ArticleBMJ open2026
Translation and psychometric evaluation of the Chinese version of the King's Stool Chart in patients receiving enteral nutrition.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aims to translate, culturally adapt, and validate the Chinese version of the King's Stool Chart among patients receiving enteral nutrition for use in nursing practice.
designThis is a descriptive, cross-sectional study.
settingThis study was conducted in the intensive care unit (ICU) of a tertiary hospital in Henan Province, China.
participantsA total of 144 patients receiving enteral nutrition were included.
methodsThis study was conducted in two phases. Phase I involved the translation and cultural adaptation of the King's Stool Chart using established methodologies, including forward translation, synthesis, back-translation and expert review. Phase II comprised psychometric evaluation with 144 patients receiving enteral nutrition. The Chinese version of the King's Stool Chart was used to assess stool frequency, consistency, weight and the daily total score. Validity was tested through content, construct and concurrent validity, while inter-rater reliability was assessed using the kappa coefficient.
resultsThe Chinese version of the King's Stool Chart demonstrated excellent content validity, with item-level indices ranging from 0.95 to 1.00. Construct validity was supported by the ability of the Chinese version of the King's Stool Chart to differentiate between clinical subgroups with varying stool characteristics. Sensitivity rates for stool weight categorisation were above 89%, and substantial inter-rater reliability (kappa=0.735) was observed. The daily total score was effective in identifying patients at risk for diarrhoea, with significant differences observed among clinical subgroups. Diarrhoea classification, using a threshold of ≥15 points, showed strong construct validity.
conclusionsWithin the scope of this single-centre sample, the Chinese version of the King's Stool Chart demonstrates acceptable validity and substantial to excellent inter-rater reliability for assessing stool frequency, consistency, weight and diarrhoea classification in enterally fed ICU patients in China. These psychometric properties provide preliminary support for its use in routine nursing practice for gastrointestinal function monitoring in ICU settings. Further multicentre and large-sample studies are required to verify its external validity and generalisability to broader Chinese-speaking populations and non-ICU clinical settings.
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