classification systems, instruments of disease activity measurement (DAM) and HRQOL are available, but few are used in routine surgical practice.

Objective To review the validity of DAM and HRQOL instruments and their applicability to surgically treated patients.

Method A systematic literature search was undertaken to identify these instruments. Qualifying articles were used to determine the construct, content and criterion validity of the instruments identified with respect to surgically treated patients.

Results Thirteen disease activity indices and 11 HRQOL assessment tools were identified. Construct validity was demonstrated throughout but concerns of content and criterion validity were noted.

Conclusion None of the current disease activity or HRQOL tools can be used without potential bias in a trial of surgical vs medical therapy as the items included favour the outcomes experienced following medical therapy. A more balanced assessment tool in the setting of a multidisciplinary trial is needed.