Validity and Reliability of the Patient Assessment of Constipation: Symptoms (PAC-SYM ©) in the Indonesian Language

Introduction: Constipation is a very subjective symptom experienced by patients. Although ROME-IV could be used for diagnosis of functional constipation, it could not assess treatment response. The Patient Assessment of Constipation – Symptoms (PAC-SYM©) questionnaire was developed for this purpose. However, the PAC-SYM©had not been translated and adapted into Indonesian language. Methods: The original PAC-SYM© questionnaire was translated and adapted based on the available guidelines. The final version of the translation was then used to perform validity and reliability analysis. A total of 64 patients with chronic constipation from the local community in Jakarta, Indonesia was used for the psychometric evaluation. Principal component analysis and structural equation modeling were also attempted. Results: Most of the study subjects were female. The Cronbach’s alpha for the overall average score was 0.869 which showed good internal consistency. The intraclass correlation coefficient for the overall score was 0.743 which showed good test-retest reliability. Content validity was considered to be sufficient by experts. Each domain correlated strongly with the total score. PAC-SYM© had moderate correlation with PAC-QOL which showed concurrent validity. The multi-trait analysis showed scaling success. Question 7 showed a very high floor effect (84.4%), and therefore omitted from the factor analysis. The principal component analysis revealed a new ‘two-factors’ structure, with question from the original ‘rectal’ domain combined into the ‘stool’ domain. The structural equation modeling indicated good model fit. Conclusion: The Indonesian version of PAC-SYM© was valid and reliable to be used in clinical settings. Keywords: constipation severity, symptoms, Indonesia, validity, reliabilit