Assessing quality of life in obstetric fistula patients: Validation of the urogenital distress inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7) in Lingala and Kikongo in DR Congo

Aims : The Urogenital Distress Inventory (UDI‐6) and the Incontinence Impact Questionnaire (IIQ‐7) are both well‐known. In obstetric fistula (OF) repair outcome is usually assessed by the surgical team. The patient perspective is often neglected. Therefore we translated both questionnaires in Lingala and Kikongo, official languages in DR Congo. Secondly used the questionnaires in an OF population to assess the real life continence status and the impact of fistula repair surgery. Methods : UDI‐6 and IIQ‐7 were translated and underwent content validity checks using focus groups. The final versions were tested in a normal population and in an OF population (33 for Kikongo, 35 for Lingala) for internal consistency and test‐retest reliability. The responsiveness was tested in an OF population and effect sizes were calculated. Results : Both questionnaires showed good internal consistency and reliability. The Cronbach's α for UDI‐6 in both languages was 0.47 for the IIQ‐7, 0.96 for Lingala and 0.94 for Kikongo in an OF population. The test‐retest reliability was high in all cohorts. Both questionnaire scores improved significantly after fistula repair. The effect size for UDI‐6 was ?1.09 and ?1.6 for IIQ‐7. Conclusion: Both IIQ‐7 and UDI‐6 questionnaires have been translated in Lingala and Kikongo, two languages of DR Congo. The questionnaires have been validated in an obstetrical fistula population, showing good content validity and test‐retest reliability. The questionnaires show a highly significant effect size, demonstrating the dramatic positive effect of fistula surgery on urogenital symptoms and on the quality of live in an obstetric fistula population.     

Test-retest reliability,validity, and sensitivity to change of the urogenital distress inventory and the incontinence impact questionnaire

AIMS: To evaluate two quality of life measures for urinary incontinence (UI) in Scottish females. METHODS: Three groups with UI from two regions in Scotland were studied. Two groups were receiving treatment for incontinence; the third was not. Women completed the UDI and IIQ twice to allow assessment of test-retest reliability and validity. Treatment groups completed the questionnaires again, postintervention, to assess ability of the measures to detect change. Other measures used to assess validity were the SF-36, HADS, weight of urine leaked, and number of incontinence episodes. By design, the three subject groups differed significantly in their characteristics, ensuring a diverse sample of women. RESULTS: Analysis of reliability showed a clinically trivial but statistically significant decrease in total UDI (mean, -6.1; 95% CI, -11.0 to -1.5) and IIQ (mean, -9.7; 95% CI, -15.5 to -3.9) scores between test and retest assessments, possibly due to a research effect. Most items of the UDI (18 of 19) and IIQ (28 of 30) performed very well on test-retest. The UDI and IIQ were valid in that higher scores (indicating more bothersomeness of symptoms/impact on daily living) were associated with greater severity of UI. Additionally the IIQ showed the expected associations with measures of anxiety and health status. CONCLUSIONS: Both the UDI and IIQ detected changes in women's conditions due to intervention. The measures had good psychometric properties, including test-retest reliability, across subject groups.     

Short forms to assess life quality and symptom distress for urinary incontinence in women: The incontinence impact questionnaire and the urogenital distress inventory

This article describes short form versions of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI). These instruments assess life impact and symptom distress, respectively, of urinary incontinence and related conditions for women. All subsets regression analysis was used to find item subsets that best approximated scores of the long form versions. The approach succeeded in reducing the 30-item IIQ and the 19-item UDI to 7- and 6 item short forms, respectively. The short form versions may be more useful than the long form versions in many clinical and research applications. © 1995 Wiley-Liss, Inc.     

Psychometric properties and validation of the German-language King's Health Questionnaire in women with stress urinary incontinence

AIMS: The purpose of this study was to evaluate the psychometric properties of and validate the German-language version of the King's Health Questionnaire (KHQ) in women with stress urinary incontinence (SUI). METHODS: A total of 145 women treated for stress incontinence with surgery or physiotherapy completed the the KHQ and the SF-36 before and after treatment. Psychometric analyses of the quality of life (QoL) instruments determined the reliability (Cronbach's alpha), internal and external validity, and responsiveness of the KHQ subscales. RESULTS: The KHQ showed good internal consistency, content validity, and criterion validity as measured by correlation with scores on the SF-36. Cronbach's alpha coefficient ranged from 0.76 to 0.86, indicating a high internal consistency of the subscales. Concerning criterion validity, correlations between the KHQ subscales and the SF-36 were low to moderate. The highest correlation was found between the general health perception subscales of both questionnaires. CONCLUSIONS: The results indicate good psychometric properties for the German-language KHQ.     

Italian validation of the urogenital distress inventory and its application in LUTS patients

OBJECTIVES: The objective of this study was to validate the Italian version of the Urogenital Distress Inventory (UDI) in a sample of women with lower urinary tract symptoms (LUTS). METHODS: The linguistic validation of the questionnaire was performed through a multistep process: backward and forward translations coordinated by clinical investigators, followed by a pretest. The final version was administered to a larger sample of female patients, aged 18 years or older who had been having LUTS for at least 3 months, numbering 53 subjects. To evaluate test-retest reliability, patients were re-rated after 1 week. To test the questionnaire's capacity to discriminate women with or without LUTS (cases and controls, respectively), a sample of 53 healthy women was enrolled. A 72-h voiding diary was used as a gold standard and compared with the UDI. RESULTS: The correlation coefficient between ratings was >or=0.80, and the discriminant power between cases and controls was confirmed. The UDI showed good internal consistency for all domains, except irritative symptoms (total score's Cronbach alpha=0.86). Factor analytic structure revealed urinary incontinence to be opposite to the other urologic symptoms, with bed wetting being loaded separately. The average daily number of urgent micturitions was higher in patients who reported they "experience a strong feeling of urgency to empty bladder" in the UDI than those ones who did not (p<0.01). CONCLUSIONS: The Italian version of the UDI is a valid and robust instrument, which can now be used reliably in daily practice and clinical research.     

Women who experience detrusor overactive at lower bladder volumes report greater bother

AIMS: To explore the relationship of cystometric volume at the time of first detection of detrusor overactive incontinence (DOI) to condition-specific quality of life (QOL). METHODS: We reviewed consecutive charts of women diagnosed with pure DOI during urodynamic testing. DOI volume was defined as the cystometric volume at the first detection of DOI. Responses to the Urine Distress Inventory (UDI6) and Incontinence Impact Questionnaire (IIQ7) were recorded. Spearman correlations were used to compare independent groups with respect to continuous variables. RESULTS: Eighty-nine women were included in this analysis. DOI volume was inversely correlated with UDI6 and IIQ7 scores (Spearman's rho = -0.514, P < 0.001 and Spearman's rho = -0.611, P < 0.001). Maximal cystometric capacity was also inversely correlated with UDI6 and IIQ7 scores (rho = -0.458, P < 0.0001 and Spearman's rho = -0.43, P < 0.0001). CONCLUSIONS: Women who experience DOI at lower volumes during urodynamics report greater bother and QOL impact from incontinence than women who leak at higher volumes.     

Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review

This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.     

Urinary incontinence after multiple gestation and delivery: impact on quality of life

An anonymous 77-item urogenital symptom questionnaire was administered to 769 women with a history of previous multifetal gestation and delivery, including long forms of the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). IIQ and UDI scores were analyzed using univariate and multivariate regression to determine the impact of incontinence on quality of life (QOL). Mean age was 37 years (22–75), and nearly half [49.8% (365)] reported at least one type of incontinence. Higher mean UDI scores were reported by women with stress incontinence (SI) (12.3 vs 4.7, p=0.0001), urge incontinence (UI) (14.9 vs 5.7, p=0.0001), and mixed incontinence (15.1 vs 6.2, p=0.0001) compared to continent women. Similarly, higher mean IIQ scores were associated with SI (6.9 vs 1.9, p=0.0001), UI (9.4 vs 2.2, p=0.0001), and mixed incontinence (9.3 vs 2.7, p=0.0001). In conclusion, among mothers of multiples, stress and urge urinary incontinence were associated with strongly adverse effects on QOL at a young age.     

Transobturator tape (TOT): Two years follow-up

AIMS: The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). METHODS: One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. RESULTS: One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48 +/- 2.42, and the score of IIQ 16.13 +/- 7.86, UDI 10.95 +/- 3.4, and GSS 1.41 +/- 1.67. All patients underwent TOT using the ObTape. Hospital stay was 0.84 +/- 0.76 days and catheter duration was 1.42 +/- 2.08 days. At a follow-up of 16.85 +/- 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15 +/- 0.56, IIQ 1.47 +/- 5.14, UDI 3.28 +/- 3.09, and GSS 8.29 +/- 1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. CONCLUSIONS: These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP < or =60 cm H2O, and patients with VLPP >60 cm H2O was observed.     

Validation of a Spanish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA)

OBJECTIVES: The purpose of this study was to develop a linguistically appropriate, culturally adapted, and appropriately validated Spanish version of the SMFA (SMFA-Mex). DESIGN: Validation of a survey-based outcome instrument. SETTING: Busy state hospital in southern Mexico. PATIENTS/PARTICIPANTS: Consecutive trauma patients with a variety of orthopedic disorders. INTERVENTION: N/A. MAIN OUTCOME MEASUREMENTS: The SMFA-Mex was forward and back translated, administered to orthopedic trauma patients, and compared against the Spanish version of the SF-36s for criterion validity. Statistical analysis included factor analysis, criterion validation with the SF-36, and internal measures of reliability. RESULTS: Factor analysis demonstrated three separate subscale dimensions: 1) upper-extremity dysfunction, 2) lower-extremity dysfunction, and 3) lifestyle alterations. Item analysis showed a high degree of internal consistency for the three subscales (subscale 1, r = 0.95; subscale 2, r = 0.94; subscale 3, r = 0.92). Test-retest reliability at 7 days was 0.93 for the upper-extremity dysfunction subscale, 0.95 for the lower-extremity dysfunction subscale, and 0.92 for the lifestyle-alterations subscale. Construct validity was established by comparison of the Brazilian version of the SF-36. CONCLUSIONS: The SMFA-Mex was successfully translated and culturally adapted from the English original. The SMFA-Mex demonstrated adequate scale reliability and validity and yielded three distinct subscales using factor analysis.