Quality of Life Research

, Volume 17, Issue 3, pp 475–483 | Cite as

EuroQol EQ-5D and condition-specific measures of health outcome in women with urinary incontinence: reliability, validity and responsiveness

  • Kirstie L. Haywood
  • Andrew M. Garratt
  • Ranjit Lall
  • Jan Fereday Smith
  • Sarah E. Lamb



To evaluate the measurement properties of the EuroQoL EQ-5D and two condition-specific patient-reported outcome measures—the Symptom Severity Index (SSI) and the Urinary Incontinence-Specific Quality of Life instrument (I-QoL)—in women with urinary incontinence.


A questionnaire comprising all instruments was completed by women taking part in a clinical trial of physiotherapy for urinary incontinence. Follow-up questionnaires were at 6 weeks and 5 months. Data quality, internal consistency reliability, validity and responsiveness were assessed.


One hundred and seventy-four patients taking part in the clinical trial completed the questionnaire. Instruments had low levels of missing data. The EQ-5D had a large ceiling effect and poor responsiveness. The SSI had poor validity and responsiveness. The I-QoL had levels of reliability that supported application in group assessment, and in some cases, individual assessment, and good evidence of validity. The I-QoL was the most responsive instrument at both 6 weeks and 5 months.


The I-QoL was the best performing instrument and is recommended as a continence-specific measure of quality of life in a clinical trial setting. The SSI and EQ-5D are not recommended. Alternative generic instruments, which support economic evaluation, require further evaluation in trials of female urinary incontinence.


Quality of life Health status Female urinary incontinence Reliability Validity 



We are very grateful to all of the patients who so willingly gave of their time to complete the various questionnaires, and the healthcare practitioners taking part in the trial. This study was funded by the Physiotherapy Research Foundation.


  1. 1.
    Norton, N. J. (2004). The perspective of the patient. Gastroenterology, 126, S175–S179.PubMedCrossRefGoogle Scholar
  2. 2.
    Miner, P. B., Jr. (2004). Economic and personal impact of fecal and urinary incontinence. Gastroenterology, 126, S8–S13.PubMedCrossRefGoogle Scholar
  3. 3.
    Martin, J. L., Williams, K. S., Abrams, K. R., et al. (2006). Systematic review and evaluation of methods of assessing urinary incontinence. Health Technology Assessment, 10(6), 1–132.Google Scholar
  4. 4.
    Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., et al. (2002). The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourology and Urodynamics, 21, 167–178.PubMedCrossRefGoogle Scholar
  5. 5.
    Fitzpatrick, R., Davey, C., Buxton, M. J., & Jones, D. R. (1998). Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment, 2(i–iv), 1–74.PubMedGoogle Scholar
  6. 6.
    Ross, S., Soroka, D., Karahalios, A., Glazener, C. M., Hay-Smith, E. J., & Drutz, H. P. (2005). Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: A systematic review. International Urogynecology Journal and Pelvic Floor Dysfunction, 17(3), 272–285.PubMedGoogle Scholar
  7. 7.
    Naughton, M. J., Donovan, J., Badia, X., Corcos, J., Gotoh, M., et al. (2004). Symptom severity and QOL scales for urinary incontinence. Gastroenterology, 126, S114–S123.PubMedCrossRefGoogle Scholar
  8. 8.
    Symonds, T. (2003). A review of condition-specific instruments to assess the impact of urinary incontinence on health-related quality of life. European Urology, 43, 219–225.PubMedCrossRefGoogle Scholar
  9. 9.
    EuroQoL-Group. (1990). EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy, 16, 199–208.CrossRefGoogle Scholar
  10. 10.
    Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13, 873–884.PubMedCrossRefGoogle Scholar
  11. 11.
    Wiebe, S., Guyatt, G., Weaver, B., Matijevic, S., & Sidwell, C. (2003). Comparative responsiveness of generic and specific quality-of-life instruments. Journal of Clinical Epidemiology, 56, 52–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Scottish-Intercollegiate-Guidelines-Network. (2004). SIGN 79: Management of urinary incontinence in primary care. A national clinical guideline. Edinburgh: Scottish-Intercollegiate-Guidelines-Network.Google Scholar
  13. 13.
    Department-of-Health. (2000). Good practice in continence services, UK. Department of Health. www.doh.gov.uk/continenceservices.htm.
  14. 14.
    Lose, G., Fantl, J. A., Victor, A., Walter, S., Wells, T. L., et al. (2001). Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Standardization Committee of the International Continence Society. Acta Obstetrica et Gynecologica Scandinavia, 80, 981–985.CrossRefGoogle Scholar
  15. 15.
    Garratt, A., Schmidt, L., Mackintosh, A., & Fitzpatrick, R. (2002). Quality of life measurement: Bibliographic study of patient assessed health outcome measures. British Medical Journal, 324, 1417.PubMedCrossRefGoogle Scholar
  16. 16.
    Black, N., Griffiths, J., & Pope, C. (1996). Development of a symptom severity index and a symptom impact index for stress incontinence in women. Neurourology and Urodynamics, 15, 630–640.PubMedCrossRefGoogle Scholar
  17. 17.
    Wagner, T. H., Patrick, D. L., Bavendam, T. G., Martin, M. L., & Buesching, D. P. (1996). Quality of life of persons with urinary incontinence: Development of a new measure. Urology, 47, 67–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Patrick, D. L., Martin, M. L., Bushnell, D. M., Yalcin, I., Wagner, T. H., & Buesching, D. P. (1999). Quality of life of women with urinary incontinence: Further development of the incontinence quality of life instrument (I-QOL). Urology, 53, 71–76.PubMedCrossRefGoogle Scholar
  19. 19.
    Black, N., Griffiths, J., Pope, C., Bowling, A., & Abel P. (1997). Impact of surgery for stress incontinence on morbidity: Cohort study. British Medical Journal, 315, 1493–1498.PubMedGoogle Scholar
  20. 20.
    Bushnell, D. M., Martin, M. L., Summers, K. H., Svihra, J., Lionis, C., & Patrick, D. L. (2005). Quality of life of women with urinary incontinence: Cross-cultural performance of 15 language versions of the I-QOL. Quality of Life Research, 14, 1901–1913.PubMedCrossRefGoogle Scholar
  21. 21.
    Marra, C. A., Woolcott, J. C., Kopec, J. A., Shojania, K., Offer, R., et al. (2005). A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Social Science and Medicine, 60, 1571–1582.PubMedCrossRefGoogle Scholar
  22. 22.
    Donovan, J. L., Kay, H. E., Peters, T. J., Abrams, P., Coast, J., et al. (1997). Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: Evidence from the ICS-‘BPH’ Study. International Continence Society–Benign Prostatic Hyperplasia. British Journal of Urology, 80, 712–721.PubMedGoogle Scholar
  23. 23.
    Kobelt, G. (1997). Economic considerations and outcome measurement in urge incontinence. Urology, 50, 100–7; discussion 8–10.Google Scholar
  24. 24.
    Fuertes, M. E., Garcia Matres, M. J., Gonzalez Romojaro, V., de la Rosa, S., Anguera Vila, A., et al. (2000). Clinical trial to evaluate trospium chloride (Uraplex) effectiveness and tolerance in patients with detrusor instability incontinence and its impact on quality of life. Archivos Españoles de Urologia, 53, 125–136.PubMedGoogle Scholar
  25. 25.
    Hawthorne, G. (2006). Measuring incontinence in Australia 2006 (153 pp). Canberra: Commonwealth of Australia. ISBN: 0 642 82980 2. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ageing-continence-measure.htm
  26. 26.
    Streiner, D., & Norman, G. (2003). Health measurement scales: A practical guide to their development and use (3rd ed.). Oxford: Oxford University Press.Google Scholar
  27. 27.
    Jolliffe, I. (1986). Principal component analysis. New York: Springer-Verlag.Google Scholar
  28. 28.
    Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
  29. 29.
    Shrout, P., & Fleiss, J. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420–428.CrossRefGoogle Scholar
  30. 30.
    Hawthorne, G., Richardson, J., & Osborne, R. (1999). The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health related quality of life. Quality of Life Research, 8, 209–224.PubMedCrossRefGoogle Scholar
  31. 31.
    Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1995). Multivariate data analysis: With readings (4th ed.). New Jersey: Prentice Hall.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Kirstie L. Haywood
    • 1
  • Andrew M. Garratt
    • 2
  • Ranjit Lall
    • 3
  • Jan Fereday Smith
    • 4
  • Sarah E. Lamb
    • 3
  1. 1.Royal College of Nursing Research Institute, School of Health and Social StudiesWarwick UniversityCoventryUK
  2. 2.Institute of Health Management and Health EconomicsUniversity of OsloOsloNorway
  3. 3.Warwick Clinical Trials Unit, Health Science Research Institute, Warwick Medical SchoolWarwick UniversityCoventryUK
  4. 4.South Warwickshire General Hospitals NHS TrustWarwickUK

Personalised recommendations