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Wuytack F, Moran P, Daly D, Panda S, Hannon K, Cusack C, O'Donovan M. A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence. Neurourol Urodyn 2021; 40:1275-1303. [PMID: 34082483 DOI: 10.1002/nau.24678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
AIM This systematic review aims to identify disease-specific and generic quality of life (QoL) outcome measurement instruments used in populations of women with urinary incontinence (UI) and to determine the most psychometrically robust and appropriate disease-specific and generic tools for measuring the quality of life in this population. METHODS A systematic search was conducted of PubMed, Embase, SCIELO, and CINAHL databases for studies evaluating measurement properties of QoL instruments in women with UI. The methodological quality of studies and the quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement INtruments (COSMIN) checklist and quality criteria. Overall, evidence for measurement properties was graded using the modified grading of recommendations, assessment, development & evaluation approach. RESULTS A total of 73 studies were included, and 27 specific and 6 generic instruments were identified. The Incontinence QoL questionnaire (IQoL) had the highest overall psychometric quality for English-speaking populations and was the most widely translated tool. Evidence for generic QoL tools in this population is limited. Few studies evaluated measurement error or cross-cultural validity. CONCLUSION The IQoL is the most psychometrically robust disease-specific tool for use in this population. More research is needed to determine the most psychometrically robust generic tool. Future studies should also evaluate measurement error and cross-cultural validity as evidence for these properties is particularly lacking.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Moran
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Hannon
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Maggie O'Donovan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J 2021; 32:2033-2092. [PMID: 34037815 DOI: 10.1007/s00192-021-04810-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these. METHODS Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included. RESULTS 85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF). CONCLUSIONS Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.
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Affiliation(s)
- Thomas G Gray
- Department of Urogynaecology and Pelvic Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, c/o Secretary, Room 27.3.024, Level Three, West Block, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Holly Vickers
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Priyanka Krishnaswamy
- Department of Urogynaecology, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; 10:CD005654. [PMID: 30288727 PMCID: PMC6516955 DOI: 10.1002/14651858.cd005654.pub4] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate. MAIN RESULTS The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
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Affiliation(s)
- Chantale Dumoulin
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - Licia P Cacciari
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - E Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineWellingtonNew Zealand
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Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, Parekh M, Tamussino K, Tosson S, Lose G, Petri E. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 2008; 19:5-33. [PMID: 18026681 PMCID: PMC2096636 DOI: 10.1007/s00192-007-0495-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/14/2007] [Indexed: 02/06/2023]
Affiliation(s)
- G Ghoniem
- Cleveland Clinic Florida, Weston, FL, USA.
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Liatsikos EN, Assimakopoulos K, Stolzenburg JU. Quality of Life after Radical Prostatectomy. Urol Int 2008; 80:226-30. [DOI: 10.1159/000127331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abdel-Fattah M, Ramsay I, Barrington JW. A simple visual analogue scale to assess the quality of life in women with urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2007; 133:86-9. [PMID: 16797114 DOI: 10.1016/j.ejogrb.2006.04.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 04/23/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
AIM The objective of this study is to determine whether a simple visual analogue scale; "incontinence bothersome scale (IBS)" can reliably assess the quality of life in women with urinary incontinence. DESIGN A prospective cohort study in a UK district general hospital. METHODS Two hundreds women with urinary incontinence participated in the study over 1-year period. They completed Kings health questionnaire version 7 (KHQ) and the incontinence bothersome scale (IBS). The results of the IBS were then compared to the total KHQ score and to each domain separately, using the Pearson correlation test. Women in the study were then classified into two main groups according to their urodynamics diagnosis (urodynamic stress incontinence group/detrusor overactivity group) and the total KHQ scores were compared with the IBS scores in each group. RESULTS The IBS scores had poor correlation with the total KHQ scores (r=0.656) and the difference between both arms was not statistically significant (p=0.084). Further analysis of KHQ domains showed that except for the impact of incontinence domain (r=0.728) all other domains correlated poorly to the IBS. This poor correlation pertained in sub-analysis of women with DO and USI (r=0.65 and 0.48, respectively). CONCLUSION This study has shown that a simple visual scale is not a reliable tool in assessing the QoL in women with urinary incontinence. A formal, validated and reliable QoL questionnaire is still the method of choice for QoL assessment, even if it takes longer to complete.
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Affiliation(s)
- M Abdel-Fattah
- Urogynaecology Unit, Southern General Hospital, South Glasgow University Hospitals, 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
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Matza LS, Brewster-Jordan J, Zyczynski TM, Bavendam T. An updated review of quality-of-life questionnaires for urinary incontinence and overactive bladder: Which ones to use and why. CURRENT BLADDER DYSFUNCTION REPORTS 2006. [DOI: 10.1007/s11884-006-0011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bushnell DM, Martin ML, Summers KH, Svihra J, Lionis C, Patrick DL. Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res 2006; 14:1901-13. [PMID: 16155777 DOI: 10.1007/s11136-005-5266-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2005] [Indexed: 10/25/2022]
Abstract
Urinary incontinence (UI) has substantial and important impacts on health-related quality of life. The purpose of this research is to report the psychometric performance of 15 different language versions of the Incontinence-specific Quality of Life (I-QOL)measure, a patient-reported outcome measure specific to stress, urge and mixed urinary incontinence. The multi-national dataset consisted of data from four clinical trials for stress incontinent females and from two additional population studies, enrolling women with stress, urge and mixed UI. All enrolled patients completed the I-QOL and comparative measures at baseline. The clinical trial populations had multiple administrations up to 12 weeks, and the two population studies included a shorter retest. Country-specific psychometric testing for validity, reliability, and responsiveness followed standardized procedures. Confirmatory factor analyses were performed to assess the I-QOL subscales. The I-QOL measurement model was confirmed as three subscales. Summary and subscale scores for the 15 versions were internally consistent (alpha values = 0.91-0.96) and reproducible (ICC = 0.72-0.97). Using changes in the independent measures of incontinence episode frequency standardized response means were predominantly strong (ranged 0.71-1.05) across 13 versions (out of 15) in association with these measures and effect sizes. These additional language versions of the I-QOL instrument demonstrate psychometric properties similar to the original version. The I-QOL has shown good results in both community studies and clinical trials with varying types and severity of urinary incontinence. It is a reliable and valid measure of HRQOL, suitable for use in a variety of international settings.
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Affiliation(s)
- Donald M Bushnell
- Health Research Associates, Inc, 6505 216th Street SW, Suite 105, Mountlake Terrace, WA 98403, USA.
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Ross S, Soroka D, Karahalios A, Glazener CMA, Hay-Smith EJC, Drutz HP. Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review. Int Urogynecol J 2005; 17:272-85. [PMID: 16025188 DOI: 10.1007/s00192-005-1357-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 06/20/2005] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Sue Ross
- Department of Obstetrics, Family Medicine and Community Health Sciences, University of Calgary, Canada.
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Bonniaud V, Raibaut P, Guyatt G, Amarenco G, Parratte B. Scores de symptômes et de qualité de vie au cours des troubles vésicosphinctériens. ACTA ACUST UNITED AC 2005; 48:392-403. [PMID: 15963831 DOI: 10.1016/j.annrmp.2005.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To identify all available symptom and quality of life questionnaires for men and women with urinary disorders and assess their psychometric properties. METHODS We systematically reviewed the literature in Medline using the key words urinary disorders, urinary incontinence, bladder, score, quality of life, questionnaire, and psychometric validation. RESULTS The first search using the terms urinary incontinence and quality of life resulted in 1018 Abstracts. Articles mentioning but not measuring quality of life were not investigated. Questionnaires were selected because their psychometric properties were tested and they assessed how much a person was bothered by urinary symptoms or quality of life specific to urinary disorders. The questionnaires were usually gender specific. Their psychometric value was far from uniform, and, for most, responsiveness was not reported. CONCLUSION Few quality of life questionnaires are at an advanced stage of validation to be applied in clinical practice. They need to be shorter, responsive and validated in different populations to permit their easy use.
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Affiliation(s)
- V Bonniaud
- Service de médecine physique et de réadaptation, hôpital Jean-Minjoz, boulevard Fleming, CHU de Besançon, 25 000 Besançon, France.
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Matza LS, Zyczynski TM, Bavendam T. A review of quality-of-life questionnaires for urinary incontinence and overactive bladder: which ones to use and why? Curr Urol Rep 2005; 5:336-42. [PMID: 15461908 DOI: 10.1007/s11934-004-0079-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Overactive bladder (OAB) and stress urinary incontinence have a profound impact on patients' health-related quality of life (HRQL). The purpose of this article is to identify and describe condition-specific HRQL measures validated among patients with symptoms of OAB or stress urinary incontinence. A Medline literature search was performed to identify published articles or abstracts focusing on the development and psychometric validation of relevant instruments. Target populations and psychometric properties (reliability, validity, responsiveness to change) of 16 questionnaires are reviewed. A range of well-validated, condition-specific HRQL measures are available. Recommendations are provided regarding which measures to use in different situations. When choosing among instruments, psychometric evidence and the match of an instrument to the study population should be considered.
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Affiliation(s)
- Louis S Matza
- MEDTAP International, Inc., Bethesda, MD 20814, USA.
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Bonniaud V, Jackowski D, Parratte B, Paulseth R, Grad S, Margetts P, Guyatt G. Quality of life in multiple sclerosis patients with urinary disorders: Discriminative validation of the english version of qualiveen. Qual Life Res 2005; 14:425-31. [PMID: 15892431 DOI: 10.1007/s11136-004-0686-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED The Qualiveen questionnaire is a urinary disorder (UD)-specific health related quality of life (HRQL) instrument. Recent data suggests Qualiveen has excellent validity in French-speaking multiple sclerosis (MS) patients. AIM To assess discriminative measurement properties of the English version of Qualiveen. METHODS Fifty-five Canadian MS out-patients completed a set of questionnaires, including Qualiveen, MSQOL-54, a MS-specific HRQL questionnaire, urinary function assessments and the Expanded Disability Status Scale (EDSS) twice at an interval of two to four weeks. RESULTS Qualiveen proved internally consistent (Cronbach's alpha coefficients 0.73 to 0.90 for the four Qualiveen domains) and test-retest reliable (intraclass correlation coefficients 0.88 to 0.94). Consistent with a priori predictions, we found a strong association between overall Qualiveen score and the degree of incontinence (0.63), a moderate correlation with the type of urinary symptoms (0.49), a weak association with manner of voiding (0.28) and weak or absent correlations with MSQOL-54 domains, EDSS bladder/bowel and global EDSS. Predictions proved generally accurate (weighted kappa = 0.65). CONCLUSION The internal consistency, test-retest reliability and cross-sectional construct validity of the English version of Qualiveen are excellent, and similar to the original French version. Further studies should explore Qualiveen's longitudinal validity and responsiveness.
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Affiliation(s)
- Véronique Bonniaud
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
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Abstract
BACKGROUND The most vulnerable older adults are often referred to as the frail elderly. There is a high prevalence of urinary incontinence (UI) in this population, yet there is little research to guide nurses in providing effective continence care to this vulnerable group of elders. OBJECTIVES To summarize current knowledge on UI in frail older adults and suggest future areas for research in this population. METHODS Existing literature about UI in the frail elderly was analyzed to generate a plan for future research. RESULTS Gaps exist in the knowledge base needed to guide the nursing care of incontinent frail elders in the following areas: effectiveness of interventions, caregiver characteristics and management models, prevalence, risk factors, and reliability and validity of outcome measures. There are barriers to conducting research in long-term care settings. CONCLUSIONS Despite the challenges inherent in doing research with incontinent frail elders, there is an urgent need for research to guide the nursing care of this population in all healthcare settings.
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Affiliation(s)
- Sandra Engberg
- School of Nursing, University of Pittsburgh, Pennsylvania, USA.
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Gray M, Wyman J. Is the Incontinence Impact Questionnaire Short Form (IIQ-7) a Clinically Useful Tool for WOC Nursing Practice? J Wound Ostomy Continence Nurs 2004; 31:317-24. [PMID: 15867706 DOI: 10.1097/00152192-200411000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mikel Gray
- WOCN Center for Clinical Investigation (CCI), USA
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Bonniaud V, Parratte B, Amarenco G, Jackowski D, Didier JP, Guyatt G. Measuring quality of life in multiple sclerosis patients with urinary disorders using the qualiveen questionnaire11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:1317-23. [PMID: 15295759 DOI: 10.1016/j.apmr.2003.09.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the impact of urinary disorders on multiple sclerosis (MS) patients' health-related quality of life and to examine the cross-sectional construct validity of Qualiveen, a questionnaire originally developed for spinal cord injury patients with urinary disorders, in patients with MS. DESIGN Cohort study. SETTING Neurourodynamic units in 3 French university hospitals. PARTICIPANTS Patients with MS (N=197). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We tested predictions about the relationships among clinical features, the French version of the Multiple Sclerosis Quality of Life questionnaire (SEP-59), the Expanded Disability Status Scale (EDSS), and the 4 domains of the 30-item Qualiveen. RESULTS Cross-sectional correlations among the 4 Qualiveen domains and type (range, .36-.54), number of symptoms (range, .23-.50), and severity of incontinence (.39-.68) were generally moderate to strong. The SEP-59 bowel and bladder function domain showed moderate to strong relationships with the Qualiveen (range, .39-.59). Relationships with other SEP-59 domains were generally weak (range, .22-.35), and with the EDSS they were very weak. Predictions proved generally accurate (weighted kappa=.61). CONCLUSIONS Our data supported the Qualiveen's validity as a discriminative instrument for use with patients with MS. Further studies should explore the Qualiveen's longitudinal validity and responsiveness.
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Abstract
The impact of urinary incontinence extends well beyond the evident physical and physiologic sequelae. Incontinence may leave affected persons in social, emotional, and mental disarray. Measuring the psychosocial impact of a disease, however, is difficult,and there is no single best tool to achieve such an assessment. Several incontinence-specific tools have been devised to document the impact of this condition and are described briefly in this review. Outcome measures have, until recently, focused on objective data; however, from the patient's viewpoint, subjective psychosocial measures may be a better reflection of the success ofa treatment intervention. For a variety of reasons, the majority of affected persons do not seek help. If the full benefit of treatment options is to be realized, the health care provider actively should seek a history of incontinence in patients who may be ashamed or embarrassed.
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Affiliation(s)
- Ramzi R Hajjar
- Saint Louis University Health Sciences Center, Division of Geriatric Medicine, 1402 S. Grand Boulevard, Room M238, St. Louis, MO 63104, USA
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Hägglund D, Walker-Engström ML, Larsson G, Leppert J. Changes in urinary incontinence and quality of life after four years. A population-based study of women aged 22-50 years. Scand J Prim Health Care 2004; 22:112-7. [PMID: 15255492 DOI: 10.1080/02813430410005676] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI. DESIGN A 4-year follow-up population-based cohort study. SETTING Surahammar, Sweden, a community of 10,500 inhabitants. SUBJECTS All 118 incontinent and 130 continent women aged between 22 and 50 years. MAIN OUTCOME MEASURES Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey. RESULTS The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help. CONCLUSIONS At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.
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Affiliation(s)
- Doris Hägglund
- Centre of Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden.
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Homma Y, Uemura S. Use of the short form of King's Health Questionnaire to measure quality of life in patients with an overactive bladder. BJU Int 2004; 93:1009-13. [PMID: 15142153 DOI: 10.1111/j.1464-410x.2003.04771.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop a short version of the King's Health Questionnaire (KHQ), as there is a practical need to have a shorter version to summarize the eight domain scores into fewer domains. PATIENTS AND METHODS Data from 293 patients were obtained from a randomized, double-blind, placebo-controlled clinical trial in Japan of oxybutynin and tolterodine in patients with symptoms of an overactive bladder. The KHQ has two single-item and six multiple-item domains. To construct the short form of the KHQ one item was selected from the each of multiple-item domains, based on standardized structural coefficients estimated by confirmatory factor analysis (CFA) in a previous study. These six items include the domains: 'daily activities from role limitation', 'travel from physical limitation', 'social life from social limitation', 'family life from personal relationship', 'depressed from emotion' and 'tired from sleep and energy'. Based on the six selected items a series of psychometric analyses were conducted. RESULTS Exploratory factor analysis (EFA) with promax rotation identified two factors 'limitation of daily life' (LDL) and mental health. LDL consisted of 'daily activities', 'travel' and 'social life', and mental health included 'family life', 'depressed' and 'tired'. Based on the results from the EFA, the second-order factor structure was tested by CFA. The model fitted the data well for both the male and female model. The KHQ short form showed excellent reliability with Cronbach's alpha coefficients for LDL and mental health for both genders. The domains in the short form were responsive to clinical efficacy variables, and had statistically significant sensitivity to change in the patients' perception of bladder condition in all domains. CONCLUSION These analyses confirm the psychometric properties and clinical validity of the short-form KHQ, which appears to offer a practical, valid and reliable health-related quality-of-life instrument.
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Affiliation(s)
- Y Homma
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Uemura S, Homma Y. Reliability and validity of King's Health Questionnaire in patients with symptoms of overactive bladder with urge incontinence in Japan. Neurourol Urodyn 2004; 23:94-100. [PMID: 14983417 DOI: 10.1002/nau.10169] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS The purpose of this study is to evaluate the psychometric properties of the Japanese version of the King's Health Questionnaire (KHQ) in patients with symptoms of overactive bladder (OAB) with urge incontinence. METHODS Data from a 12-week, randomized, double-blind, placebo-controlled clinical trial comparing tolterodine with oxybutynin in patients with symptoms of OAB in Japan were analyzed. Cronbach's alpha coefficient was calculated as a reliability index. Inter-domain correlation was calculated for convergent and discriminant validity assessment. A factor analysis was conducted to explore the underlying factor structure of the KHQ. Sensitivity to clinical change was also evaluated. RESULTS The psychometric properties and clinical validity of the KHQ Japanese version were confirmed in this study population, and were similar between males and females. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of >0.60, indicating reasonable consistency except for the personal relationship domain in males (0.47) and severity (coping) measure domain in females (0.59). Discriminant, convergent, and construct validity of the KHQ were also good, with the factor analysis identifying those factors which the KHQ was intended to measure. Finally, KHQ domains were generally responsive to clinical efficacy variables; the KHQ also showed statistically significant sensitivity to change in patients' perception of bladder condition in all domains, except General Health Perception. CONCLUSIONS Our analyses confirm psychometric properties and clinical validity of the KHQ Japanese version, which appears to offer a valid and reliable HRQoL instrument for use in clinical trials of antimuscarinics in Japan.
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Affiliation(s)
- Shinichi Uemura
- Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan.
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Stothers L. Reliability, validity, and gender differences in the quality of life index of the SEAPI-QMM incontinence classification system. Neurourol Urodyn 2004; 23:223-8. [PMID: 15098217 DOI: 10.1002/nau.20001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate reliability and validity of the SEAPI-QMM 15-item quality of life index and assess differences between male and female patients with urinary incontinence. MATERIALS AND METHODS Twice pre- and once post-treatment, 315 patients (102 men, 213 women) with incontinence and 35 without incontinence completed the self-directed SEAPI-QMM quality of life index. A voiding diary reported frequency of incontinence episodes with number of pads or type of protection used daily for incontinence. In 30%, the Nottingham Health Profile (NHP) was administered to further validate the measure. RESULTS Cronbach's alpha coefficient for the index was 0.91. Domain-specific alpha coefficients ranged from 0.88 to 0.73. Test-retest reliability scores at 5 days gave a reliability coefficient of 0.93. Split half reliability was 0.89. Correlation of the index with the NHP was 0.78 for women, 0.72 for men. Mean scores before and after treatment with medical or surgical management were significantly different in both genders and were sensitive to the presence or absence of use of protection and the type of protection chosen in men. Men with incontinence (61%) reported a high level of impact in the sexuality domain compared to 7% of women. CONCLUSIONS The SEAPI quality of life index has a high degree of reliability relating to stability and internal consistency across a wide age range in both genders. There are differences between men and women in life domains most frequently affected by urinary incontinence.
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Affiliation(s)
- Lynn Stothers
- Department of Surgery, Division of Urology, and Department of Health Care and Epidemiology, University of British Columbia, #590-1144 Burrard Street, Vancouver, BC, Canada V6Z 2A5.
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Abstract
Cross-cultural research often involves physicians, nurses, and other health care providers. In studies of fecal and urinary incontinence, cross-cultural research has been applied to quality-of-life comparisons, and instruments have been translated to foreign languages for use in other countries. This report presents some of the principal methodological issues and problems associated with translating questionnaires for use in cross-cultural research in a manner relevant to clinicians and health care practitioners who are aware that, unless these potential problems are addressed, the results of their research may be suspect. Translation is the most common method of preparing instruments for cross-cultural research and has pitfalls that threaten validity. Some of these problems are difficult to detect and may have a detrimental effect on the study results. Identification and correction of problems can enhance research quality and validity. A method for translation and validation is presented in detail. However, the specific validation method adopted is less important than the recognition that the translation process must be appropriate and the validation process rigorous.
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Affiliation(s)
- Ami D Sperber
- Department of Gastroenterology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
The evaluation and treatment of female pelvic floor disorders is an evolving sub-specialty in urology. Recent attention has been directed toward more rigorous evaluation of treatment efficacy and durability of female urologic procedures. Throughout the past few decades, questionnaires have emerged as important subjective instruments for evaluation. Today, practitioners must choose from a burgeoning amount of questionnaires. This staggering number of questionnaires has raised two important issues: which questionnaire should be used in a female urology practice and should more refined criteria be developed for evaluating questionnaires to make the decision easier?
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Affiliation(s)
- Christopher E Kelly
- Department of Urology, New York University School of Medicine, 150 East 32nd Street, New York, NY 10016, USA.
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van der Vaart CH, de Leeuw JRJ, Roovers JPWR, Heintz APM. Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 2003; 22:97-104. [PMID: 12579625 DOI: 10.1002/nau.10038] [Citation(s) in RCA: 180] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- C Huub van der Vaart
- Department of Obstetrics, Neonatology and Gynecology, University Medical Center, Utrecht, The Netherlands.
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Abstract
AIMS To identify the characteristics of optimal symptom questionnaires in women with lower urinary tract symptoms (LUTS). METHODS Literature review. RESULTS Although numerous questionnaires have been developed for the evaluation of female LUTS, no one instrument has emerged as that preferred for collecting and reporting subjective information about LUTS in women. Questionnaires currently available range widely in intended purpose, extent and style, and in the quality of testing used to validate them. CONCLUSIONS Questionnaires should be constructed based on scientifically sound validation techniques that reflect disease and/or symptoms in the target population. They should be concise, easily administered and scored, discriminant between sphincter and bladder causes of incontinence, and able to measure severity and the effect of the symptom on the patient.
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“Oh, Thatʼs a Bit of a Nuisance”. J Wound Ostomy Continence Nurs 2002. [DOI: 10.1097/00152192-200211000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Vaart CH, de Leeuw JRJ, Roovers JPWR, Heintz APM. The effect of urinary incontinence and overactive bladder symptoms on quality of life in young women. BJU Int 2002; 90:544-9. [PMID: 12230614 DOI: 10.1046/j.1464-410x.2002.02963.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the consequences that the symptoms of urinary incontinence and an overactive bladder have on the quality of life in young, community-dwelling women. SUBJECTS AND METHODS A population-based, cross-sectional cohort study was conducted in women aged 20-45 years. Urogenital symptoms and quality of life were assessed using standardized questionnaires, e.g. the Urogenital Distress Inventory and Incontinence Impact Questionnaire. RESULTS The prevalence of symptoms of stress incontinence (39%), urge incontinence (15%) and an overactive bladder (12%) was high in this young population. Compared with urge incontinence, the symptoms of an overactive bladder similarly reduced the quality of life, but stress incontinence did not significantly affect the quality of life. Women with symptoms of an overactive bladder were especially limited in their mobility, whereas urge incontinence was especially associated with feelings of embarrassment. Although many women reported to be bothered by their symptoms, only a minority consulted their physician for them. CONCLUSIONS The symptoms of urinary incontinence and overactive bladder are common among young adult women and have the same detrimental effect on quality of life as urge incontinence. The reduction in mobility associated with overactive bladder symptoms may be especially distressing for these young and active women.
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Affiliation(s)
- C H van der Vaart
- Research Group of Pelvic Floor, Department of Obstetrics and Gynaecology, University Medical Centre, Utrecht, The Netherlands.
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Coyne K, Revicki D, Hunt T, Corey R, Stewart W, Bentkover J, Kurth H, Abrams P. Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: the OAB-q. Qual Life Res 2002; 11:563-74. [PMID: 12206577 DOI: 10.1023/a:1016370925601] [Citation(s) in RCA: 456] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Overactive bladder (OAB) is characterized by symptoms of urinary frequency and urgency, with and without incontinence, and has been shown to have significant impact on health-related quality of life (HRQL). Currently, no OAB-specific questionnaires exist to evaluate all symptoms of OAB; thus we sought to evaluate the psychometric properties of a newly developed OAB HRQL questionnaire. METHODS The 33-item, self-administered OAB-q contains a symptom bother and HRQL scale. Both the OAB-q and SF-36 were completed by participants from two sources: (1) a community sample who screened positive for OAB in a random-digit dial telephone survey and participated in a clinical validation study (n = 254); and (2) a clinical study of patients' seeking treatment for OAB symptoms (baseline assessment) (n = 736). Item and exploratory factor analysis were performed to assess the subscale structure of the questionnaire. Psychometric evaluation was conducted to assess reliability and validity. RESULTS Seventy-four percent of the sample were women with mean age of 58.5. Participants with continent and incontinent symptoms reported significantly greater symptom bother and HRQL impact than normal participants. Significant differences were present among all patient groups in all OAB-q subscales (p < 0.0001) except sleep where the impact of continent and incontinent OAB was similar, but significantly worse than normal participants (p < 0.0001). Internal consistency was high with the subscale Cronbach alpha-values ranging from 0.86 to 0.94. CONCLUSION The OAB-q is a reliable and valid instrument that discriminates between normal and clinically diagnosed continent and incontinent OAB participants. The OAB-q demonstrates that both continent and incontinent OAB symptoms cause significant symptom bother and have a negative impact on HRQL.
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Affiliation(s)
- K Coyne
- MEDTAP International, Inc., Bethesda, MD 20814, USA.
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Affiliation(s)
- G Willy Davila
- Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic, Ft. Lauderdale, Florida, USA.
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Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 2001; 185:1388-95. [PMID: 11744914 DOI: 10.1067/mob.2001.118659] [Citation(s) in RCA: 434] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ). METHODS The PFDI and PFIQ are based on the structure and content of two previously validated questionnaires (the Urinary Distress Inventory [UDI] and the Incontinence Impact Questionnaire [IIQ]) and have additional questions regarding pelvic organ prolapse and colorectal dysfunction. The PFDI assesses symptom distress in women with pelvic floor disorders and has 3 scales: UDI (28 items), Colorectal-anal Distress Inventory (17 items), and Pelvic Organ Prolapse Distress Inventory (16 items). The PFIQ assesses life impact and also has 3 scales: IIQ, Colorectal-anal Impact Questionnaire, and the Pelvic Organ Prolapse Impact Questionnaire (31 items each). One hundred women with pelvic floor symptoms were enrolled and completed both the PFDI and PFIQ at baseline and again 1 week later. Patients underwent a comprehensive evaluation that included a structured history, Pelvic Organ Prolapse Quantitation, and a 1-week prospective bowel/bladder diary. Patients with urinary incontinence and stage III or IV pelvic organ prolapse also had a urodynamic evaluation. RESULTS Each scale of the PFDI and PFIQ proved to be internally consistent (alphas: PFDI.82-.89; PFIQ.96-.97) and reproducible (interclass correlations: PFDI.86-.87; PFIQ.77-.92). Both the UDI and the IIQ significantly correlated with the number of urinary incontinence episodes per week (rho =.26, P <.05; rho =.46, P <.0001, respectively) and the number of pads used per week (rho =.26, P <.05; rho =.40, P <.0001, respectively). The Pelvic Organ Prolapse Distress Inventory and the Pelvic Organ Prolapse Impact Questionnaire significantly correlated with the stage of prolapse (rho =.32 and rho =.33, P <.01 each), and the Colorectal-anal Distress Inventory and Colorectal-anal Impact Questionnaire significantly correlated with the number of fecal incontinence episodes per month (rho =.49, P <.0001 and rho =.30, P <.01) and a diagnosis of defecatory dysfunction (rho =.47, P <.0001 and rho =.29, P <.01). The total time taken to complete both instruments averaged 23 minutes (range, 9-55). CONCLUSION The PFDI and the PFIQ are reliable, valid, condition-specific quality of life instruments for women with pelvic floor disorders.
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Affiliation(s)
- M D Barber
- Division of Gynecologic Specialties, Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC, USA
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FitzGerald MP, Kenton K, Shott S, Brubaker L. Responsiveness of quality of life measurements to change after reconstructive pelvic surgery. Am J Obstet Gynecol 2001; 185:20-4. [PMID: 11483898 DOI: 10.1067/mob.2001.116364] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine whether Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores are sensitive to changes in clinical status after surgery for genuine stress incontinence (GSI) or pelvic organ prolapse (POP). STUDY DESIGN Patients were included in this study if they had completed the IIQ-7 and UDI-6 scales and had undergone urodynamic testing before and 3 months after surgery for GSI or POP. Kruskal-Wallis tests and logistic regression were used to compare IIQ-7 and UDI-6 scores according to the outcome of surgery. RESULTS Among 55 patients satisfying inclusion criteria for the study, 34 (62%) underwent Burch colposuspension, and 21 (38%) underwent suburethral sling procedures for GSI; 44 (80%) patients were subjectively continent after surgery. Thirty-four (62%) patients underwent surgical treatment of their POP; 31 (90%) were subjectively cured of their POP symptoms. Mean IIQ-7 and UDI-6 scores were lower in patients who were subjectively continent, and UDI-6 scores were lower in patients who were objectively cured of GSI. CONCLUSION UDI-6 and IIQ-7 scores change after surgery for GSI and POP, with patients who are subjectively continent having lower postoperative scores on both scales.
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Affiliation(s)
- M P FitzGerald
- Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL, USA.
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Harvey MA, Kristjansson B, Griffith D, Versi E. The Incontinence Impact Questionnaire and the Urogenital Distress Inventory: a revisit of their validity in women without a urodynamic diagnosis. Am J Obstet Gynecol 2001; 185:25-31. [PMID: 11483899 DOI: 10.1067/mob.2001.116369] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to assess validity of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI) (long and short forms) in incontinent women previously urodynamically undiagnosed. STUDY DESIGN Post hoc analysis of responses to the IIQ and UDI questionnaires were obtained from a trial on a urethral device in community-dwelling incontinent women. Internal consistency and validity were evaluated against the 1-hour pad test. RESULTS Internal consistency (Cronbach's alpha) for the long forms was high for the IIQ and moderately high for the UDI, good for the IIQ-short, but poor for the UDI-short. Correlations with 1h pad test were low and non-significant for both versions. Correlation of the short with the long forms was high. CONCLUSION In the community-dwelling population, without a urodynamic diagnosis, neither long nor short versions of the questionnaires correlate with the severity of the urinary incontinence as shown by the pad test. The validity of the current questionnaires in women without urodynamic diagnosis is questionable.
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Affiliation(s)
- M A Harvey
- Department of Obstetrics and Gynecology, University of Ottawa, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6.
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Testing of the Incontinence Impact Questionnaire (IIQ-7) With Men After Radical Prostatectomy. J Wound Ostomy Continence Nurs 2000. [DOI: 10.1097/00152192-200011000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND One of the more prevalent conditions associated with aging is urinary incontinence (UI), which may affect up to 55% of women and 34% of men older than 65 years. As a result of increasing longevity in developed nations, the proportion of UI-susceptible individuals continues to grow, presenting clinical and economic challenges to healthcare providers. OBJECTIVE To assist the clinician in making informed decisions regarding UI, provide information on the wider ramifications of the disease, and provide a comprehensive overview of the condition. DATA SOURCES MEDLINE (1966-December 1998) was searched for relevant publications using the following search terms: UI, UI in the elderly, treatment of UI, oxybutynin, flavoxate, vasopressin, quality of life in UI, and economic impact of UI. DATA SYNTHESIS Key articles relating to the etiology, diagnosis, classification, economic burden, quality of life, and treatment of UI were retrieved, and this information formed the basis of the review. CONCLUSIONS Although UI can be controlled relatively well with existing therapies, only about 50% of affected patients may actually seek care. There are a variety of therapeutic options available for the treatment of UI, although pharmacologic intervention is presently a relatively minor component of overall care; this suggests that effective drug therapy might play a more significant role in the future. The economic burden associated with the care of the incontinent patient is substantial, and in the US the direct medical cost of the disease was estimated at $25.5 billion in 1995. The disease also has a large impact on the individual UI patient, negatively affecting many parameters normally associated with a tolerable health-related quality of life.
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Affiliation(s)
- J A Couture
- Internal Medicine and Geriatric Medicine Division, Hôtel-Dieu de Lévis, Québec, Canada.
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Brittain KR, Perry SI, Peet SM, Shaw C, Dallosso H, Assassa RP, Williams K, Jagger C, Potter JF, Castleden CM. Prevalence and impact of urinary symptoms among community-dwelling stroke survivors. Stroke 2000; 31:886-91. [PMID: 10753993 DOI: 10.1161/01.str.31.4.886] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To establish prevalence of urinary symptoms among community-dwelling stroke survivors and how these symptoms affected lives of these survivors compared with a nonstroke population. METHODS The present study was a community-based postal survey in Leicestershire community, UK (that excluded institutional settings), that was designed to track stroke, urinary, and bowel symptoms and the effect of such symptoms on relationships, social life, daily activities, and overall quality of life. Subjects included 14 600 people who were living in the community and </=40 years of age, randomly selected from the Leicestershire Health Authority Register. RESULTS A 70% response rate was achieved with the return of 10 226 questionnaires. Prevalence of reported stroke was 4% (n=423). Prevalence of urinary symptoms was 34% (n=3197). Overall, stroke survivors had a higher prevalence of symptoms than the nonstroke population (64% to 32%, respectively). These symptoms were reported to have more of an effect on the lives of the stroke survivors compared with the nonstroke population even when adjusted for age and sex differences. This reported impact was not related to the stroke per se but to the severity of the urinary symptoms. CONCLUSIONS These data show a high prevalence of urinary symptoms among community-dwelling stroke survivors. These symptoms were reported to have considerable impact on the lives of stroke survivors, which needs to be taken into account in future research and clinical practice.
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Affiliation(s)
- K R Brittain
- Division of Medicine for the Elderly, Leicester General Hospital, Leicester, England
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Abstract
Quality of life assessments have become increasingly important for the assessment of urinary incontinent women. The advent of validated condition-specific questionnaires with proven reliability and sensitivity to clinical change has encouraged their inclusion in clinical trials of continence care. Only by fully understanding the impact of urinary incontinence on quality of life of women can we hope to improve its treatment.
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DuBeau CE, Kiely DK, Resnick NM. Quality of life impact of urge incontinence in older persons: a new measure and conceptual structure. J Am Geriatr Soc 1999; 47:989-94. [PMID: 10443861 DOI: 10.1111/j.1532-5415.1999.tb01295.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a condition-specific measure for assessing the impact of urge urinary incontinence (UI) on the quality of life (QoL) of older persons. DESIGN A 32-item Urge Impact Scale (URIS) was drafted using content area data from focus groups composed of urge incontinent older persons. Pilot testing in 21 urge incontinent persons (mean age 67.7 years) resulted in the elimination of eight items by internal consistency, skew, and patient response criteria. The resulting scale (URIS-24) was tested for reliability (internal consistency and test-retest correlation) and construct validity (correlation with UI severity from voiding records) in a separate group of 27 urge incontinent persons (89% women, mean age 72 years). Factor analysis of URIS-24 data from the combined 48 persons was used to explore the conceptual structure underlying urge UI-related QoL. SETTING University-affiliated community-based practice and tertiary hospital. PARTICIPANTS Community-dwelling women and men, older than age 60 and with urge incontinence at least twice weekly, recruited from newspaper, newsletter, and radio advertisements. RESULTS Cronbach's alpha for URIS-32 was 0.84, and for URIS-24 it was 0.94. When administered (mean +/- standard deviation) 9.2 +/- 5.1 days apart, URIS-24 had good test-retest reliability for total scores (interclass coefficient = .88, concordance coefficient = .88), and individual item scores at time 2 were within 1 point (on a 5-category Likert scale) of time 1 answers for 89% of responses. URIS-24 scores had modest but nearly significant correlation with the number of UI episodes (r = -0.39, P = .05). Factor analysis revealed a three component structure corresponding to psychological burden, perception of personal control, and self concept. CONCLUSIONS The URIS-24 is an internally-consistent, highly reproducible tool for the assessment of the QoL impact of urge UI on older persons. It can be used to evaluate QoL impact by specific items as well as by overall score. Compared with other UI-specific QoL measures, the URIS-24 had similar or superior internal consistency, test-retest reliability, and validity, but it is the first measure designed and tested specifically for older persons with urge UI. These results also highlight the multifactorial structure of urge UI-related QoL and the importance of its psychological dimensions.
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Affiliation(s)
- C E DuBeau
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kobelt G, Kirchberger I, Malone-Lee J. Review. Quality-of-life aspects of the overactive bladder and the effect of treatment with tolterodine. BJU Int 1999; 83:583-90. [PMID: 10233562 DOI: 10.1046/j.1464-410x.1999.00004.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G Kobelt
- Health Dynamics, Eschentzwiller, France
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Effect of a Vaginal Device on Quality of Life With Urinary Stress Incontinence. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199903000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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URINARY INCONTINENCE AMONG ELDERLY PERSONS WHO LIVE AT HOME. Nurs Clin North Am 1998. [DOI: 10.1016/s0029-6465(22)02610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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DuBeau CE, Levy B, Mangione CM, Resnick NM. The impact of urge urinary incontinence on quality of life: importance of patients' perspective and explanatory style. J Am Geriatr Soc 1998; 46:683-92. [PMID: 9625182 DOI: 10.1111/j.1532-5415.1998.tb03801.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The impact of urinary incontinence (UI) on health-related quality of life (QoL) is significant yet variable, but little is known about patient-defined content areas regarding the influence of UI on QoL and whether patient-specific factors correlate with specific content areas of UI-related QoL. In order to identify the most valid content areas for a new UI-related QoL questionnaire, our primary goal was to determine the content areas of greatest concern regarding UI-related QoL among older persons with urge incontinence. The second goal was to examine the possible role of patients' explanatory style as a mediator of UI impact on health-related QoL. Data on the questionnaire will be presented elsewhere. DESIGN Focus groups comprising urge-incontinent persons were used to obtain verbatim descriptions of the impact of UI on QoL. SETTING A university-affiliated tertiary hospital. PARTICIPANTS Community-dwelling women (n = 25) and men (n = 5) more than 60 years of age, with urge incontinence, recruited from newspaper, newsletter, and radio advertisements. MEASUREMENTS Qualitative content analysis of focus group transcripts was used to determine QoL items. These were compared with previously described UI-related QoL items obtained from the literature. Subjects' statements regarding causes of UI were evaluated for predominant explanatory style. RESULTS Thirty-two UI-related QoL items were identified, more than half of which were not described previously. Compared with expert-defined UI-related QoL items from the literature, patient-defined items focused more on coping with embarrassment and interference from UI than on prevention of actual activity performance. Explanatory statements were made frequently by patients talking about their UI. Although positive style explanatory statements were most common, they did not correlate with any QoL items. By contrast, there was a significant correlation between negative explanatory style and six specific UI-related QoL items. CONCLUSIONS Focus groups of older persons with urge incontinence suggest that experts and patients view the impact of urge UI on QoL differently. Whereas experts focus more on functional impact, patients more often cite the impact of UI on their emotional well-being and on the interruption of activities. In addition, the association between negative explanatory style and specific UI-related QoL items suggests that explanatory style may be an important mediator of patients' perceptions of UI-related QoL.
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Affiliation(s)
- C E DuBeau
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Division on Aging, Harvard Medical School, Boston, Massachusetts 02115, USA
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Duckett JR. The use of periurethral injectables in the treatment of genuine stress incontinence. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:390-6. [PMID: 9609263 DOI: 10.1111/j.1471-0528.1998.tb10121.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J R Duckett
- Department of Obstetrics and Gynaecology, Heartlands Hospital, Bordesley Green East, Birmingham
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J. Skelly and K. Kenny Clinical Effectiveness in Nursing (1998) 2, 4–10The impact of the nurse continence advisor on continence care. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s1361-9004(98)80077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVES Psychosocial adjustment to illness is an important as the status of the physical disease itself; focusing on this necessitates some measurement of abstract, subjective feelings of "quality of life" (QOL). Assessments of QOL are particularly important for conditions such as urinary incontinence (UI) that have little or no impact on mortality. METHODS This presentation describes the reasons for, and methods of, measuring lower urinary tract symptoms and disease impact. Validated instruments available for such measurements are reviewed, as are published studies that address the impact of UI (and urge incontinence in particular) on QOL. Potential applications for these new disease measures are discussed. RESULTS The bladder is an unreliable witness, and symptom assessment is diagnostically disappointing; cystometry is essential if a definitive diagnosis is required. However, objective tests take no account of the patient's perception of the problem. General health status questionnaires have been used to show that urge incontinence is associated with emotional problems, reduced social and recreational activity, and sexual dysfunction. Newly developed, condition-specific instruments have greater specificity and, hence, improved sensitivity for measuring incontinence and its impact. These instruments have the potential for monitoring disease progression and evaluating treatment outcome. CONCLUSIONS In a proportion of people with bladder overactivity, the disorder has a profound impact on the QOL. Methods of measuring this impact have been developed that may allow identification of this group of individuals while also improving the assessment of treatment efficacy. However, this science is in its infancy and these dimensions await further exploration.
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Affiliation(s)
- S Jackson
- Bristol Urological Institute, Southmead Hospital, United Kingdom
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Naughton MJ, Wyman JF. Quality of Life in Geriatric Patients With Lower Urinary Tract Dysfunction. Am J Med Sci 1997. [DOI: 10.1016/s0002-9629(15)40204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Lower urinary tract dysfunctions, such as urinary incontinence, detrusor instability, and benign prostatic hyperplasia, are prevalent in older adults. These conditions, which can occur alone or in combination, result in irritative or obstructive symptoms that can interfere with everyday functioning, leading to negative consequences on health-related quality of life. The nature and severity of these symptoms and the perception of their impact on daily activities can be quite variable. Until recently, relatively little was known about the effect of lower urinary tract dysfunctions on general health status and quality of life. An increasing research base is now available that shows the impact of different urologic dysfunctions in clinical and general populations. This article will provide a brief background on the definition and measurement of health-related quality of life and will summarize the literature about the quality of life of community-dwelling elderly patients with urinary incontinence or prostate conditions. Implications to guide clinical practice and future research will be derived.
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Affiliation(s)
- M J Naughton
- Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1063, USA.
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Duckett JR. Women with urinary incontinence should be referred to a specialist. BMJ (CLINICAL RESEARCH ED.) 1996; 313:754. [PMID: 8819466 PMCID: PMC2352127 DOI: 10.1136/bmj.313.7059.754b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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