International Urogynecology Journal

, Volume 24, Issue 4, pp 655–670 | Cite as

Spanish translation and validation of four short pelvic floor disorders questionnaires

  • Alejandro D. Treszezamsky
  • Deborah Karp
  • Madeline Dick-Biascoechea
  • Nazanin Ehsani
  • Christina Dancz
  • T. Ignacio Montoya
  • Cedric K. Olivera
  • Aimee L. Smith
  • Rosa Cardenas
  • Tola Fashokun
  • Catherine S. Bradley
  • Society of Gynecologic Surgeons Fellows’ Pelvic Research Network
Original Article


Introduction and hypothesis

Globally, Spanish is the primary language for 329 million people; however, most urogynecologic questionnaires are available in English. We set out to develop valid Spanish translations of the Questionnaire for Urinary Incontinence Diagnosis (QUID), the Three Incontinence Questions (3IQ), and the short Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7).


The TRAPD method (translation, review, adjudication, pretesting, and documentation) was used for translation. Eight native Spanish-speaking translators developed Spanish versions collaboratively. These were pretested with cognitive interviews and revised until optimal. For validation, bilingual patients at seven clinics completed Spanish and English questionnaire versions in randomized order. Participants completed a second set of questionnaires later. The Spanish versions’ internal consistency and reliability and Spanish-English agreement were measured using Cronbach’s alpha, weighted kappa, and intraclass correlation coefficients.


A total of 78 subjects were included; 94.9 % self-identified as Hispanic and 73.1 % spoke Spanish as their primary language. The proportion of per-item missing responses was similar in both languages (median 1.3 %). Internal consistency for Spanish PFDI-20 subscales was acceptable to good and for PFIQ-7 and QUID excellent. Test-retest reliability per item was moderate to near perfect for PFDI-20, substantial to near perfect for PFIQ-7 and 3IQ, and substantial for QUID. Spanish-English agreement for individual items was substantial to near perfect for all questionnaires (kappa range 0.64–0.95) and agreement for PFDI-20, PFIQ-7, and QUID subscales scores was high [intraclass correlation coefficient (ICC) range 0.92–0.99].


We obtained valid Spanish translations of the PFDI-20, PFIQ-7, QUID, and 3IQ. These results support their use as clinical and research assessment tools in Spanish-speaking populations.


3IQ PFDI-20 PFIQ-7 QUID Spanish translation Validation 



Marisol Alvarez, R.N. (translations); Margarita Aponte, M.D. (translations); Héctor Cáceres, M.D. (cognitive interviews); Joel Cardenas-Goicoechea, M.D. (translations); Alfredo De la Guardia, M.D. (translations); Pedro A Maldonado, M.D. (translations); Erin Moshier (statistical analysis); Enrique Soto, M.D. (translations); Nelly Szlachter, M.D. (translations); Arlene Walczak (back-translations); Amber Warmsley, M.D. (back-translations). Funding for this study was provided by the Society of Gynecologic Surgeons.

Conflicts of interest

Alejandro D Treszezamsky: none. Deborah Karp: none. Madeline Dick-Biascoechea: none. Nazanin Ehsani: consultant for American Medical Systems. Christina Dancz: none. T. Ignacio Montoya: none. Cedric K. Olivera: speaker and consultant for Oceana Therapeutics. Aimee L. Smith: none. Rosa Cardenas: none. Tola Fashokun: none. Catherine S. Bradley: none.


  1. 1.
    Castillo PA, Espaillat-Rijo LM, Davila GW (2010) Outcome measures and definition of cure in female stress urinary incontinence surgery: a survey of recent publications. Int Urogynecol J 21:343–348PubMedCrossRefGoogle Scholar
  2. 2.
    American Community Survey 2010. US Census Bureau, Table S1601. Available via: Accessed 5 Jun 2011
  3. 3.
    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113PubMedCrossRefGoogle Scholar
  4. 4.
    Barber MD, Kuchibhatla MD, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185(6):1388–1395PubMedCrossRefGoogle Scholar
  5. 5.
    Bradley CS, Rovner ES, Morgan MA et al (2005) A new questionnaire for urinary incontinence diagnosis in women: development and testing. Am J Obstet Gynecol 192(1):66–73PubMedCrossRefGoogle Scholar
  6. 6.
    Bradley CS, Rahn DD, Nygaard IE et al (2010) The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing non-surgical therapies for treatment of stress predominant urinary incontinence. Neurourol Urodyn 29(5):727–734PubMedCrossRefGoogle Scholar
  7. 7.
    Brown JS, Bradley CS, Subak LL et al (2006) The sensitivity and specificity of a simple test to distinguish between urge and stress urinary incontinence. Ann Intern Med 144(10):715–723PubMedGoogle Scholar
  8. 8.
    Harkness J (2003) Questionnaire translation. In: Harkness JA, Van de Vijver FJR, Mohler PP (eds) Cross-cultural survey methods. Wiley-Interscience, Hoboken, pp 35–56Google Scholar
  9. 9.
    Van de Vijver FJR, Leung K (1997) Methods and design. In: Van de Vijver FJR, Leung K (eds) Methods and data analysis for cross-cultural research. Sage, Thousand Oaks, pp 27–58Google Scholar
  10. 10.
    Willis GB (2010) Cognitive interviewing - a “how to” guide; Meeting of the American Statistical Association 1999. Available via: Accessed 15 Apr 2010
  11. 11.
    Omotosho TB, Hardart A, Rogers RG, Schaffer JI, Kobak WH, Romero AA (2009) Validation of Spanish versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ): a multicenter validation randomized study. Int Urogynecol J Pelvic Floor Dysfunct 20(6):623–639PubMedCrossRefGoogle Scholar
  12. 12.
    Young AE, Fine PM, McCrery R et al (2007) Spanish language translation of pelvic floor disorders instruments. Int Urogynecol J Pelvic Floor Dysfunct 18(10):1171–1178PubMedCrossRefGoogle Scholar
  13. 13.
    George D, Mallery P (2003) SPSS for Windows step by step: a simple guide and reference. 11.0 update, 4th edn. Allyn & Bacon, BostonGoogle Scholar
  14. 14.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  15. 15.
    Portney LG, Watkins MP (1993) Foundations of clinical research: applications to practice. Appleton & Lange, NorwalkGoogle Scholar
  16. 16.
    Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14:131–139PubMedCrossRefGoogle Scholar
  17. 17.
    Flack VF, Afifi AA, Lachenbruch PA, Schouten HJ (1988) Sample size determinations for the two rater kappa statistic. Psychometrika 53(3):321–325CrossRefGoogle Scholar
  18. 18.
    Streiner DL, Norman GR (2008) Reliability. In: Streiner DL, Norman GR (eds) Health measurement scales: a practical guide to their development and use, 4th edn. Oxford University Press, New York, pp 167–210Google Scholar
  19. 19.
    Romero AA, Hardart A, Kobak W, Qualls C, Rogers R (2003) Validation of a Spanish version of the Pelvic Organ Prolapse Incontinence Sexual Questionnaire. Obstet Gynecol 102(5 Pt 1):1000–1005PubMedCrossRefGoogle Scholar
  20. 20.
    Kaplan JB, Bennett T (2003) Use of race and ethnicity in biomedical publication. JAMA 289(20):2709–2716PubMedCrossRefGoogle Scholar
  21. 21.
    Office of Management and Budget (2011) Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Available via: Accessed 9 Oct 2011
  22. 22.
    US Census Bureau (2011) 2010 Census Briefs. Overview of race and hispanic origin 2010. March 2011. Available via: Accessed 9 Oct 2011.
  23. 23.
    Smith FD, Woo M, Austin SB (2010) ‘I didn’t feel like any of those things were me’: results of a qualitative pilot study of race/ethnicity survey items with minority ethnic adolescents in the USA. Ethn Health 15(6):621–638PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Alejandro D. Treszezamsky
    • 1
  • Deborah Karp
    • 2
  • Madeline Dick-Biascoechea
    • 3
  • Nazanin Ehsani
    • 4
  • Christina Dancz
    • 5
  • T. Ignacio Montoya
    • 6
  • Cedric K. Olivera
    • 7
  • Aimee L. Smith
    • 2
  • Rosa Cardenas
    • 8
  • Tola Fashokun
    • 9
  • Catherine S. Bradley
    • 10
  • Society of Gynecologic Surgeons Fellows’ Pelvic Research Network
  1. 1.Mount Sinai School of MedicineNew YorkUSA
  2. 2.Cleveland Clinic FloridaWestonUSA
  3. 3.Yale School of MedicineNew HavenUSA
  4. 4.St. Luke’s Hospital and Health NetworkBethlehemUSA
  5. 5.Los Angeles County-University of Southern California Medical CenterLos AngelesUSA
  6. 6.University of Texas Southwestern Medical CenterDallasUSA
  7. 7.SUNY Downstate Medical CenterBrooklynUSA
  8. 8.Mount Sinai Medical CenterNew YorkUSA
  9. 9.Johns Hopkins University School of MedicineBaltimoreUSA
  10. 10.Iowa City VA Health Care System and Carver College of MedicineUniversity of IowaIowa CityUSA

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