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International Validation of the Low Anterior Resection Syndrome Score

Juul, Therese MHSc*; Ahlberg, Madelene MHSc; Biondo, Sebastiano MD, PhD; Emmertsen, Katrine Jøssing MD*; Espin, Eloy MD, PhD§; Jimenez, Luis Miguel MD§; Matzel, Klaus E. MD, PhD; Palmer, Gabriella MD, PhD; Sauermann, Anna MD; Trenti, Loris MD; Zhang, Wei MD; Laurberg, Søren MD, PhD*; Christensen, Peter MD, PhD, DMSc*

doi: 10.1097/SLA.0b013e31828fac0b
Original Articles

Objective: The aims of this study were to investigate the convergent and discriminative validity and reliability of the low anterior resection syndrome (LARS) score in an international setting.

Background: The LARS score is a simple self-administered questionnaire measuring bowel dysfunction after rectal cancer surgery. The score is intended to be commonly used in international research and clinical practice in the future. Therefore, a thorough validation in an international setting is of utmost importance.

Methods: The LARS score was translated using methods in keeping with current international recommendations. A total of 801 patients operated for rectal cancer in Sweden, Spain, Germany, and Denmark completed the LARS score questionnaire, including an anchor question assessing the impact of bowel function on quality of life. A subgroup of 218 patients completed the LARS score twice. Data were analyzed per country.

Results: The LARS score has demonstrated a high convergent validity in terms of a high correlation between LARS score and quality of life (P < 0.001). Sensitivity ranged from 67.7% to 88.3% and specificity from 58.1% to 86.3%. The LARS score was able to discriminate between groups of patients differing with regard to radiotherapy, surgery, and age (P < 0.05). The score also demonstrated high reliability at test-retest with narrow limits of agreement and no statistically significant difference between scores at the first and second test.

Conclusions: The Swedish, Spanish, German, and Danish versions of the LARS score have proven to be valid and reliable tools for measuring LARS in European rectal cancer patients.

The psychometric properties of the low anterior resection syndrome (LARS) score were investigated in this international validation study. A total of 801 patients operated for rectal cancer from Sweden, Spain, Germany, and Denmark participated and the results provide the necessary documentation of a high validity and reliability of the LARS score.

*Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark

General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, Barcelona, Spain

Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

§Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

Department of Surgery, University Erlangen, Erlangen, Germany

Reprints: Therese Juul, MHSc, Department of Surgery P, Aarhus University Hospital, Tage Hansensgade 2, 8000 Aarhus C, Denmark. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.