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Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome
Open accessAbstract
Summary: Background: The Bristol Stool Form Scale (BSFS) is a 7‐point scale used extensively in clinical practice and research for stool form measurement, which has undergone limited validity and reliability testing. Aim: To determine the validity and reliability of the BSFS in measuring stool form in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome (IBS‐D). Methods: One hundred and sixty‐nine healthy volunteers provided a stool sample and used the BSFS to classify stool form, which was compared with measured stool water content and with values from 19 patients with IBS‐D. Eighty‐six volunteers used the BSFS to classify 26 stool models to determine accuracy and reliability. Results: Volunteers’ classifications of stool type correlated with stool water (Spearman's rho = 0.491, P < 0.001), which increased in hard (Types 1–2), normal (Types 3–5) and loose stools (Types 6–7) (P < 0.001). The BSFS detected differences in stool form between healthy volunteers (mean 3.7, s.d. 1.5) and IBS‐D patients (mean 5.0, s.d. 1.2) (P < 0.001). Overall, 977/1204 (81%) stool models were correctly classified (substantial accuracy, κ = 0.78), although <80% of Types 2, 3, 5 and 6 were classified correctly. On 852/1118 (76%) occasions, volunteers classified covert duplicate models to the same stool type (substantial reliability, κ = 0.72), but with only moderate reliability for Types 2 (63%, κ = 0.57) and 3 (62%, κ = 0.55). Conclusions: The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.
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Citations
Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148
A Coefficient of Agreement for Nominal Scales
Cohen, J. (1960) · Educational and Psychological Measurement · doi:10.1177/001316446002000104 · Cited by 42,398
Weighted kappa: nominal scale agreement provision for scaled disagreement or partial credit
Cohen, J. (1968) · Psychological Bulletin · doi:10.1037/h0026256 · Cited by 8,736
Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.061 · Cited by 4,856
Fleiss, J. L., & Cohen, J. (1973) · Educational and Psychological Measurement · doi:10.1177/001316447303300309 · Cited by 3,354
Stool form scale as a useful guide to intestinal transit time
Lewis, S. J., & Heaton, K. W. (1997) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529709011203 · Cited by 3,244
High agreement but low Kappa: I. the problems of two paradoxes
Feinstein, A. R., & Cicchetti, D. V. (1990) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(90)90158-l · Cited by 3,034
Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.031 · Cited by 2,866
Defecation frequency and timing, and stool form in the general population: a prospective study.
Heaton, K. W., Radvan, J., Cripps, H., Mountford, R. A., Braddon, F. E., & Hughes, A. O. (1992) · Gut · doi:10.1136/gut.33.6.818 · Cited by 733
Staudacher, H. M., Lomer, M. C. E., Anderson, J. L., Barrett, J. S., Muir, J. G., Irving, P. M., & Whelan, K. (2012) · The Journal of Nutrition · doi:10.3945/jn.112.159285 · Cited by 590
Self-citationDetection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate.
O'Donnell, L. J. D., Virjee, J., & Heaton, K. (1990) · British medical journal · doi:10.1136/bmj.300.6722.439 · Cited by 537
Duboc, H., Rainteau, D., Rajca, S., Humbert, L., Farabos, D., Maubert, M., Grondin, V., Jouet, P., Bouhassira, D., Seksik, P., et al. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01893.x · Cited by 256
Saad, R. J., Rao, S. S. C., Koch, K. L., Kuo, B., Parkman, H. P., McCallum, R. W., Sitrin, M. D., Wilding, G. E., Semler, J. R., & Chey, W. D. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.612 · Cited by 242
Statistics Notes: Validating scales and indexes
Bland, J. M. (2002) · BMJ · doi:10.1136/bmj.324.7337.606 · Cited by 239
Bowel function measurements of individuals with different eating patterns.
Davies, G. J., Crowder, M., Reid, B., & Dickerson, J. W. (1986) · Gut · doi:10.1136/gut.27.2.164 · Cited by 229
How well does stool form reflect colonic transit?
Degen, L., & Phillips, S. (1996) · Gut · doi:10.1136/gut.39.1.109 · Cited by 201
Colonic Transit Time and IBS Symptoms: What's the Link?
Törnblom, H., Van Oudenhove, L., Sadik, R., Abrahamsson, H., Tack, J., & Simrén, M. (2012) · American Journal of Gastroenterology · doi:10.1038/ajg.2012.5 · Cited by 185
An Office Guide to Whole-Gut Transit Time
Heaton, K. W., & Donnell, L. J. D. O. (1994) · Journal of Clinical Gastroenterology · doi:10.1097/00004836-199407000-00008 · Cited by 168
Reliability and Validity of a Modified Bristol Stool Form Scale for Children
Lane, M. M., Czyzewski, D. I., Chumpitazi, B. P., & Shulman, R. J. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.03.002 · Cited by 163
Determinants of decreased fecal consistency in patients with diarrhea
Wenzl, H., Fine, K. D., Schiller, L. R., & Fordtran, J. S. (1995) · Gastroenterology · doi:10.1016/0016-5085(95)90134-5 · Cited by 133
Constipation: a different entity for patients and doctors
Herz, M. J., Kahan, E., Zalevski, S., Aframian, R., Kuznitz, D., & Reichman, S. (1996) · Family Practice · doi:10.1093/fampra/13.2.156 · Cited by 112
Gleason, P., Harris, J. E., Sheean, P., Boushey, C. J., & Bruemmer, B. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2009.11.022 · Cited by 109
Learning how to Differ: Agreement and Reliability Statistics in Psychiatry
Streiner, D. L. (1995) · The Canadian Journal of Psychiatry · doi:10.1177/070674379504000202 · Cited by 94
Creation and Initial Evaluation of a Stool Form Scale for Children
Chumpitazi, B. P., Lane, M. M., Czyzewski, D. I., Weidler, E. M., Swank, P. R., & Shulman, R. J. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2010.04.040 · Cited by 79
Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart
Whelan, K., Judd, P. A., & Taylor, M. A. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601927 · Cited by 64
Self-citationIntestinal transit time in the population calculated from self made observations of defecation.
Probert, C. J., Emmett, P. M., & Heaton, K. W. (1993) · Journal of Epidemiology & Community Health · doi:10.1136/jech.47.4.331 · Cited by 63
Sartori, R., & Pasini, M. (2006) · Quality & Quantity · doi:10.1007/s11135-006-9006-x · Cited by 62
Parés, D., Comas, M., Dorcaratto, D., Araujo, M. I., Vial, M., Bohle, B., Pera, M., & Grande, L. (2009) · Revista Española de Enfermedades Digestivas · doi:10.4321/s1130-01082009000500002 · Cited by 54
Rater Training in Multicenter Clinical Trials
Kobak, K. A., Engelhardt, N., Williams, J. B. W., & Lipsitz, J. D. (2004) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000116651.91923.54 · Cited by 51
Comparison of subjective classification of stool consistency and stool water content*1
Bliss, D. Z. (1999) · Journal of Wound Ostomy and Continence Nursing · doi:10.1016/s1071-5754(99)90031-1 · Cited by 48
A Comparison of Stool Characteristics from Normal and Constipated People
Aichbichler, B. W., Wenzl, H. H., Ana, C. A. S., Porter, J. L., Schiller, L. R., & Fordtran, J. S. (1998) · Digestive Diseases and Sciences · doi:10.1023/a:1026699525487 · Cited by 44
The Bristol scale - a useful system to assess stool form?
Pérez, M. M., & Martínez, A. B. (2009) · PubMed · Cited by 43
Whelan, K., Judd, P. A., Preedy, V. R., & Taylor, M. A. (2008) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607108314769 · Cited by 42
Self-citationNanda, R., Gupta, S., Kanapathipillai, P., Liow, R., & Rangan, A. (2008) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-008-0341-6 · Cited by 31
Definitions, Attitudes, and Management Practices in Relation to Diarrhea During Enteral Nutrition
Majid, H. A., Emery, P. W., & Whelan, K. (2012) · Nutrition in Clinical Practice · doi:10.1177/0884533611431986 · Cited by 30
Self-citationReliability of a Stool Consistency Classification System
Bliss, D. Z., Larson, S. J., Burr, J. K., & Savik, K. (2001) · Journal of Wound Ostomy and Continence Nursing · doi:10.1067/mjw.2001.119013 · Cited by 27
Discrepancy between recalled and recorded bowel habits in irritable bowel syndrome
Coletta, M., Palma, L. D., Tomba, C., & Basilisco, G. (2010) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04322.x · Cited by 26
Pharmacodynamic and Clinical Endpoints for Functional Colonic Disorders: Statistical Considerations
Zinsmeister, A. R., Burton, D. D., & Camilleri, M. (2012) · Digestive Diseases and Sciences · doi:10.1007/s10620-012-2369-z · Cited by 26
Interrater Reliability Decline Under Covert Assessment
Topf, M. (1988) · Nursing Research · doi:10.1097/00006199-198801000-00010 · Cited by 24
Escala de Bristol: ¿un sistema útil para valorar la forma de las heces?
Pérez, M. M., & Martínez, A. B. (2009) · Revista Española de Enfermedades Digestivas · doi:10.4321/s1130-01082009000500001 · Cited by 24
Gallstones in a community free of obesity but prone to slow intestinal transit
Spathis, A., Heaton, K. W., Emmett, P. M., Norboo, T., & Hunt, L. P. (1997) · European Journal of Gastroenterology & Hepatology · doi:10.1097/00042737-199702000-00018 · Cited by 21
Stool characteristics and colonic transit in irritable bowel syndrome: evaluation at two time points
Shim, L., Talley, N., Boyce, P., Tennant, C., Jones, M. P., & Kellow, J. (2013) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365521.2012.758767 · Cited by 14
Streiner, D. L., & Norman, G. R. (2008) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780199231881.003.0010 · Cited by 14
Tool to classify stool consistency: Content validity and use by persons of diverse cultures
Bliss, D. Z., Dhamani, K. A., Savik, K., & Kirk, K. S. (2003) · Nursing and Health Sciences · doi:10.1046/j.1442-2018.2003.00145.x · Cited by 13
Evaluation of Stool Frequency and Stool Form as Measures of HIV-Related Diarrhea
Tinmouth, J., TOMLINSON, G. A., Kandel, G. P., Walmsley, S. L., Steinhart, H., & Glazier, R. H. (2007) · HIV Clinical Trials · doi:10.1310/hct0806-421 · Cited by 11
Seppänen, S., Niittynen, L., Poussa, T. A., & Korpela, R. (2007) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1602787 · Cited by 9
Fast Facts: Irritable Bowel Syndrome
Thompson, W., & Heaton, K. W. (2003) · KARGER eBooks · doi:10.1159/isbn.978-1-912776-02-3 · Cited by 9
Reliability of a Stool Consistency Classification System
Bliss, D. Z., Larson, S. J., Burr, J. K., et al. (2001) · Journal of Wound Ostomy and Continence Nursing · doi:10.1097/00152192-200111000-00010 · Cited by 5
Do Patients Understand the Bristol Stool Scale? Results of Cognitive De-Briefing of IBS Patients
Spiegel, B. M. R., Bolus, R. E., Agarwal, N., Sayuk, G. S., Harris, L. A., Lucak, S. L., Esrailian, E., Chey, W. D., Lembo, A. J., Karsan, H. A., et al. (2011) · Gastroenterology · doi:10.1016/s0016-5085(11)62544-4 · Cited by 4
M1202 Children's Reliability Using a Modified Bristol Stool Scale to Indicate Stool Form
Lane, M. M., Czyzewski, D. I., Vasen, N., Chumpitazi, B. P., & Shulman, R. (2010) · Gastroenterology · doi:10.1016/s0016-5085(10)61628-9 · Cited by 3
Saps, M., & Chogle, A. S. (2010) · Gastroenterology · doi:10.1016/s0016-5085(10)62214-7 · Cited by 1
Research works printed but not linked: 1
- U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER), 2012, Guidance for Industry: Irritable Bowel Syndrome ‐ Clinical Evaluation of Drugs for Treatment
Cited by
Sorted by citations
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Self-citationMohr, A. E., Jäger, R., Carpenter, K. C., Kerksick, C. M., Purpura, M., Townsend, J. R., West, N. P., Black, K., Gleeson, M., Pyne, D. B., et al. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00353-w · Cited by 378
Microbiota composition and metabolism are associated with gut function in Parkinson's disease
Cirstea, M. S., Yu, A. C., Golz, E., Sundvick, K., Kliger, D., Radisavljevic, N., Foulger, L. H., Mackenzie, M., Huan, T., Finlay, B. B., et al. (2020) · Movement Disorders · doi:10.1002/mds.28052 · Cited by 326
Svolos, V., Hansen, R., Nichols, B., Quince, C., Ijaz, U. Z., Papadopoulou, R., Edwards, C. A., Watson, D. G., Alghamdi, A., Brejnrod, A., et al. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.12.002 · Cited by 320
Whelan, K., Martin, L. D., Staudacher, H. M., & Lomer, M. C. E. (2018) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12530 · Cited by 322
Self-citation
Metadata
- Authors
- Blake, M. R., Raker, J. M., & Whelan, K.
- Affiliations
- King's College London (GB)
- Corresponding author
- Whelan, K.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2016-08-05
- Volume
- 44
- Issue
- 7
- Pages
- 693-703
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2504563199
- Cited by
- 495
- References
- 50
- Citations by year
- 2026: 57 · 2025: 71 · 2024: 83 · 2023: 63 · 2022: 69 · 2021: 66 · 2020: 40 · 2019: 28 · 2018: 12 · 2017: 6
- FWCI
- 16.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Nursing › Research and Theory › Health Education and Validation
- Keywords
- Bristol Stool Form Scale, diarrhea-predominant irritable bowel syndrome, stool water content, measurement validity, inter-rater reliability, healthy adults
- MeSH terms
- Adult, Diarrhea, Feces, Female, Humans, Male, Middle Aged, Reproducibility of Results, Irritable Bowel Syndrome, Young Adult
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