Item bank development, calibration and validation for patient-reported outcomes in female urinary incontinence

Common Patient-Reported Outcomes Within the Food and Drug Administration Voice of the Patient Reports

OBJECTIVES

Proponents of disease-specific patient-reported outcome measurements (PROMs) often argue disease-agnostic measures do not adequately capture their patient population's experience. Patient-Reported Outcomes Measurement Information System (PROMIS) provides a disease-agnostic domain set that may adequately cover many diseases. This study seeks to investigate whether PROMIS's quality of life domain coverage can span patient-reported outcomes (PROs) elicited from patients across unrelated diseases.

METHODS

The Food and Drug Administration Voice of the Patient reports were an initiative to elevate patient voices regarding their condition and associated treatments. Two reviewers extracted patient-reported health-related (quality of life) domains from the reports and categorized them into PROMIS domains or non-PROMIS domains. Domain coverage was summarized for each report. Any extracted PROs not covered by PROMIS domains were placed in an "other" category and analyzed for common themes.

RESULTS

Across 26 reports, PROMIS covered 216 of 374 (70%) of the reports' PRO domains. The heritable bleeding disorders report had the highest coverage (82%). Human immunodeficiency virus had the lowest coverage (50%). The most common PROMIS domain, "ability to participate in social roles," appeared in 25 reports (96%). The most common domains not included in PROMIS were stigma, sensitivities, and sensory deficits as evident in 19 (73%), 18 (69%), and 18 reports (69%), respectively. If the top 3 unincluded domains were amended into PROMIS, the total domain coverage would increase to 84%.

CONCLUSIONS

PRO domains elicited in the Food and Drug Administration Voice of the Patient reports were widely captured by PROMIS, suggesting domains patients experience contain enough overlap to be recorded by appropriate PROMIS domains. PROMIS could increase its coverage by adding domains.

Recent Developments in the Assessment of Nutrition Knowledge in Athletes

PURPOSE OF REVIEW

Adequate nutrition knowledge may influence dietary behaviour, and the performance and health of athletes. Assessment of the nutrition knowledge of athletes can inform practice and provide a quantitative way to evaluate education interventions. This article aims to review nutrition knowledge questionnaires published in the last 5 years to identify advances, possible improvements in questionnaire development and design, and challenges that remain.

RECENT FINDINGS

Twelve new or modified questionnaires were identified. All had undergone validity and reliability testing. Advancements included quantitative measures of content validity and Rasch analysis. Online questionnaires were common, with at least seven using this format. Advances included use of images (n = 2), automated scored feedback (n = 1), and use of applied questions. While advancements have been made in validation and reliability testing and electronic delivery, new questionnaires would benefit from interactive and attractive features including images, provision of electronic feedback, and applied questions.

The International Consultation on Incontinence Questionnaires (ICIQ): An update on status and direction

AIMS

In its 22nd year, the International Consultation on Incontinence Questionnaire (ICIQ) project continues to promote its primary objective; the development and dissemination of patient completed questionnaires for the standardized, high-quality assessment of urinary, bowel, and vaginal symptoms. The paper gives an update on the ICIQ in the context of current scientific developments of PROM design and regulatory requirements, and plans are outlined for its future direction.

METHODS

An online library of all questionnaires, including over 300 translations has been launched to facilitate access through a semi-automated registration system. The ICIQ project continues to update its protocol to meet current scientific standards and incorporate methodological advances within PROM development.

RESULTS

Nineteen psychometrically validated patient-reported outcome measures (PROMs) are published for use in clinical practice and research, including amongst others, a bladder diary, male and female lower urinary tract symptoms, long term catheter, pad use, and bowel symptom questionnaires. The original ICIQ-UI Short Form for the assessment of urinary incontinence continues to be the most internationally used questionnaire and has been translated into over 60 languages. New questionnaires which are under development include the ICIQ-Underactive Bladder and ICIQ-Satisfaction. We anticipate the new website and online library will further facilitate the ease of dissemination and availability of the questionnaires for clinical practice and research.

CONCLUSION

The ICIQ continues to successfully achieve its primary objective. Going forward, a greater focus on promoting routine clinical use and the potential for electronic integration into databases and medical records is envisaged.

Sleep disturbance changes in women after treatment of refractory overactive bladder with sacral neuromodulation

Purpose

The aim of this study is to evaluate changes in sleep disturbance following treatment of overactive bladder with sacral neuromodulation.

Materials and Methods

This is a sub-analysis of data collected from an institutional review board approved retrospective cohort study evaluating women with Patient-Reported Outcomes Measurement Information System-Sleep Disturbance (PROMIS-SD) before and after sacral neuromodulation for overactive bladder between March 2016 and October 2017. Data collected included demographics, clinical characteristics, and additional PROMIS item banks. Within-group analysis was performed with paired t-tests. Groups based up on PROMIS-SD improvement (change <0) were then compared using Fisher's exact test, t-test, or Mann-Whitney U-test as appropriate.

Results

Those with improved sleep disturbance (n=7) noted a significant mean improvement of -3.99 (95% confidence interval, -6.32, -1.65; p<0.01). Both pre- and post-procedure PROMIS-Physical Function (38.86±2.35 vs. 34.13±5.58, p=0.07 and 37.14±5.10 vs. 35.44±4.74, p=0.53), Pain Interference (60.04±6.34 vs. 65.50±6.20, p=0.13 and 57.89±5.08 vs. 64.73±7.35, p=0.07), Depression (44.2±4.73 vs. 61.29±9.53, p=0.17 and 54.29±6.25 vs. 57.96±11.42, p=0.47) t-scores were similar between sleep response groups.

Conclusions

Those with improved sleep disturbance reported significant changes after sacral neuromodulation for overactive bladder. However, no significant differences were identified between those with and without improvement. Further investigation of changes in sleep disturbance and factors affecting change are needed within this population.

The Comprehensive Assessment of Self-Reported Urinary Symptoms: A New Tool for Research on Subtypes of Patients with Lower Urinary Tract Symptoms

PURPOSE

To improve the potential for finding clinically important subtypes of patients with lower urinary tract symptoms we developed the CASUS (Comprehensive Assessment of Self-reported Urinary Symptoms). We used it to present data on the experiences of lower urinary tract symptoms in treatment seeking women and men from a prospective observational cohort.

MATERIALS AND METHODS

We created an initial list of lower urinary tract symptoms that were confirmed in 22 qualitative interviews with providers, and 88 qualitative interviews with care seeking and noncare seeking women and men with lower urinary tract symptoms. Items from extant measures were adopted and revised, and new items were developed. All items were evaluated for understanding in 64 cognitive interviews. Items were administered to a prospective cohort of female and male patients with lower urinary tract symptoms who were seeking care. Analyses were done to describe item response distributions and correlations among item responses separately for women and men.

RESULTS

A total of 444 males and 372 females provided responses to the CASUS. Several sets of items showed different relationships for women compared to men. In particular the associations between sensation related items and incontinence related items were generally positive among females but often negative among males.

CONCLUSIONS

After using an intensive development process the CASUS addresses a wide range of lower urinary tract symptoms. It should help identify clinically important subtypes of patients. Further, item collection can provide the foundation for shorter measures for use in the clinic and as trial end points.

Designation and psychometric properties of the Short Form Postpartum Quality of Life Questionnaire (SF-PQOL): an application of multidimensional item response theory and genetic algorithm

Background: Utilizing multidimensional item response theory (MIRT) and genetic algorithm (GA) we aimed to design and test the psychometric properties of the short form Postpartum Quality of Life Questionnaire (PQOL). Methods: In this methodological study, 500 women aged 18 to 42 were enrolled through a multistage random sampling scheme in Tabriz, Iran. We used MIRT model and GA to identify a short form of the 40-item PQOL measure (SF-PQOL). Construct and criterion validity of the SF-PQOL was assessed by confirmatory factor analysis (CFA) and the correlation between SFPQOL scores with a 12-item short form of QOL (SF-12) and Edinburg Postnatal Depression Scale (EPDS) scores, respectively. The internal consistency, test-retest reliability and feasibility of the measure were evaluated. Results: sixteen- and 13-item SF-PQOL were identified based on MIRT and GA, respectively.The results indicate the better performance of the MIRT based 13-item SF-PQOL; Construct and criterion validity, the test-retest and internal consistency reliability, and the feasibility were confirmed in the MIRT based SF-PQOL, but not in the GA-based SF-PQOL. Conclusion: The MIRT suggests a 13-item SF-PQOL with adequate content which demonstrated satisfactory validity, reliability, and feasibility. SF-PQOL could be used across the population for both research and clinical objectives.

Calibration and validation of an item bank for measuring general physical function of patients in medical rehabilitation settings

Objective

The objective of this study was to report the item response theory (IRT) calibration of an 18-item bank to measure general physical function (GPF) in a wide range of conditions and evaluate the validity of the derived scores.

Methods

All 18 items were administered to a large sample of patients (n=2337) who responded to the items in the context of their outpatient rehabilitation care. The responses, collected 1997– 2000, were modeled using the graded response model, an IRT model appropriate for items with two or more response options. Inter-item consistency was evaluated based on Cronbach’s alpha and item to total correlations. Validity of scores was evaluated based on known-groups comparisons (age, number of health problems, symptom severity). The strength of a single, general factor was evaluated using a bi-factor model. Results were used to evaluate IRT assumption and as an indicator of construct validity. Local independence of item responses was also evaluated.

Results

Response data met the assumptions of unidimensionality and local independence. Explained common variance of a single general factor was 0.88 (omega hierarchical =0.86). Only two of the 153 pairs of item residuals were flagged for local dependence. Inter-item consistency was high (0.93) as were item to total correlations (mean =0.61). Substantial variation was found in both IRT location (difficulty) and discrimination parameters. All omnibus known-groups comparisons were statistically significant (p<0.001).

Conclusion

Item responses fit the IRT unidimensionality assumptions and were internally consistent. The usefulness of GPF scores in discriminating among patients with different levels of physical function was confirmed. Future studies should evaluate the validity of GPF scores based on an adaptive administration of items.