The PISQ-IR: considerations in scale scoring and development

Abstract

Introduction

This paper provides a detailed discussion of the psychometric analysis and scoring of a revised measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).

Methods

Standard tools for evaluating item distributions, relationships, and psychometric properties were used to identify sub-scales and determine how the sub-scales should be scored. The evaluation of items included a nonresponse analysis, the nature of missingness, and imputation methods. The minimum number of items required to be answered and three different scoring methods were evaluated: simple summation, mean calculation, and transformed summation.

Results

Item nonresponse levels are low in women who are sexually active and the psychometric properties of the scales are robust. Moderate levels of item nonresponse are present for women who are not sexually active, which presents some concerns relative to the robustness of the scales. Single imputation for missing items is not advisable and multiple imputation methods, while plausible, are not recommended owing to the complexity of their application in clinical research. The sub-scales can be scored using either mean calculation or transformed summation. Calculation of a summary score is not recommended.

Conclusion

The PISQ-IR demonstrates strong psychometric properties in women who are sexually active and acceptable properties in those who are not sexually active. To score the PISQ-IR sub-scales, half of the items must be answered, imputation is not recommended, and either mean calculation or transformed sum methods are recommended. A summary score should not be calculated.

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Acknowledgements

This study was reviewed and approved by the University of Minnesota IRB #0908 M70626. This study was funded by the International Urogynecological Association. University of Minnesota, Grant Award Number CON000000021500, Todd H Rockwood, PhD, PI.

Conflict of interest

None.

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Corresponding author

Correspondence to Todd H. Rockwood.

Additional information

A related editorial can be found at doi:10.1007/s00192‐012‐1952‐3.

Appendix A: transformed sum scoring for the PISQ-IR

Appendix A: transformed sum scoring for the PISQ-IR

Example—scale: NSA-GQ not sexually active: global quality rating

Item Response Reverse response Item score Minimum determination Maximum determination
Q4a: satisfied to dissatisfied 2 (1 to 5) 6–2 (response) 4 1 (enter 1 if answered) 5 (enter 5 if answered)
Q4b: adequate to inadequate 3 (1 to 5) 6–3 (response) 3 1 (enter 1 if answered) 5 (enter 5 if answered)
Q5a: I feel frustrated by my sex life 3 (1 to 4)   3 1 (enter 1 if answered) 4 (enter 4 if answered)
Q6: Overall, how bothersome is it to you that you are not sexually active? − (1 to 4) 5– = (response) – (enter 1 if answered) – (enter 4 if answered)
    10 3 14
   Sum Sum: minimum Sum: maximum
    Range: 11 = 3 –14
     (minimum) to (maximum)

Example—scale: SA-AO sexually active: arousal, orgasm

Item Response Reverse response Item score Minimum determination Maximum determination
Q7: How often do you feel sexually aroused (physically excited or turned on) during sexual activity? 3 (1 to 5)   3 1 (enter 1 if answered) 5 (enter 5 if answered)
Q8a: fulfilled 2 (1 to 5)   2 1 (enter 1 if answered) 5 (enter 5 if answered)
Q10:Compared with orgasms you have had in the past, how intense are your orgasms now? 3 (1 to 5)   3 1 (enter 1 if answered) 5 (enter 5 if answered)
Q11:How often do you feel pain during sexual intercourse? (If you don’t have intercourse check this box X and skip to the next item) 1 (1 to 5) 6–1 = (box checked value is 1) 5 1 (enter 1 if answered) 5 (enter 5 if answered)
Scoring note: If the box is checked enter 1 as response value      
    13 sum 4 sum: minimum 25 sum: maximum
     Range: 21 = 4–25
     (minimum) to (maximum)

Example—scale: NSA-CS not sexually active: condition-specific

figurea

Scoring—not sexually active

Scale: NSA-PR not sexually active: partner-related

figureb

Scale: NSA-CS not sexually active: condition-specific

figurec

Scale: NSA-GQ not sexually active: global quality rating

figured

Scale: NSA-CI: Not sexually active: condition impact

figuree

Scoring—sexually active

Scale: SA-AO sexually active: arousal, orgasm

figuref

Scale: SA-PR sexually active: partner-related

figureg

Scale: SA-CS sexually active: condition-specific

figureh

Scale: SA-GQ sexually active: global quality rating

figurei

Scale: SA-CI sexually active: condition impact

figurej

Scale: SA-D sexually active: desire

figurek

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Rockwood, T.H., Constantine, M.L., Adegoke, O. et al. The PISQ-IR: considerations in scale scoring and development. Int Urogynecol J 24, 1105–1122 (2013). https://doi.org/10.1007/s00192-012-2037-z

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Keywords

  • Sexual function questionnaire
  • Pelvic organ prolapse
  • Urinary incontinence
  • Anal incontinence
  • Psychometric analysis
  • Scale development