Symptom Based Scoring for Haemorrhoidal Disease: A Systematic Review.

BACKGROUND Haemorrhoidal disease can severely affect quality of life. Its classification is commonly based on morphology of the degree of prolapse, however this does not take into account the symptoms and impact on the quality of life. The aim of this systematic review was to determine the most appropriate instruments that classify the severity of disease according to symptoms. METHODS A PRISMA compliant search was conducted in December 2019 to identify studies that described the validation of a haemorrhoidal symptom score. The measurement properties of the scoring systems were assessed based on the Consensus based standards for the selection of health status measurement instruments (COSMIN) methodology for systematic reviews for patient reported outcome measures. RESULTS A total of 5288 articles were identified with 5 articles included. Three studies developed a scoring system based on a set of core symptoms for a cohort of patients and validated the score against treatment outcomes. One study developed a disease specific quality of life questionnaire based on symptoms to evaluate disease burden. One study combined both quality of life and symptom measures and tested measurement properties on two cohorts of patients. Only one study demonstrated satisfactory valid, reliable and responsive measurement criteria. CONCLUSION A single study demonstrated sufficient quality in measurement properties to be recommended for clinical use. Further studies in this area should utilise consensus-based standards for designing and reporting validation research to ensure that the appropriate evidence base is acquired for any further patient reported outcome measures to be recommended.