A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence

Quality of life following transobturator sling surgery for female stress urinary incontinence

OBJECTIVE

This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence.

MATERIALS AND METHODS

This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression.

RESULTS

At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome.

CONCLUSION

Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

GSM and Quality of Life Measures

The impact of bothersome vulvovaginal symptoms related to hypoestrogenism on quality of life (QOL) has been evaluated in large international surveys and qualitative studies of vulvovaginal atrophy, most of which were completed before the introduction of the term genitourinary syndrome of menopause (GSM) and focus primarily on vulvovaginal atrophy. The QOL domain most affected in these studies is sexual function, although women also report impacts on self-confidence, self-esteem, sleep, and general enjoyment of life. Health-related QOL measures are available that evaluate the impact of some symptoms associated with GSM on QOL; new measures are in development that assess the full range of symptoms associated with GSM.

Measures of quality of life of people with neurogenic overactive bladder: A systematic review of psychometric properties

OBJECTIVE

To identify psychometrically robust quality-of-life (QOL) outcome measures for evaluating QOL among people with neurogenic overactive bladder (OAB).

STUDY DESIGN

Electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from inception to January 2023. Two independent reviewers participated in study screening, data extraction and quality appraisal. Studies were included if they validated at least one psychometric property of a QOL outcome measure among adults (age ≥ 18 years) with neurogenic OAB. The COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool were used to evaluate the methodological quality and quality of evidence, respectively, for each included study.

RESULTS

Database searches identified 47 studies that tested the psychometric properties of 15 QOL measures in a total of 19,994 participants with stroke, spinal cord injury, Parkinson's disease or multiple sclerosis. The Incontinence Quality of Life Questionnaire (I-QOL), King's Health Questionnaire, Overactive Bladder Questionnaire and Qualiveen were the best validated measures, with strong reliability, validity and responsiveness. I-QOL was the most robust, cross-culturally administered and psychometrically strong measure. The COSMIN checklist indicated sufficient methodological quality for 70% of measures, and the modified GRADE tool indicated quality of evidence ranging from moderate (67%) to high (33%).

CONCLUSIONS

This review identified the I-QOL as a culturally diverse measure with robust reliability, validity and responsiveness for assessing QOL among people with neurogenic OAB. These findings are supported by studies with good methodological quality (COSMIN) and high-quality evidence (GRADE).

Should the Preference-Based Index Set of Values Be Country or Disease Specific? An Analysis Using Data From Women With Symptoms of Overactive Bladder

OBJECTIVES

Overactive bladder (OAB) and urinary incontinence (UI) are common conditions among women. We aimed to verify the difference between the preference-based index extracted from short-form six-dimension version one (SF-6Dv1) in women with OAB using different country-specific value sets, translate and cross-culturally adapt the King's Health Questionnaire Five Dimension (KHQ-5D) into Brazilian Portuguese, and examine the association between preference-based index obtained by the SF-6Dv1 and KHQ-5D.

METHODS

This cross-sectional study included 387 women with OAB, divided into groups with and without UI. The participants answered the sociodemographic questionnaire, KHQ, KHQ-5D, and SF-6Dv1. A two-way mixed analysis of variance, with post hoc to multiple comparisons were applied and a Spearman's test was applied to verify the correlation between the preference-based index of SF-6Dv1 and KHQ-5D.

RESULTS

The main analysis showed a statistically significant interaction between the presence of UI and the value set obtained from the different countries (P = .005, Cohen's d = 0.02). The post hoc analyses showed that there was a statistically significant main effect of the value sets obtained from different countries (P < .001, d = 0.63) and in the presence of UI (P = .012, d = 0.02). The correlations between the preference-based index obtained from different countries using the SF-6Dv1 and KHQ-5D were significant.

CONCLUSIONS

Differences were observed between the preference-based index obtained in different countries and presence of UI, although positive and significant results were observed in the correlation between preference-based index from different countries. The correlation between general and specifics preference-based index was small; the SF-6Dv1 could be used in cost-utility studies for this population.

Brazilian version of the King's Health Questionnaire: assessment of the structural validity and internal consistency in female urinary incontinence

INTRODUCTION AND HYPOTHESIS

The use of valid patient-reported outcome measurements is essential in clinical and research settings. The structure of the Brazilian version of the King's Health Questionnaire (Br-KHQ) has not been evaluated. Thus, this study sought to evaluate the structural validity and internal consistency of the multi-item domains of the Br-KHQ in women with urinary incontinence (UI).

METHODS

A total of 462 Brazilian Portuguese speakers with UI aged 18 years or older were included in this study. Participants answered the Br-KHQ, and a questionnaire containing demographic and personal information. The structure of the Br-KHQ was examined through Exploratory Factor Analysis (EFA) with the implementation of parallel analysis and evaluated using confirmatory factor analysis (CFA). For the latter, several goodness-of-fit indices were considered to evaluate the model fit of the structures tested in this study. Internal consistency was assessed using Cronbach's alpha, composite reliability, and coefficient omega.

RESULTS

The EFA showed that the questionnaire has a five-factor structure, i.e., limitations of daily life, personal relationship, emotions, sleep/energy, and severity measures. The CFA demonstrated that this structure presented the most adequate goodness-of-fit indices and the lowest values of Akaike information criterion and Bayesian information criterion, compared with the original and Portuguese structure. High values (>0.70) of internal consistency were found.

CONCLUSIONS

The Brazilian version of the KHQ is composed of a five-factor structure. Further studies should evaluate other measurement properties of the Br-KHQ to ensure reliable interpretation of this patient-reported outcome measure in clinical practice.