Assessment of Mobile APP for Constipation and Incontinence: Randomized Crossover Study in Healthy Subjects

INTRODUCTION: An accurate history is important for diagnosis, treatment and clinical decision making but patients with bowel problems cannot accurately recall or quantify stool habit.We determined whether an electronic mobile phone APP can reliably and accurately records bowel symptoms of constipation and fecal incontinence (FI), when compared to paper form stool diary in healthy subjects. METHODS: Healthy subjects were randomly assigned to complete either a paper diary or 2 mobile phone APPs (separate for FI and constipation) for 2 weeks each, in a crossover study. The APP has approximately 10 questions each that assess severity of symptoms, bowel habit, stool consistency etc. Usability of APP versus paper form diary was assessed after 4 weeks. Intraclass correlation coefficients (ICC) assessed equivalence. RESULTS: Ten healthy subjects (34.7 ± 4.1 years, F/M = 6/4) participated. The number of BM, spontaneous (SBM), and complete spontaneous bowel movement (CSBM), over 2 weeks showed strong correlation between APP and paper form diaries, and for all questions related to either FI or constipation (ICC >0.79) (Table 1). Although mean stool consistency was strongly correlated with paper diary, the number of hard (BSFS1-2) and normal (BSFS3-4) stools were moderately significantly correlated with paper diary, possibly because of day to day variability in normal stool pattern. No leakage episodes were recorded in both FI APP and paper diary. The urgency of BM in FI APP was significantly associated with paper diary. The number of gas and bloating episodes ranged rom 0.8 to 2.5 in both APPs and paper diary. The VAS scores for functionality and usability for electronic APP were significantly higher (P < 0.027) compared to paper diary, and 90% of subjects preferred (P < 0/001) the APP (Table 2). CONCLUSION: The mobile APPs for FI and constipation were reliable, reproducible and useful and strongly correlated with paper diary. However they were strongly preferred by the subjects over paper form. These APPs could aid screening and assessment of bowel function in patients with FI and constipation but require validation for clinical or research use. (Table Presented).