Abstract
Introduction and hypothesis
Urinary urgency is the cardinal symptom of overactive bladder (OAB). However, there is no single instrument that assesses the context, severity, intensity, and daily life impact of urinary urgency. The purpose of this manuscript is to describe the methods and results of the qualitative and quantitative research conducted to develop a new tool for this purpose, the Urgency Questionnaire (UQ).
Methods
Qualitative data from interviews with patients with urinary urgency were used to develop and refine the items and response options of the UQ. Three studies were used to evaluate psychometric properties: a clinical trial of tolterodine (Detrol; n = 974); a psychometric validation study (n = 163); and a test–retest validation study (n = 47). Item and exploratory factor analysis (EFA) were performed to assess the subscale structure, and the psychometric performance of the resulting scales was evaluated.
Results
Fifteen Likert-scale items and four VAS questions were retained. A four-factor solution was shown to best fit the data, with the subscales: Impact on Daily Activities, Time to Control Urgency, Nocturia, and Fear of Incontinence. All subscales and VAS items demonstrated good reliability (Cronbach’s α 0.79–0.94), convergent and discriminant validity, and responsiveness to change. The UQ differentiated between OAB patients and controls.
Conclusion
The results provide quantitative evidence that urinary urgency, as assessed by the UQ, is a pathological sensation distinctive from the normal urge to void and suggest that the UQ might be a reliable, valid, and responsive instrument for evaluating the severity and HRQL impact of urinary urgency in OAB.
Similar content being viewed by others
References
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29(1):4–20. doi:10.1002/nau.20798
Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: Results of the epic study. Eur Urol 50(6):1306–1314. doi:10.1016/j.eururo.2006.09.019, discussion 1314–1305
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ (2003) Prevalence and burden of overactive bladder in the United States. World J Urol 20(6):327–336. doi:10.1007/s00345-002-0301-4
Coyne KS, Margolis MK, Hsieh R, Vats V, Chapple CR (2011) Validation of the urinary sensation scale (USS). Neurourol Urodyn 30(3):360–365. doi:10.1002/nau.21005
Tubaro A (2004) Defining overactive bladder: epidemiology and burden of disease. Urology 64 [6 Suppl 1]:2–6. doi:10.1016/j.urology.2004.10.047
Nicolson P, Kopp Z, Chapple CR, Kelleher C (2008) It's just the worry about not being able to control it! A qualitative study of living with overactive bladder. Br J Health Psychol 13(Pt 2):343–359. doi:10.1348/135910707X187786
Cardozo L, Chapple C, Wein A (2009) Urgency as the cardinal symptom of overactive bladder: A critical analysis. World J Urol 27(6):701–703. doi:10.1007/s00345-009-0445-6
Cartwright R, Panayi D, Cardozo L, Khullar V (2010) Reliability and normal ranges for the patient's perception of intensity of urgency scale in asymptomatic women. BJU Int 105(6):832–836. doi:10.1111/j.1464-410X.2009.08846.x
EMA (2001) Note for guidance on the clinical investigation of medicinal products for the treatment of urinary incontinence in women. London
Dmochowski R, Heit M, Sand P (2003) The effect of anticholinergic therapy on urgency severity in patients with overactive bladder: clinical assessment of a newly validated tool. Neurourol Urodyn 22(5):411–412, abstract 433
Nixon A, Colman S, Sabounjian L, Sandage B, Schwiderski UE, Staskin DR, Zinner N (2005) A validated patient reported measure of urinary urgency severity in overactive bladder for use in clinical trials. J Urol 174(2):604–607. doi:10.1097/01.ju.0000165461
Al-Buheissi S, Khasriya R, Maraj BH, Malone-Lee J (2008) A simple validated scale to measure urgency. J Urol 179(3):1000–1005. doi:10.1016/j.juro.2007.10.075
Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C, Chaikin DC (2007) The urgency perception score: validation and test-retest. J Urol 177(1):199–202. doi:10.1016/j.juro.2006.08.091
Cardozo L, Coyne KS, Versi E (2005) Validation of the urgency perception scale. BJU Int 95(4):591–596. doi:10.1111/j.1464-410X.2005.05345.x
Lowenstein L, FitzGerald MP, Kenton K, Hatchett L, Durazo-Arvizu R, Mueller ER, Goldman K, Brubaker L (2009) Evaluation of urgency in women, with a validated urgency, severity and impact questionnaire (usiq). Int Urogynecol J Pelvic Floor Dysfunct 20(3):301–307. doi:10.1007/s00192-008-0770-0
Lowenstein L, Rickey L, Kenton K, Fitzgerald MP, Brubaker L, Tulke M, Fordham J, Mueller ER (2012) Reliability and responsiveness of the urgency severity and life impact questionnaire (usiq). Int Urogynecol J 23(2):193–196. doi:10.1007/s00192-011-1531-z
Lowenstein L, Kenton K, Mueller ER, Brubaker L, Sabo E, Durazo-Arivzu RA, Fitzgerald MP (2012) Solifenacin objectively decreases urinary sensation in women with overactive bladder syndrome. Int Urol Nephrol 44(2):425–429. doi:10.1007/s11255-011-0059-y
Lowenstein L, Pham T, Abbasy S, Kenton K, Brubaker L, Mueller ER, Shott S, Vardi Y, Gruenwald I, FitzGerald MP (2009) Observations relating to urinary sensation during detrusor overactivity. Neurourol Urodyn 28(6):497–500. doi:10.1002/nau.20680
Dmochowski RR, FitzGerald MP, Wyndaele JJ (2009) Measuring urgency in clinical practice. World J Urol 27(6):739–745. doi:10.1007/s00345-009-0467-0
Gorsuch RL (1983) Factor analysis, 2nd edn. Lawrence Erlbaum, Hillsdale
Hatcher L (1994) A step-by-step approach to using the SAS® system for factor analysis and structural equation modeling. SAS Institute, Cary
Nunnally JC (1978) Psychometric theory, 2nd edn. McGraw-Hill, New York
Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10(4):407–415
Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T, Chen CI, Quentin Clemens J (2012) The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-poll. Neurourol Urodyn 32(3):230–237. doi:10.1002/nau.22295
Coyne K, Revicki D, Hunt T, Corey R, Stewart W, Bentkover J, Kurth H, Abrams P (2002) Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: The OAB-q. Qual Life Res 11(6):563–574
Matza LS, Thompson CL, Krasnow J, Brewster-Jordan J, Zyczynski T, Coyne KS (2005) Test-retest reliability of four questionnaires for patients with overactive bladder: the overactive bladder questionnaire (OAB-q), patient perception of bladder condition (PPBC), urgency questionnaire (UQ), and the primary OAB symptom questionnaire (POSQ). Neurourol Urodyn 24(3):215–225. doi:10.1002/nau.20110
Fayers PM, Hays R (2005) Assessing quality of life in clinical trials: methods and practice. Oxford University Press, Oxford
Hays RD, Hayashi T (1990) Beyond internal consistency reliability: Rationale and user’s guide for multitrait analysis program on the microcomputer. Behav Res Methods Instrum Comput 22(2):167–175
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, Hilldale
Starkman JS, Dmochowski RR (2008) Urgency assessment in the evaluation of overactive bladder (OAB). Neurourol Urodyn 27(1):13–21. doi:10.1002/nau.20472
Nunnally JC, Bernstein IH (1994) Psychometric theory, 3rd edn. McGraw-Hill, New York
De Wachter S, Wyndaele JJ (2008) How sudden is a compelling desire to void? An observational cystometric study on the suddenness of this sensation. BJU Int 101(8):1000–1003. doi:10.1111/j.1464-410X.2007.07422.x
Coyne KS, Sexton CC, Kopp Z, Chapple CR, Kaplan SA, Aiyer LP, Symonds T (2010) Assessing patients' descriptions of lower urinary tract symptoms (LUTS) and perspectives on treatment outcomes: results of qualitative research. Int J Clin Pract 64(9):1260–1278. doi:10.1111/j.1742-1241.2010.02450.x
Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C (2009) Two types of urgency. Neurourol Urodyn 28(3):188–190. doi:10.1002/nau.20525
Chapple CR, Artibani W, Cardozo LD, Castro-Diaz D, Craggs M, Haab F, Khullar V, Versi E (2005) The role of urinary urgency and its measurement in the overactive bladder symptom syndrome: Current concepts and future prospects. BJU Int 95(3):335–340. doi:10.1111/j.1464-410X.2005.05294.x
Funding
Funding for this work was provided by Pfizer.
Conflicts of interest
Karin S. Coyne, Chris C. Sexton, and Christine Thompson are employed by Evidera (formerly United Biosource Corporation), which provides consulting and other research services to pharmaceutical, device, government, and nongovernment organizations. As Evidera employees, they work with a variety of companies and organizations and are expressly prohibited from receiving any payment or honoraria directly from these organizations for services rendered. Tamara Bavendam has equity interests with Pfizer. Linda Brubaker does not have any conflicts at this time. Karin S. Coyne, Chris C. Sexton, and Christine Thompson were paid consultants to Pfizer in connection with the development of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coyne, K.S., Sexton, C.C., Thompson, C. et al. Development and psychometric evaluation of the urgency questionnaire for evaluating severity and health-related quality of life impact of urinary urgency in overactive bladder. Int Urogynecol J 26, 373–382 (2015). https://doi.org/10.1007/s00192-014-2435-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2435-5