Quality of Life, Psychological Wellbeing, and Sexuality in Women with Urinary Incontinence—Where Are We Now: A Narrative Review

Enhanced recovery after surgery (ERAS) in prolapse repair: A prospective study on pre-emptive uterosacral/cervical block

OBJECTIVE

Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery.

METHODS

This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively.

RESULTS

We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180).

CONCLUSIONS

For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.

AI-Enhanced evaluation of YouTube content on post-surgical incontinence following pelvic cancer treatment

Background

Several pelvic area cancers exhibit high incidence rates, and their surgical treatment can result in adverse effects such as urinary and fecal incontinence, significantly impacting patients' quality of life. Post-surgery incontinence is a significant concern, with prevalence rates ranging from 25 to 45% for urinary incontinence and 9-68% for fecal incontinence. Cancer survivors are increasingly turning to YouTube as a platform to connect with others, yet caution is warranted as misinformation is prevalent.

Objective

This study aims to evaluate the information quality in YouTube videos about post-surgical incontinence after pelvic area cancer surgery.

Methods

A YouTube search for "Incontinence after cancer surgery" yielded 108 videos, which were subsequently analyzed. To evaluate these videos, several quality assessment tools were utilized, including DISCERN, GQS, JAMA, PEMAT, and MQ-VET. Statistical analyses, such as descriptive statistics and intercorrelation tests, were employed to assess various video attributes, including characteristics, popularity, educational value, quality, and reliability. Also, artificial intelligence techniques like PCA, t-SNE, and UMAP were used for data analysis. HeatMap and Hierarchical Clustering Dendrogram techniques validated the Machine Learning results.

Results

The quality scales presented a high level of correlation one with each other (p < 0.01) and the Artificial Intelligence-based techniques presented clear clustering representations of the dataset samples, which were reinforced by the Heat Map and Hierarchical Clustering Dendrogram.

Conclusions

YouTube videos on "Incontinence after Cancer Surgery" present a "High" quality across multiple scales. The use of AI tools, like PCA, t-SNE, and UMAP, is highlighted for clustering large health datasets, improving data visualization, pattern recognition, and complex healthcare analysis.

Assessing the Quality of YouTube's Incontinence Information after Cancer Surgery: An Innovative Graphical Analysis

BACKGROUND

Prostate and colorectum cancers rank among the most common cancers, and incontinence is a significant postsurgical issue affecting the physical and psychological well-being of cancer survivors. Social media, particularly YouTube, has emerged as a vital source of health information. While YouTube offers valuable content, users must exercise caution due to potential misinformation.

OBJECTIVE

This study aims to assess the quality of publicly available YouTube videos related to incontinence after pelvic cancer surgery.

METHODS

A search on YouTube related to "Incontinence after cancer surgery" was performed, and 108 videos were analyzed. Multiple quality assessment tools (DISCERN, GQS, JAMA, PEMAT, and MQ-VET) and statistical analyses (descriptive statistics and intercorrelation tests) were used to evaluate the characteristics and popularity, educational value, quality, and reliability of these videos, relying on novel graphical representation techniques such as Sankey and Chord diagrams.

RESULTS

Strong positive correlations were found among quality rating scales, emphasizing agreement. The performed graphical analysis reinforced the reliability and validity of quality assessments.

CONCLUSIONS

This study found strong correlations among five quality scales, suggesting their effectiveness in assessing health information quality. The evaluation of YouTube videos consistently revealed "high" quality content. Considering the source is mandatory when assessing quality, healthcare and academic institutions are reliable sources. Caution is advised with ad-containing videos. Future research should focus on policy improvements and tools to aid patients in finding high-quality health content.

[Psychosocial consequences of urinary incontinence - tabooed and undertreated: a systematic review]

BACKGROUND

Urinary incontinence is a significant health problem that can affect both women and men of all ages. It is not a life-threatening condition, but symptoms can have a strong impact on the physical, psychological and social well-being of those affected. Existing literature mainly reports on incontinent patients over 65 years of age. Studies about stress and effects of incontinence in younger patients are limited. Incontinence is a social taboo subject, with few sufferers seeking professional help for reasons of shame. Some incontinent individuals seek support when symptoms worsen and further reduce their quality of life. This study aims to explain which psychosocial stresses and effects of urinary incontinence in adults are described in the literature and how those affected experience these.

METHODS

A systematic literature search was performed for the years 2007 to 2022 in the databases CINAHL, Cochrane Database of Systematic Reviews via OvidSP, PsycINFO via OvidSP and PubMed. In addition to the research in the databases, a hand search was carried out on the internet and via the reference lists of the included and critically evaluated articles.

RESULTS

Incontinence affects the entire life of those affected. Incontinent patients suffer from low self-esteem and shame. They reduce physical activities, have fewer social contacts and experience problems in working life. The condition often leads to impairments in partnership and sexuality. Younger patients have a higher level of suffering than older patients.

SUMMARY

In order to contribute to removing the taboo on urinary incontinence, health professionals should be made aware of the living situation of incontinent patients. Patient education is given high priority and strategies need to be developed to help those affected to cope.

Flat Magnetic Stimulation for Urge Urinary Incontinence

Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.

Italian validation of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire

INTRODUCTION AND HYPOTHESIS

The use of validated Quality of Life (QoL) questionnaires is useful in the standardization and interpretation process of pelvic floor patient symptoms, due to their functional nature and high prevalence. The Pelvic Floor Distress Inventory QoL questionnaire (PFDI-20) serves both as a symptom inventory and a measure of the degree of bother and distress caused by pelvic floor symptoms. It includes items related to pelvic organ prolapse and lower gastrointestinal and bladder dysfunction.

METHODS

After consensus translation and a comprehension test, the Italian version of the questionnaire was submitted to patients reporting bowel, bladder, or pelvic disorders (cases) and to asymptomatic women (controls). Cases received the questionnaire once again 2 weeks later by email.

RESULTS

A total of 254 patients answered the questionnaire. Construct validity was demonstrated by discriminating between cases and controls. Convergent validity was demonstrated for each domain (F < 0.001). In-ernal consistency reliability showed a satisfactory range (0.816-0.860).

CONCLUSIONS

The PFDI-20 allows a comprehensive assessment of the effect of pelvic floor disorders on the quality of life of women. Moreover, the PFDI-20 represents a very solid QoL tool, since it has been extensively used in literature, and its use is highly recommended by the International Consultation on Incontinence. The present study demonstrated good features for the Italian version of the PFDI-20 questionnaire.

Effect of pelvic floor muscle training on female sexual function: A systematic review protocol and meta-analysis

AIM

To recognize, appraise and summarize the research evidence that has explored the results of pelvic floor muscle training on female sexual function.

DESIGN

Systematic review and possible meta-analysis.

METHODOLOGY

Between September and October 2022, the Cochrane Library, CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus electronic databases will be searched. We will include RCT's in English, Spanish and Portuguese that investigate the results of pelvic floor muscle training on female sexual function. The data will be extracted by two researchers independently. Risk of bias will be measured from the Cochrane Risk of Bias Tool. The meta-analysis of the results will be performed using Comprehensive Meta-Analysis Version 2.

RESULTS

This systematic review and possible meta-analysis will contribute significantly to the promotion of pelvic floor health and women's sexual function and to strengthen clinical practice and define other areas of study.

The Effectiveness of Pelvic Floor Muscle Exercise in Urinary Incontinence: A Systematic Literature Review and Meta-Analysis

Urinary incontinence (UI) is a prevalent health concern in females over 60, but it is prevalent in a smaller percentage of males. The medical and social elements of UI are crucial. This disorder may cause embarrassment and low self-esteem, reducing social and physical activities. Consequently, this may impair healthy aging. Researchers have shown that pelvic floor muscle training (PFMT) may improve UI symptoms in middle-aged, older, and young people. Clinical practice highlights the importance of PFMT for UI due to its low cost-effectiveness. To assess PFMT's overall efficacy, we conducted a systematic review of the literature (SRL) and a meta-analysis (MA) of randomized clinical trials (RCTs). The previous 10 years of published material were combed using the online databases the Cochrane Library, PubMed, and Google Scholar. Eligible total studies were RCTs referring to the effectiveness of PFMT. The pooled incidence, risk ratio, and 95% confidence interval (CI) of the effectiveness of PFMT were calculated using the fixed effects model. Given the possibility of a between-study variance, we used the fixed effects model rather than the random effects model.

Review of self-efficacy assessment scales for geriatric patients with urinary incontinence

Urinary incontinence is a common condition in the elderly, which can be improved with rehabilitation. However, compliance with the rehabilitation regimen is influenced by the level of self-efficacy. Self-efficacy of elderly patients in dealing with urinary incontinence can be clinically assessed and understood by using a suitable scale, to implement specific improvement measures. At present, the tools used for assessing the self-efficacy of elderly patients with urinary incontinence include the General Self-Efficacy Scale (GSES), the Pelvic Floor Muscle Self-efficacy Scale, the Geriatric Self-efficacy Index for Urinary Incontinence, and the Yoga Self-Efficacy Scale. Most of these tools are suitable for female patients with urinary incontinence, but lack relevance to the disease characteristics of geriatric patients. In this study, we reviewed the self-efficacy assessment tools for geriatric patients with urinary incontinence, to provide a reference for related research. It is important to accurately assess the self-efficacy of patients with geriatric UI to effectively enhance their level of self-efficacy, so that patients with geriatric UI can avail early help and quickly reintegrate with family and society.

Efficacy and Adverse Effects After Single-Incision Slings for Women with Stress Urinary Incontinence: A 12-Year Follow-Up

Objective

Single-incision slings (SISs) are not considered the first surgical choice for stress urinary incontinence due to few data about long-term results. Our aim was to evaluate the outcomes of SISs 12 years after implantation and to search for consequences such as deterioration after a certain amount of time.

Methods

We included women with stress urinary incontinence both clinically and urodynamically proven who underwent SISs procedure. Objective and subjective cure rates were compared to short-term outcomes to detect possible deterioration over time.

Results

A total of 85 patients were analysed with a median follow-up of 12.0 (IQR 10.4-12.8) years. Objective and subjective cure rates were 81.0% and 82.1%, respectively. Median (IQR) PGI-I scores and ICIQ-SF, respectively, were 1 (1-2) and 0 (0-6.8). No significant deterioration of outcomes over time was shown after comparison between short-term and long-term follow-ups (objective cure rate 84.5% vs 81.0%, p=0.684; subjective cure rates 92.9% vs 82.1%, p=0.060). Also, voiding symptoms and overactive bladder did not differ over time (20.2% vs 21.4%, p=1.000; 20.2% vs 33.3%, p=0.080, respectively).

Conclusion

SISs were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up.

Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study

BACKGROUND

flat magnetic stimulation is based on a stimulation produced by electromagnetic fields with a homogenous profile. Patients with stress urinary incontinence (SUI) can take advantage of this treatment. We aimed to evaluate medium-term subjective, objective, and quality-of-life outcomes in patients with stress urinary incontinence to evaluate possible maintenance schedules.

METHODS

a prospective evaluation through the administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Incontinence Impact Questionnaire (IIQ7), and the Female Sexual Function Index (FSFI) was performed at three different time points: at the baseline (T0), at the end of treatment (T1), and at 3-month follow-up (T2). The stress test and the Patient Global Impression of Improvement questionnaire (PGI-I) defined objective and subjective outcomes, respectively.

RESULTS

25 consecutive patients were enrolled. A statistically significant reduction in the IIQ7 and ICIQ-SF scores was noticed at T1 returned to levels comparable to the baseline at T2. However, objective improvement remained significant even at a 3-month follow-up. Moreover, the PGI-I scores at T1 and T2 were comparable, demonstrating stable subjective satisfaction.

CONCLUSION

despite a certain persistence of the objective and subjective continence improvement, the urinary-related quality of life decreases and returns to baseline values three months after the end of flat magnetic stimulation. These findings indicate that a further cycle of treatment is probably indicated after 3 months since benefits are only partially maintained after this timespan.

Urethral Injury After Vaginal Birth and Stress Urinary Incontinence: Bulking Agents are Feasible Options

Introduction and Hypothesis

Lower urinary tract tears after vaginal delivery are a very rare event, estimated to occur in 0.03-0.05% of women and may be associated with severe stress urinary incontinence, due to great reduction of urethral resistance resulting in a significant intrinsic urethral deficit. Urethral bulking agents represent an alternative, minimally invasive anti-incontinence procedure in the management of stress urinary incontinence. Our aim is to present the management of severe stress urinary incontinence in a patient with concomitant urethral tear caused by obstetric trauma using a minimally invasive treatment option.

Methods

A 39-year-old woman referred to our Pelvic Floor Unit for severe stress urinary incontinence. Our evaluation demonstrated an undiagnosed urethral tear involving the ventral portion of the middle and distal urethra, for about 50% of urethral length. Urodynamic evaluation confirmed the presence of severe urodynamic stress incontinence. After proper counseling, she was admitted to mini-invasive surgical treatment with urethral bulking agent injection.

Results

The procedure was completed in 10 minutes and she was successfully discharged home on the same day, and no complications occurred. The treatment resulted in total relief of urinary symptoms, which persists at 6-month follow-up.

Conclusion

Treatment with urethral bulking agent injection represents a feasible mini-invasive option to manage stress urinary incontinence related to urethral tears.

Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference?

(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester.

Prevalence and severity of urinary incontinence and associated factors in Iranian postmenopausal women: a cross-sectional study

BACKGROUND

Urinary incontinence (UI) is one of the most common symptoms during menopause, leading to a decreased quality of life and limited social activities. This study aimed to determine the prevalence and severity of urinary incontinence and associated risk factors in postmenopausal women.

METHODS

It was a cross-sectional study using cluster sampling on 433 postmenopausal women in Tabriz-Iran, 2021-2022. Data were collected using questionnaires of socio-demographic characteristics, Questionnaire for Urinary Incontinence Diagnosis (QUID), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF). Multivariate logistic regression was used to determine factors related to urinary incontinence.

RESULTS

The overall prevalence of urinary incontinence was 39.5%; 20.6% stress urinary incontinence (SUI), 10.4% urgency urinary incontinence (UUI), and 8.5% mixed urinary incontinence (MUI). Multivariate logistic regression analysis showed that the prevalence of SUI (aOR 0.38; 95% CI 0.18-0.77) and UUI (aOR 0.38; 95% CI 0.15-0.94) was significantly lower in women with three childbirths than the ones with fewer childbirths. Also, the odds of UUI increased significantly in women at the 50-55 age range (aOR 3.88; 95% CI 1.16-12.93) than those less than 50 years.

CONCLUSION

Due to the high prevalence of urinary incontinence in postmenopausal women, caregivers should screen for early diagnosis and appropriate treatment of urinary incontinence to prevent its destructive impact on the quality of life.

Kegel Exercise Training Program among Women with Urinary Incontinence

A common condition with a large global prevalence and a persistent medical taboo for many people is urinary incontinence. Around one in three women globally are impacted by it. The most frequently suggested physical therapy treatment for women with stress incontinence or urge incontinence is Kegel exercise (also called pelvic floor muscle training). This study aims to assess the effects of a Kegel exercise training program among women with urinary incontinence. The study was conducted at three government hospitals in Egypt's Port Said city's outpatient gynecological clinic. The intervention design was quasi-experimental. In total, 292 women with urine incontinence who visited the research sites made up the subjects. The necessary data were gathered using an interview questionnaire. Improvements in urinary incontinence and quality of life were positively correlated with daily Kegel exercise practice. Urinary incontinence has statistically significant positive correlations with age (p = 0.026), respiratory rate (p = 0.007), and body mass index (p = 0.026) as women grow older. Urinary incontinence, being single, and increasing pulse, however, had adversely significant negative correlations (p = 0.031 and 0.020, respectively). Urinary incontinence affects women's overall wellbeing, particularly in the emotional and social spheres, as well as their quality of life and their ability to participate in normal everyday activities. Following the adoption of the Kegel exercise training program, there was a substantial improvement in both urine incontinence and quality of life.

Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed.

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review

Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.

Italian validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)

INTRODUCTION AND HYPOTHESIS

The aim of this study was to translate the English short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and evaluate its validity, internal consistency, and test-retest reliability.

METHODS

The questionnaire was translated into Italian by standardized procedural steps, and the final version was submitted to women referred to urogynecological outpatient care for genital prolapse or urinary incontinence reporting sexual disorders (cases) or not (controls). For the test-retest evaluation, cases received the questionnaire 2 weeks later. The Wilcoxon test (non-parametric) was used to assess differences between cases and controls. Convergent validity was tested with the Italian version of the FSFI-19. The internal consistency was tested using Cronbach's alpha. The degree of concordance/agreement was measured with Cohen's kappa. The absolute agreement of test-retest results was tested with the intraclass correlation coefficient (ICC).

RESULTS

Sixty women were recruited for the study and answered the questionnaire. The overall rate of missing items was 1.3%. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms. Convergent validity with FSFI-19 was tested, and a linear correlation between scores was demonstrated (F < 0.001). Internal consistency reliability evaluated with Cronbach's alpha was satisfactory (0.54-0.81). Cohen's kappa values as absolute agreement coefficients were between 0.59 and 0.80 (good agreement). Intraclass correlation coefficients ranged between 0.88 and 0.94 (very satisfactory agreement) for each functional domain.

CONCLUSIONS

The Italian version of the PISQ-12 is reliable, valid, and consistent.