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.     

Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited

AIMS: Symptoms of urogenital dysfunction are known to negatively affect health-related quality of life in women. To assess effectiveness of treatment, it is currently recommended to include measurements of quality of life in outcome analysis. One of the questionnaires that is commonly used is the combination of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). Unfortunately, the validity of the UDI and IIQ has only been tested in highly selected subgroups of female patients. Therefore, it is unclear whether this questionnaire is suitable for use in populations with different characteristics. METHODS: We analyzed the scale construction and validity of the UDI and IIQ in a random sample of 2,042 women, aged 20-70 years old and a clinical sample of 196 women. RESULTS: Our results show that the UDI can be divided into five subscales, namely discomfort/pain, urinary incontinence, overactive bladder, genital prolapse, and obstructive micturition. The internal consistency (Cronbach's alpha) ranged between 0.74 and 0.82. In addition to the original four subscales of the IIQ (mobility, physical, social, and emotional functioning), we identified a fifth subscale with four items about embarrassment. Internal consistency of these subscales ranged between 0.83 and 0.93. In addition to the internal consistency, we tested the criterion and construct validity of these new subscale division. CONCLUSIONS: We found these subscales to be reliable and of clinical use. It is recommended to use the revised UDI and IIQ in outcome analysis of treatments for urogenital symptoms in women.     

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.     

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.     

Transvaginal bone-anchored sling for the treatment of female stress urinary incontinence: effect of Valsalva leak point pressure and prior pelvic surgery on outcomes

The effect of lower Valsalva leak point pressure (VLPP) and previous pelvic surgery on outcomes following sling surgery is controversial. We assessed outcomes following bone-anchored sling (BAS) placement in patients with intrinsic sphincteric deficiency (ISD) and previous pelvic surgery. A retrospective review of 149 patients undergoing BAS placement was performed. Patients were stratified by VLPP (>/=60, <60, and <30) and by history of previous anti-incontinence/pelvic floor surgery. Outcomes were assessed using a questionnaire comprising validated urogenital distress inventory (UDI)-6, incontinence impact questionnaire (IIQ)-7 questionnaires and additional items addressing satisfaction. In comparing the three VLPP cohorts, the percentage of patients reporting incontinence episodes of <1/week (64%, 68%, and 63%, respectively) and postoperative UDI/IIQ questionnaire scores were similar (p > 0.2, all comparisons). Lower rates of patients achieving <1 episode of incontinence per week (50%; p = 0.07) and worse UDI/IIQ scores (p = 0.02) were associated with patients with >/=2 prior surgeries. Whereas results are similar following BAS in patients with or without varying degrees of ISD, worse outcomes are associated with prior surgery.     

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.     

Measuring the severity of stress urinary incontinence using the Incontinence Impact Questionnaire

AIMS: Questionnaires, including the Incontinence Impact Questionnaire (IIQ), have been used to assess the severity of urinary incontinence in clinical trials. However, the summed score derived from the IIQ does not have any inherent clinical meaning. Also, a summed score does not have interval properties, complicating the interpretation of changes in severity. The purpose of this study is to test the hypothesis that incontinence-related disability is a measurable variable and that the IIQ can measure that variable accurately. METHODS: We used Rasch analysis, a logistic regression technique, to estimate an interval scale of incontinence severity. Rasch analysis is based on the mathematical assumption that each subject's response to any given item is a function of (a) the individual's inherent level of disability and (b) the inherent difficulty of that item. RESULTS: Twenty-seven women with urodynamic stress urinary incontinence (USUI) completed the IIQ. Using Rasch analysis, we found that women with USUI had the most difficulty engaging in "physical recreational activities" and the least difficulty participating in "relationship with family." We also assessed the ability of the IIQ to discriminate between individuals with respect to disease severity. We found that most of the items in the IIQ are useful for discriminating incontinence severity among women with mild or moderate incontinence, but very few IIQ items distinguish among women with severe incontinence. CONCLUSIONS: Our results have important implications for clinical trials using the IIQ: among women treated for severe incontinence, the standard IIQ summed score will underestimate the magnitude of any change in incontinence severity.     

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.     

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.     

Long-term patient satisfaction following cadaveric pubovaginal sling incontinence surgery using the UDI and IIQ-7 questionnaires

AIMS: The goal of any incontinence surgery is overall long-term patient satisfaction. The purpose of our study was to assess long-term patient satisfaction following cadaveric fascia lata pubovaginal sling surgery using the urogenital distress inventory (UDI) and the short form of the incontinence impact questionnaire (IIQ-7). MATERIALS AND METHODS: A total of 47 patients who underwent pubovaginal sling incontinence surgery with a minimum follow-up of 2 years were sent by mail the UDI (total score = 300) and the IIQ-7 (total score = 100). Thirty-seven responses (78.7%) were obtained, with a mean follow-up of 3.8 years (range 2.0-6.2). RESULTS: Of the 37 patients who responded, the mean UDI score was 75.8 and the mean IIQ-7 score was 21.4. There was no difference in the mean IIQ-7 score for patients with more than 4 years follow-up as compared to the entire group (28.8, P = 0.22). In contrast, the mean UDI score for patients with more than 4 years follow-up was greater compared to the entire group (99.1, P = 0.04). UDI subscale analysis revealed that patients mainly complained of both irritative and stress symptoms as opposed to obstructive/discomfort symptoms (P < 0.01). Patients with pre-operative mixed incontinence had greater mean UDI and IIQ-7 scores compared to patients with pre-operative pure stress incontinence (96.7 vs. 58.0, P = 0.04; 32.5 vs. 11.9, P = 0.03). CONCLUSIONS: Overall long-term scores assessing quality of life (IIQ-7) were good and those assessing symptom distress (UDI) were satisfactory following pubovaginal sling surgery. Patients with pre-operative mixed incontinence are at greatest risk for post-operative dissatisfaction.     

Is there an alternative to pad tests? Correlation of subjective variables of severity of urinary loss to the 1‐h pad test in women with stress urinary incontinence

OBJECTIVE

To compare the 1‐h pad test in women who have urodynamically confirmed stress incontinence (USI) with a patient‐based 3‐point symptom severity scale and validated quality of life (QoL) questionnaires.

PATIENTS AND METHODS

In all, 98 women with USI were prospectively recruited; all had a 1‐h pad test and completed the validated disease‐specific QoL questionnaires, including short forms of the International Consultation on Incontinence Questionnaire (ICIQ‐SF), Urogenital Distress Inventory (UDI‐6), and Incontinence Impact Questionnaire (IIQ‐7). In addition, the severity of incontinence was determined using the Stamey grading scale, a visual analogue scale (VAS) score, and a patient‐based 3‐point symptom severity scale.

RESULTS

The VAS, symptom severity scale, Stamey grade, UDI‐6, and IIQ‐7 failed to correlate significantly with the 1‐h pad test. Only the ICIQ‐SF correlated significantly with this test.

CONCLUSION

The ICIQ‐SF is easy to administer and, in this study, correlated best with the 1‐h pad test in women with pure primary or secondary USI. It incorporates both symptom severity and QoL variables. We recommend its routine use in clinical practice.     

Comparison of the impact on health-related quality of life of repeated detrusor injections of botulinum toxin in patients with idiopathic or neurogenic detrusor overactivity

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? We know that repeated injections of botulinum toxin A are effective in treating refractory detrusor overactivity particularly in NDO. This study shows that in both NDO and IDO repeated injections of the toxin improve quality of life as assessed by three validated questionnaires. The effect is most marked after the first injection in NDO patients but thereafter similar in both groups.

OBJECTIVE

? To compare the effect of repeated detrusor injections of botulinum toxin (BoNT‐A) on health‐related quality of life (HRQL) in patients with idiopathic (IDO) or neurogenic detrusor overactivity (NDO).

PATIENTS AND METHODS

? Between 2003 and 2009, 151 patients (109 with NDO and 42 with IDO) were treated by BoNT‐A (Botox®, Allergan Inc., Irvine, CA, USA). Changes in HRQL were assessed using the validated short forms of Urogenital Distress Inventory (UDI‐6), the Incontinence Impact Questionnaire (IIQ‐7) and EuroQOL‐5D (EQ‐5D) before and 4 weeks after BoNT‐A.

RESULTS

? The maximum number of repeated injections was five (mean ±sd , 2.8 ± 1.05). Mean ±sd follow‐up was 27.49 ± 17.01 months. ? The UDI‐6 and IIQ‐7 questionnaires showed a consistent improvement after repeated injections in both groups with detrusor overactivity. The EQ‐5D was not statistically different before and after each injection in either the NDO or IDO population. ? After repeated injections, no statistical differences in the change on the UDI‐6 and IIQ‐7 scores were found between NDO and IDO, except after the first treatment, when the decrease in UDI‐6 was higher in NDO than in IDO. ? The EQ‐5D anxiety and depression subscore improved in both groups after each injection and with the number of injections. ? In IDO, after the second injection, no patient reported extreme anxiety or depression and, after the fourth injection, none had anxiety or depression. ? The inter‐injection interval was shorter after the first injection in those with NDO than in IDO but was similar thereafter.

CONCLUSIONS

? Intradetrusor injections of BoNT‐A improved the HRQL of both NDO and IDO patients. ? Although improvement in HRQL was greater and the duration of efficacy shorter in NDO patients after the first injection, there was no significant difference after subsequent injections. ? Mean inter‐injection interval in IDO and in NDO patients was similar from the second injection onwards and improvements in HRQL score were the same.     

Somatic,psychological, and sexual triggers for overactive bladder syndrome in women

Aims

Patients with overactive bladder (OAB) often describe somatic, psychological, and sexual triggers for their symptoms. The aim of this study was to characterize these triggers and assess their impact on patients’ symptoms and quality of life (QoL).

Methods

Patients who visited our urogynecologic clinic between August 2015 and March 2016 and diagnosed with OAB syndrome were asked to fill a questionnaire comprising 34 statements regarding SOmatic, Psychological, and Sexual Triggers for OAB (SOPSETO). Patients additionaly completed the UDI‐6 and IIQ‐7 questionnaires. Statistical analysis was performed to determine the prevalence of each trigger and its correlation with the UDI‐6 and IIQ‐7 scores.

Results

Sixty four women enrolled in this study. The SOPSETO questionnaire was found to be relaiable with Cronbach's alpha of 0.73‐0.88. Construct validity was high with good correlation between the SOPSETO and the UDI‐6 and IIQ‐7 questionnaires. The triggers which had the highest correlation with the total UDI‐6 scores were: Being far from toilets (r = 0.32, P = 0.004), swimming (r = 0.44, P = 0.02), taking a shower/bath (r = 0.36, P = 0.004), touching water (r = 0.35, P = 0.004), stepping out of a car (r = 0.32, P = 0.014), and experiencing an orgasm (r = 0.59, P = 0.001). The triggers: Experiencing an orgasm (r = 0.4, P = 0.033), having intercourse (r = 0.53, P = 0.002), stepping out of a car (r = 0.45, P = 0.001), and touching water (r = 0.28, P = 0.03) most significantly correlated with the total IIQ‐7 scores.

Conclusions

Certain somatic, psychological, and sexual factors may trigger OAB symptoms and are therefore potential targets for behavioral therapy of this disorder, and for further research regarding its pathophysiological mechanisms.     

Midline anterior repair alone vs anterior repair plus vaginal paravaginal repair: a comparison of anatomic and quality of life outcomes

Our aim was to study the anatomic recurrence rates and quality of life outcomes of patients who had undergone either anterior colporrhaphy (AC) or anterior colporrhaphy and vaginal paravaginal repair (AC + VPVR) as part of surgery for pelvic organ prolapse. Chart reviews were used to identify anatomic prolapse recurrence. Phone interviews assessed quality of life outcomes [Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ)] outcomes. There was a trend towards longer time to anatomic recurrence (any compartment ≥grade 2) in the AC group compared with the AC + VPVR group (median 24 vs 13 months, p=0.069). If only patients who had undergone previous surgery were compared, time to anatomic recurrence appeared significantly longer in the AC group (median 41 vs 12 months, p=0.022). There were 55% of women in the AC group and 46% of women in the AC + VPVR group who reported significant bladder or bulge symptoms based on responses to the phone-administered UDI and IIQ (p=0.89). Our retrospective study did not suggest that adding VPVR was superior in terms of anatomic or quality of life outcomes. Prospective assessment of the role of VPVR in the treatment of pelvic organ prolapse is needed.     

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.     

Identifying cut-off scores with neural networks for interpretation of the incontinence impact questionnaire

We propose to determine cut-off scores for the Incontinence Impact Questionnaire (IIQ) based on the neural network (NN) approach. These cut-off scores should discriminate between patients having poor, moderate, or good quality of life (QoL) secondary to their incontinence problems. Data from two prospectively completed QoL questionnaires, the IIQ (n = 237) and the MOS 36-Item Short-Form Health Survey (SF-36) (n = 237), were analyzed using NN and conventional statistical tools. Kohonen networks identified three distinct clusters of IIQ scores. The three clusters represent the full spectrum of possible scores on the IIQ. We interpreted these clusters as reflecting good, moderate, and poor QoL. We estimated that a score of less than 50 on the IIQ would be representative of good QoL, between 50 and 70 would be moderate QoL, and greater than 70 would be indicative of poor QoL. Validation with the SF-36 data confirmed these categories. The present study demonstrated that the NN approach is opening new areas in the interpretation and clinical usefulness of QoL questionnaires. NN allowed the identification of three levels of QoL and should be useful in clinical decision making.     

Use of the Dowell Bryant Incontinence Cost Index as a post-treatment outcome measure after non-surgical therapy

The aim of this study was to use the previously validated Dowell Bryant Incontinence Cost Index (DBICI) as a post-treatment outcome measure after non-surgical therapy and to determine whether the magnitude of reduced leakage would correlate with the magnitude of reduced personal cost. A simple urethral occlusive device (Femassist) was employed in 57 women with stress, urge, or mixed incontinence for 1 month. The DBICI was administered at baseline and after device use, along with a visual analogue scale (VAS) for severity of incontinence impact, a 3-day frequency volume chart (FVC) that documented leaks per 24 hours and pad usage, a 1-hour ICS pad test at standard volume, and two disease-specific quality of life measures (Urogenital Distress Inventory [UDI] and Incontinence Impact Questionnaire [IIQ]). The severity of leakage was significantly reduced on all parameters, and the median personal costs of incontinence fell from AU$6.52 per week (IQR 1.50-10.59) to a median of AU$ 1.57 per week (IQR 0-4.89). A significant correlation (Kendall's rank, tau) was observed between reduction in personal costs and reduction in VAS (tau = 0.24, P= 0.01), leaks/day (tau = 0.20, P = 0.03), pad test loss (tau = 0.29, P = 0.002), and quality of life scores (UDI, tau = 0.23, P = 0.01; IIQ, tau = 0.26, P = 0.005). The personal costs subset of the DBICI appears to be a useful outcome measure for urinary incontinence research and could be widely employed to assess the impact of continence treatments on the patient's economic burden.     

Development and psychometric characteristics of the SCI-QOL Ability to Participate and Satisfaction with Social Roles and Activities item banks and short forms

ObjectiveTo develop a spinal cord injury (SCI)-focused version of PROMIS and Neuro-QOL social domain item banks; evaluate the psychometric properties of items developed for adults with SCI; and report information to facilitate clinical and research use.DesignWe used a mixed-methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups helped define the constructs; cognitive interviews helped revise items; and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics.SettingFive SCI Model System sites and one Veterans Administration medical center.ParticipantsThe calibration sample consisted of 641 individuals; a reliability sample consisted of 245 individuals residing in the community.ResultsA subset of 27 Ability to Participate and 35 Satisfaction items demonstrated good measurement properties and negligible differential item functioning related to demographic and injury characteristics. The SCI-specific measures correlate strongly with the PROMIS and Neuro-QOL versions. Ten item short forms correlate >0.96 with the full banks. Variable-length CATs with a minimum of 4 items, variable-length CATs with a minimum of 8 items, fixed-length CATs of 10 items, and the 10-item short forms demonstrate construct coverage and measurement error that is comparable to the full item bank.ConclusionThe Ability to Participate and Satisfaction with Social Roles and Activities CATs and short forms demonstrate excellent psychometric properties and are suitable for clinical and research applications.     

The reliability and validity of three‐item screening measures for burnout: Evidence from group‐employed health care practitioners in upstate New York

We investigate the psychometric validity and reliability of three‐item screening measures for emotional exhaustion, depersonalization, and personal achievement comprising an abbreviated version of the Maslach Burnout Inventory®. Despite its utilization in multiple studies, the shortened instrument has not been sufficiently validated in diverse settings, populations, and organizational contexts. We examine its ability to assess burnout accruing from patient care practice in a rural, underserved area. Utilizing data from a cross‐sectional survey of 308 rural‐based medical professionals, we investigate how the three short‐form subscales of the nine‐item abbreviated inventory compare with their gold‐standard parent subscales from the original 22‐item human services scale in measuring corresponding dimensions of burnout. The findings provide significant evidence that the three‐item measures are valid and reliable proxies for the long‐form subscales. The short‐form measures are highly correlated with the original subscales and display high convergent and discriminant validity. Each of the abbreviated subscales manifests the kind of high sensitivity with adequate specificity that one would expect to see in a good screening instrument. We conclude that the short‐form measures can be utilized to rapidly screen human service professionals such as rural health care practitioners for symptoms of each of the three dimensions of burnout.     

Measuring psychological trauma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Psychological Trauma item bank and short form

ObjectiveTo describe the development and psychometric properties of the SCI-QOL Psychological Trauma item bank and short form.DesignUsing a mixed-methods design, we developed and tested a Psychological Trauma item bank with patient and provider focus groups, cognitive interviews, and item response theory based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision.SettingWe tested a 31-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Veterans Administration hospital.ParticipantsA total of 716 individuals with SCI completed the trauma itemsResultsThe 31 items fit a unidimensional model (CFI=0.952; RMSEA=0.061) and demonstrated good precision (theta range between 0.6 and 2.5). Nine items demonstrated negligible DIF with little impact on score estimates. The final calibrated item bank contains 19 itemsConclusionThe SCI-QOL Psychological Trauma item bank is a psychometrically robust measurement tool from which a short form and a computer adaptive test (CAT) version are available.