Crohn''s disease: systematic review of assessment of disease severity and its relevance to surgery

BACKGROUND: The aims of treatments for Crohn's disease are symptom control by medical or surgical means and improvement in health-related quality of life (HRQOL). A wide number of classification systems, instruments of disease activity measurement (DAM) and HRQOL are available, but few are used in routine surgical practice. OBJECTIVE: To review the validity of DAM and HRQOL instruments and their applicability to surgically treated patients. METHOD: A systematic literature search was undertaken to identify these instruments. Qualifying articles were used to determine the construct, content and criterion validity of the instruments identified with respect to surgically treated patients. RESULTS: Thirteen disease activity indices and 11 HRQOL assessment tools were identified. Construct validity was demonstrated throughout but concerns of content and criterion validity were noted. CONCLUSION: None of the current disease activity or HRQOL tools can be used without potential bias in a trial of surgical vs medical therapy as the items included favour the outcomes experienced following medical therapy. A more balanced assessment tool in the setting of a multidisciplinary trial is needed.