TY - JOUR
T1 - Psychometric Development and Internal Validation of a Short Version of the Crohn’s Anal Fistula Quality of Life Scale
AU - Mulders, Lieven G.M.
AU - Beek, Kim J.
AU - Tielbeek, Jeroen A.W.
AU - Zwart, Marloes
AU - Rietdijk, Svend T.
AU - Jansen, Jeroen M.
AU - Wildenberg, Manon E.
AU - van Hulst, Rob A.
AU - Stoker, Jaap
AU - Bemelman, Willem A.
AU - Buskens, Christianne J.
AU - D’Haens, Geert R.
AU - Gecse, Krisztina B.
AU - Admiraal, Iris
AU - van der Bilt, Jarmila D.W.
AU - van Croonenburg, Thirza
AU - Fung, Ivan
AU - Hulshoff, Melanie
AU - de Jonge, Wouter
AU - Ridderikhof, Milan
AU - van Thiel, Isabelle
AU - Verhoeff, Jan
AU - Verseijden, Caroline
AU - Weiss, Roni
AU - Yim, Andrew Li
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2026
Y1 - 2026
N2 - Background & Aims Perianal fistulizing Crohn’s disease (PFCD) substantially impairs health-related quality of life (HRQoL). This prospective study aimed to validate the CAFQOL (Crohn’s Anal Fistula-QoL) scale in an independent cohort and to develop a short version for disease monitoring in PFCD. Methods This prospective, multicenter study included patients with PFCD starting medical and/or surgical treatment. Patient-reported CAFQOL and Inflammatory Bowel Disease Questionnaire (32 items) (IBDQ-32), Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI), and MRI Magnetic Resonance Novel Index for Fistula Imaging in CD (MAGNIFI-CD) were assessed at baseline, and weeks 9, 26, and 52. Psychometric properties were evaluated using classical test and item response theory; a short version was derived and internally tested. Results Sixty-two patients were included with a mean CAFQOL of 59.8 (standard deviation [SD], 16.4) at baseline. CAFQOL improved significantly over time ( P < .001, week 52 standardized response mean, −1.26). Convergent validity with IBDQ-32 was strong (r = −0.77; P < .001), whereas correlations with FDA, PDAI, and MAGNIFI-CD (r = −0.27–0.45; P < .001) were weak to negligible, supporting discriminant validity. Internal consistency was high (α = 0.89). Exploratory factor analysis revealed 2 subscales: social-practical impact, and physical-emotional distress. Nine items with the strongest discrimination and coverage were selected for the short CAFQOL, which showed high reliability and strong correlation with the full scale. Deep remission corresponded with a CAFQOL score of 37 (range, 0–108), and a short CAFQOL score of 15 (range, 0–36). Median completion times for CAFQOL, short CAFQOL, and IBDQ-32 were 4, 1, and 5 minutes, respectively. Conclusions CAFQOL is a reliable and responsive tool that captures meaningful changes over time. The short CAFQOL is a feasible tool for repeated disease monitoring.
AB - Background & Aims Perianal fistulizing Crohn’s disease (PFCD) substantially impairs health-related quality of life (HRQoL). This prospective study aimed to validate the CAFQOL (Crohn’s Anal Fistula-QoL) scale in an independent cohort and to develop a short version for disease monitoring in PFCD. Methods This prospective, multicenter study included patients with PFCD starting medical and/or surgical treatment. Patient-reported CAFQOL and Inflammatory Bowel Disease Questionnaire (32 items) (IBDQ-32), Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI), and MRI Magnetic Resonance Novel Index for Fistula Imaging in CD (MAGNIFI-CD) were assessed at baseline, and weeks 9, 26, and 52. Psychometric properties were evaluated using classical test and item response theory; a short version was derived and internally tested. Results Sixty-two patients were included with a mean CAFQOL of 59.8 (standard deviation [SD], 16.4) at baseline. CAFQOL improved significantly over time ( P < .001, week 52 standardized response mean, −1.26). Convergent validity with IBDQ-32 was strong (r = −0.77; P < .001), whereas correlations with FDA, PDAI, and MAGNIFI-CD (r = −0.27–0.45; P < .001) were weak to negligible, supporting discriminant validity. Internal consistency was high (α = 0.89). Exploratory factor analysis revealed 2 subscales: social-practical impact, and physical-emotional distress. Nine items with the strongest discrimination and coverage were selected for the short CAFQOL, which showed high reliability and strong correlation with the full scale. Deep remission corresponded with a CAFQOL score of 37 (range, 0–108), and a short CAFQOL score of 15 (range, 0–36). Median completion times for CAFQOL, short CAFQOL, and IBDQ-32 were 4, 1, and 5 minutes, respectively. Conclusions CAFQOL is a reliable and responsive tool that captures meaningful changes over time. The short CAFQOL is a feasible tool for repeated disease monitoring.
KW - Patient-reported Outcomes
KW - Perianal Fistulizing Crohn’s Disease
KW - Quality of Life
UR - https://www.scopus.com/pages/publications/105029290158
U2 - 10.1016/j.cgh.2025.12.016
DO - 10.1016/j.cgh.2025.12.016
M3 - Article
C2 - 41448480
AN - SCOPUS:105029290158
SN - 1542-3565
JO - Clinical gastroenterology and hepatology
JF - Clinical gastroenterology and hepatology
ER -