Constipation is defined by the International Continence Society as the complaint that bowel motions are infrequent and/or incomplete and/or there is a need for frequent straining or manual assistance to defecate (1). The Cleveland Clinic Florida Constipation Scoring System (CCFCSS) was published in 1996 and was developed to assist in diagnosing and treating patients with constipation. It is generally used for the adult population and evaluates eight clinical aspects that define constipation symptoms with eight questions (2). Considering the short application period, it was decided to conduct this study with the idea that the CCFCSS would be useful in diagnosis and follow-up for patients in the clinic. Therefore, this study aimed to provide the Turkish equivalence of the CCFCSS, to determine its reliability, and validity, and to contribute it to literature.

This study is a methodological type, reliability, and validity study. 
The study was conducted with the participation of 121 volunteers over the age of 18 who were diagnosed with functional constipation by a general surgeon. The Constipation Severity Score (CSS), which already has validity and reliability in Turkish (3), and the Turkish version of the CCFCSS were applied to the volunteers two times. Translation-re-translation method has been used to adapt the scale. While the first interviews were made face-to-face, the second interviews were made by phone/email, after 2 weeks. The opinions of experts in the field were consulted for content and construct validity.

The suitability of the CCFCSS for factor analysis in construct validity assessments was determined by the Kaiser-Meyer-Olkin measure of sampling adequacy and found to be 0.850. In the reliability analysis on the internal consistency level of the CCFCSS, the Cronbach alpha internal consistency coefficient of the scale was calculated as 0.845. In the Pearson correlation analysis results, in which the scores obtained from the original study and test-retest study, were examined and there was a statistically significant (p<0.05), positive, and strong (r=0.987) correlation between the scores. There are statistically significant (p<0.05), positive, and strong (r=0,862) correlation between the scores obtained from the CCFCSS and the CSS. The split-half correlation applied to evaluate the internal consistency of the scale (0.762) and indicates that the scale has a high level of stability and consistency, Cronbach's Alpha value (0.815) indicates that the scale has a high level of internal consistency. According to the dependent sample t-test result comparing the relationship between test-retest scores, no statistically significant difference exists between the test-retest score averages (p>0.05).

According to the results of the study, the Turkish version of the CCFCSS showed good internal consistency, excellent test-retest reliability, good construct validity, and good criterion validity. This being case the case, the CCFCSS can be used in the Turkish language and culture.

The CCFCSS is a widely used tool to examine the severity of constipation in research and clinical practice, and all questions take less than 5 minutes to answer (2). As an output of this study, the Turkish version of CCFCSS can be used as a valid, reliable, standard scale in clinics and research in individuals with functional chronic constipation.

D’Ancona CD, Haylen BT, Oelke M, Herschorn S, Abranches-Monteiro L, Arnold EP, Goldman HB, Hamid R, Homma Y, Marcelissen T, Rademakers K, Schizas A, Singla A, Soto I, Tse V, de Wachter S. An International Continence Society (ICS) Report on the Terminology for Adult Male Lower Urinary Tract and Pelvic Floor Symptoms and Dysfunction. Neurourol Urodyn. 2019 DOI: 10.1002/nau.23897
Agachan F, Chen T, Pfeifer J, Reissman P,  Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Diseases of the colon & rectum. 1996, 39(6): p. 681-685.
Kaya, N., & Turan, N. Konstipasyon ciddiyet ölçeginin güvenilirlik ve geçerliligi. Turkiye Klinikleri Journal of Medical Sciences. 2011, 31(6), 1491-1501.