Abstract
Introduction and hypothesis
Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys.
Methods
A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test–retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik’s score.
Results
Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p < 0.001). The BHS UI score was significantly correlated with the Sandvik severity score (r = 0.68, p < 0.01).
Conclusion
The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples.
Similar content being viewed by others
References
Thomas TM, Plymat KR, Blannin J, Meade TW (1980) Prevalence of urinary incontinence. Br Med J 281:1243–1245
Thom D (1998) Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 46:473–480
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT Study. J Clin Epidemiol 53:1150–1157
Milsom I (2000) The prevalence of urinary incontinence. Acta Obstet Gynecol Scand 79:1056–1059
Stewart WF, Minassian VA, Hirsch AG, Kolodner K, Fitzgerald M, Burgio K et al (2010) Predictors of variability in urinary incontinence and overactive bladder symptoms. Neurourol Urodyn 20:328–335
Townsend MK, Curhan GC, Resnick NM, Grodstein F (2011) Original research: rates of remission, improvement, and progression of urinary incontinence in Asian, Black, and White women. Am J Nurs 111:26–33. doi:10.1097/01.NAJ.0000396551.56254.8f
Irwin DE, Milsom I, Chancellor MB, Kopp Z, Guan Z (2010) Dynamic progression of overactive bladder and urinary incontinence symptoms: a systematic review. Eur Urol 58:532–543. doi:10.1016/j.eururo.2010.06.007
Bradley CS, Rahn DD, Nygaard IE, Barber MD, Nager CW, Kenton KS et al (2010) The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing nonsurgical therapies for treatment of stress predominant urinary incontinence. Neurourol Urodyn 29:727–734. doi:10.1002/nau.20818
Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA, The Continence Program in Women (CPW) Research Group (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res 3:291–306
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Continence Program for Women Research Group (2005) Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodyn 14:131–139
Coyne KS, Tubaro A, Brubaker L, Bavendam T (2006) Development and validation of patient-reported outcomes measures for overactive bladder: a review of concepts. Urology 68:9–16
Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. Br J Urol 77:805–812
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23:322–330. doi:10.1002/nau.20041
Herzog AR, Fultz NH (1990) Prevalence and incidence of urinary incontinence in community-dwelling populations. J Am Geriatr Soc 38:273–281
Lukacz ES, Lawrence JM, Buckwalter JG, Burchette RJ, Nager CW, Luber KM (2005) Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey. Int Urogynecol J Pelvic Floor Dysfunct 16:272–284
Sandvik H, Seim A, Vanvik A, Hunskaar S (2000) A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn 19:137–145
Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98–101
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379
Ross S, Soroka D, Karahalios A, Glazener CM, Hay-Smith EJ, Drutz HP (2006) Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct 17:272–285. doi:10.1007/s00192-005-1357-7
Stewart WF, Hirsh AG, Kirchner HL, Clarke DN, Litchtenfeld MJ, Minassian VA (2014) Urinary incontinence incidence: quantitative meta-analysis of factors that explain variation. J Urol 191:996–1002
Hirsch AG, Minassian VA, Dilley A, Sartorius J, Stewart WF (2010) Parity is not associated with urgency with or without urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 21:1095–1102. doi:10.1007/s00192-010-1164-7
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R et al (2003) Prevalence and burden of overactive bladder in the United States. World J Urol 20:327–336
Gardner M, Altman D (1989) Calculating confidence intervals for proportions and their differences. In: Statistics with confidence. BMJ Publishing Group, London, pp 28–33
Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF (2012) The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J 23:1087–1093. doi:10.1007/s00192-012-1743-x
Nygaard IE, Lemke JH (1996) Urinary incontinence in rural older women: prevalence, incidence and remission. J Am Geriatr Soc 44:1049–1054
Samuelsson EC, Victor FT, Svardsudd KF (2000) Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. Am J Obstet Gynecol 183:568–574
Townsend MK, Danforth KN, Lifford KL, Rosner B, Curhan GC, Resnick NM et al (2007) Incidence and remission of urinary incontinence in middle-aged women. Am J Obstet Gynecol 197:e1–e5
Financial support disclosure
Research reported in this publication was supported by the National Institutes of Health under Award Number #R01DK082551. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Minassian, V.A., Yan, X.S., Sun, H. et al. Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women. Int Urogynecol J 27, 453–461 (2016). https://doi.org/10.1007/s00192-015-2849-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-015-2849-8