Outcome Measures in Pelvic Floor Rehabilitation

  • Kate H. Moore
  • Emmanuel Karantanis


Throughout this textbook, many different measures are used to evaluate the pelvic floor and urinary or fecal incontinence. In this chapter, those measures that are also suitable for evaluating posttreatment response, or “outcome”, are considered. In the past 3–4 decades, numerous tests, scoring systems, and quality-of-life instruments have been created. Unfortunately many of these tests have not been formally validated as outcome measures. Therefore they may not give an accurate picture of the “quantity” of a patient’s response to treatment. Also, when many different outcome measures are used to gauge response to any treatment (by different authors), it is almost impossible to compare results.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lose G, Fantl JA, Victor A, et al. Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourol Urodyn. 1998;17:255–262.CrossRefPubMedGoogle Scholar
  2. 2.
    Karantanis E, O’Sullivan R, Moore KH. The 24-hour pad test in continent women and men: normal values and cyclical alterations. Br J Obstet Gynaecol. 2003;110:567–571.Google Scholar
  3. 3.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.PubMedGoogle Scholar
  4. 4.
    Stamey T. Urinary incontinence in the female. Campbells Urology, 4th ed. Philadelphia: WB Saunders Co.; 1979;2272-2293.Google Scholar
  5. 5.
    Ingelmann-Sundberg A. Urininkontinens hos kvinnan. Nord Med. 1953;50:1149–1152.Google Scholar
  6. 6.
    Bent A, Dmochowski RR, Herschorn S, et al. Evaluation of Uryx versus contigen as periurethral bulking agents in female stress incontinence: a mulitcenter randomized controlled study. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:S24.Google Scholar
  7. 7.
    Sand PK, Dochowski RR. Clinical experience with coaptite urological bulking agent. Int Urogynecol J Pelvic Floor Dysfunct. 2000;13:S20.Google Scholar
  8. 8.
    Soulie R. Bladder suspension by retropubic endoscopy. Techniques and preliminary results (24 cases). [in French] Prog Urol. 1996;6:60–69.PubMedGoogle Scholar
  9. 9.
    Lagro-Janssen TLM, Debruyne FMJ, Smits AJA, et al. Controlled trial of pelvic floor exercises in the treatment of urinary stress incontinence in general practice. Br J Gen Prac. 1991;41:445–449.Google Scholar
  10. 10.
    Sandvik H, Hunskaar S, Seim A, et al. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health. 1993;47:497–499.CrossRefPubMedGoogle Scholar
  11. 11.
    Sandvik H, Seim, A, Vanvik A, et al. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. neurourol Urodyn. 2000;19:137–145.CrossRefPubMedGoogle Scholar
  12. 12.
    Blackwell AL, Yoong W, Moore KH. Criterion validity, test retest reliability and sensitivity to change of the St. George Urinary Incontinence Score. Br J Urol Int. 2004;93:331–335.Google Scholar
  13. 13.
    Moore KH, O’Sullivan RJ, Simons A, et al. Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up. BJOG. 2003;110:649–657.CrossRefPubMedGoogle Scholar
  14. 14.
    Groutz A, Blaivas JG, Rosenthal JE. A simplified urinary incontinence score for the evaluation of treatmentoutcomes. Neurourol Urodyn. 2000;19:127–135.CrossRefPubMedGoogle Scholar
  15. 15.
    Donovan JL, Badia X, Corcos J, et al. Symptom and quality of life assessment. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, volume 1, second edition. Bristol: Health Publication, Ltd.; 2002:269–316.Google Scholar
  16. 16.
    Avery K, Donovan J, Peters TJ, et al. ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23:322–330.CrossRefPubMedGoogle Scholar
  17. 17.
    Karantanis E, Fynes M, Moore KH, et al. Comparison of the ICIQ-SF and 24-hour pad test with other measures for evaluating the severity of urodynamic stress incontinence. Int Urogynecol J. 2004;15:111–116.CrossRefGoogle Scholar
  18. 18.
    Vaizey C, Garapeti E, Cahill J, et al. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44:77–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Groutz A, Blaivas JG, Chaikin DC, et al. Noninvasive outcome measures of urinary incontinence and lower urinary tract symptoms: a multicenter study of micturition diary and pad tests. J Urol. 2000;164:698–701.CrossRefPubMedGoogle Scholar
  20. 20.
    Locher JL, Goode Ps, Roth DL, et al. Reliability assessment of the bladder diary for urinary incontinence in older women. J Gerontol A Biol Sci Med Sci. 2001;56:M32–M35.PubMedGoogle Scholar
  21. 21.
    Robinson D, McClish DK, Wyman JF, et al. Comparison between urinary diaries completed with and without intensive patient instructions. Neurourol Urodyn. 1996;15:143–1488.CrossRefPubMedGoogle Scholar
  22. 22.
    Wyman JF, Choi SC, Harkins SW. The urinary diary in evaluation of incontinent women: a testretest analysis. Obstet Gynecol. 1988;71:812–817.PubMedGoogle Scholar
  23. 23.
    Nygaard I, Holcomb R. Reproducibility of the seven-day voiding diary in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:15–17.CrossRefPubMedGoogle Scholar
  24. 24.
    Payne C, Van Kerrebroeck P. Research methodology in urinary incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. 1 vol. Bristol: Health Publication, Ltd.; 2002: 1047–1077.Google Scholar
  25. 25.
    Miller JM, Ashton-Miller JA, Delancey JO. Quantification of cough-related urine loss using the paper towel test. Obstet Gynecol. 1998;91:705–709.CrossRefPubMedGoogle Scholar
  26. 26.
    Miller JM, Ashton-Miller JA, Carchidi LT, et al. On the lack of correlation between self-report and urine loss measured with standing provocation test in older stress-incontinent women. J Womens Health. 1999;8:157–162.CrossRefPubMedGoogle Scholar
  27. 27.
    Sutherst J, Brown M, Shawer M. Assessing the severity of urinary incontinence in women by weighing perineal pads. Lancet. 1981;1:1128–1130.CrossRefPubMedGoogle Scholar
  28. 28.
    Walsh JB, Mills GL. Measurement of urinary loss in elderly incontinent patients. A simple and accurate method. Lancet. 1981;1:1130–1131.CrossRefPubMedGoogle Scholar
  29. 29.
    Bates P, Bradley W, Glen E, et al. Fifth report on the standardisation of terminology of lower urinary tract function. Bristol: International Continence Society; 1983.Google Scholar
  30. 30.
    Abrams P, Blaivas JG, Stanton SL, et al. The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol Suppl. 1988;114:5–19.PubMedGoogle Scholar
  31. 31.
    Klarskov P, Hald T. Reproducibility and reliability of urinary incontinence assessment with a 60 min test. Scand J Urol Nephrol. 1984;18:293–298.PubMedGoogle Scholar
  32. 32.
    Lose G, Gammelgaard J, Jorgensen T. The onehour pad-weighing test: Reproducibility and the correlation between the test result, the start volume in the bladder and the diuresis. Neurourol Urodyn. 1986;5:17–21.CrossRefGoogle Scholar
  33. 33.
    Jorgenson L, Lose G, Andersen Jt. One-hour pad-weighing test for objective assessment of female urinary incontinence. Obstet Gynecol. 1987;69:39–42.Google Scholar
  34. 34.
    Christensen SJ, Colstrup H, Hertz JB, et al. Inter-and intra-departmental variations of the perineal pad weighing test. Neurourol Uroydyn. 1986;5:23–28.CrossRefGoogle Scholar
  35. 35.
    Lose G, Rosenkilde P, Gammelgaard J, et al. Pad-weighing test performed with standardized bladder volume. Urology. 1988;32:78–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Jakobsen H, Kromann-Andersen B, Nielsen KK, et al. Pad weighing tests with 50% or 75% bladder filling. Does it matter? Acta Obstet Gynecol Scand. 1993;72:377–381.CrossRefPubMedGoogle Scholar
  37. 37.
    Simons AM, Yoong WC, Buckland S, et al. Inadequate repeatability of the one hour pad test: the need for a new incontinence outcome measure. BJOG. 2001;108:315–319.CrossRefPubMedGoogle Scholar
  38. 38.
    Lose G, Jorgensen L, Thunedborg P. 24-hour home pad weighing test versus 1-hour ward test in the assessment of mild stress incontinence. Acta Obstet Gynecol Scand. 1989;68:211–215.CrossRefPubMedGoogle Scholar
  39. 39.
    Thind P, Gerstenberg TC. One-hour ward test vs 24-hour home pad weighing test in the diagnosis of incontinence. Neurourol Urodyn. 1991;10:241–245.CrossRefGoogle Scholar
  40. 40.
    Soroka D, Drutz HP, Glazener CM, et al. Perineal pad test in evaluating outcome of treatments for female incontinence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:165–75.CrossRefPubMedGoogle Scholar
  41. 41.
    Theofrastous JP, Bump RC, Elser DM, et al. Correlation of urodynamic measures of urethral resistance with clinical measures of incontinence severity in women with pure genuine stress incontinence. The Continence Program for Women Research Group. Am J Obstet Gynecol. 1995;173: 407–412.CrossRefPubMedGoogle Scholar
  42. 42.
    Fantl JA, Harkins SW, Wyman JF, et al. Fluid loss quantitation test in women with urinary incontinence: a test-retest analysis. Obstet Gynecol. 1987; 70:739–743.PubMedGoogle Scholar
  43. 43.
    Versi E, Cardozo LD. Perineal pad weighing versus videographic analysis in genuine stress incontinence. Br J Obstet Gynaecol. 1986;93:364–366.PubMedGoogle Scholar
  44. 44.
    Haylen BT, Frazer MI, Stuherst JR. Diuretic response to fluid load in women with urinary incontinence: optimum duration of pad test. Br J Urol. 1998;62:331–333.CrossRefGoogle Scholar
  45. 45.
    Richmond DH, Sutherst JR, Brown MC. Quantification of urine loss by weighing perineal pads. Observation on the exercise reigmen. Br J Urol. 1987;59:224–227.CrossRefPubMedGoogle Scholar
  46. 46.
    Frazer MI, Haylen BT, Sutherst JR. The severity of urinary incontinence in women. Comparison of subjective and objective tests. Br J Urol. 1989; 63:14–15.CrossRefPubMedGoogle Scholar
  47. 47.
    Wilson PD, Mason MV, Herbison GP, et al. Evaluation of the home pad test for quantifying incontinence. Br J Urol. 1989;64:155–157.CrossRefPubMedGoogle Scholar
  48. 48.
    Pierson CA. Assessment and quantification of urine loss in incontinent women. Nurse Pract. 1984;9:18–19.CrossRefPubMedGoogle Scholar
  49. 49.
    Ekelund P, Bergstrom H, Milsom I, et al. Quantification of urinary incontinence in elderly women with the 48-hour pad test. Arch Gerontol Geriatr. 1888;7:281–287.CrossRefGoogle Scholar
  50. 50.
    Versi E, Orrego G, Hardy E, et al. Evaluation of the home pad test in the investigation of female urinary incontinence. Br J Obstet Gynaecol. 1996; 103:162–167.PubMedGoogle Scholar
  51. 51.
    Mouritsen L, Berild G, Hertz J. Comparison of different methods for quantification of urinary leakage in incontinent women. Neurourol Urodyn. 1989;8:579–587.CrossRefGoogle Scholar
  52. 52.
    Ryhammer AM, Laurberg S, Djurhuus JC, Hermann AP. No relationship between subjective assessmetn of urinary incontinence and pad test weight gain in a random population sample of menopausal women. J Urol. 1998;159:800–803.CrossRefPubMedGoogle Scholar
  53. 53.
    O’Sullivan R, Karantanis E, Stevermuer TL, et al. Definition of mild, moderate and severe incontinence on the 24-hour pad test. Br J Obstet Gynaecol. 2004;111:859–862.Google Scholar
  54. 54.
    Rasmussen A, Mouritsen L, Dalgaard A, et al. Twenty-four hour pad weighing test: reproducibility and dependency of activity level and fluid intake. Neurourol Urodyn. 1994;13:261–265.CrossRefPubMedGoogle Scholar
  55. 55.
    Karantanis E, Allen W, Stevermuer TL, et al. The repeatability of the 24-hour pad test. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:63–68CrossRefPubMedGoogle Scholar
  56. 56.
    Laycock J. Clinical evaluation of the pelvic floor. In Schussler J, Laycock J, Norton P, Stanton S (eds), Pelvic Floor Re-education, Vol 1. London: Springer-Verlag; 1994:42–48.Google Scholar
  57. 57.
    Sampselle C, Brink C, Wells T. Digital measurement of pelvic floor muscle strength in childbearing women. Nurs Res. 1989;38:134–138.CrossRefPubMedGoogle Scholar
  58. 58.
    Bump RC, Hurt WG, Fantl JA, et al.. Assessment of Kegel pelvic muscle exercise performance after breif verbal instruction. Am J Obstet Gynecol. 1991;165:322–327.PubMedGoogle Scholar
  59. 59.
    Isherwood PJ, Rane A. Comparative assessment of pelvic floor strength using a perineometer and digital examination. BJOG. 2000;107:1007–1011.CrossRefPubMedGoogle Scholar
  60. 60.
    Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80:883–887.PubMedGoogle Scholar
  61. 61.
    Kerschan-Schindl K, Uher E, Wiesinger G, et al. Reliability of pelvic floor muscle strength measurement in elderly incontinent women. Neurourol Urodyn. 2002;21:42–47.CrossRefPubMedGoogle Scholar
  62. 62.
    Mortensen S, Lose G, Thyssen H. Repeatability of cystometry and pressure-flow parameters in female patients. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:72–75.CrossRefPubMedGoogle Scholar
  63. 63.
    Brostrom S, Jennum P, Lose G, et al. Short-term reproducibility of cystometry and pressure-flow micrturition studies in healthy women. Neurourol Urodyn. 2002;21:457–460.CrossRefPubMedGoogle Scholar
  64. 64.
    Swift SE, Yoon EA. Test-retest reliability of the cough stress test in the evaluation of urinary incontinence. Obstet Gynecol. 1999;94:99–102.CrossRefPubMedGoogle Scholar
  65. 65.
    McGuire EJ. Urodynamic findings in patients after failure of stress incontinence operations. In Zinner NR, Sterling AM (eds). Female Incontinence. New York: Alan R Liss; 1980.Google Scholar
  66. 66.
    Brown MC. The urethral pressure profile. Proc R Soc Med. 1970;63:701.PubMedGoogle Scholar
  67. 67.
    Hilton P, Stanton SL. Urethral pressure measurement by microtransducer: the results in symptomfree women and in those with genuine stress incontinence. Br J Obstet Gynaecol. 1983;90:919–933.PubMedGoogle Scholar
  68. 68.
    Lose G, Griffiths D, Hosker G, et al. Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn. 2002;21:258–260.CrossRefPubMedGoogle Scholar
  69. 69.
    Martin S and Griffiths DJ. Model of the female urethra: Part 1-Static measurements of pressure and distensibility. Med Biol Eng. 1976;14:512–518.CrossRefPubMedGoogle Scholar
  70. 70.
    Meyhoff HH, Nordling J, Walter S. Short and long term reproducibility of urethral closure pressure profile parameters. Urol Res. 1979;7:269–271.CrossRefPubMedGoogle Scholar
  71. 71.
    McGuire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter function. J Urol. 1993;150:1452–1454.PubMedGoogle Scholar
  72. 72.
    Song JT, Rozanski TA, Belville WD. Stress leak point pressure: a simple and reproducible method utilizing a fiberoptic microtransducer. Urology. 1995;46:81–84.CrossRefPubMedGoogle Scholar
  73. 73.
    Fleischmann N, Flisser AJ, Blaivas JG, et al. Sphincteric urinary incontinence: relationship of vesical leak point pressure, urethral mobility and severity of incontinence. J Urol. 2003;169:999–1002.CrossRefPubMedGoogle Scholar
  74. 74.
    Nitti VW, Combs AJ. Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. J Urol. 1996;155: 281–285.CrossRefPubMedGoogle Scholar
  75. 75.
    Faerber GJ, Vashi AR. Variations in Valsalva leak point pressure with increasing vesical volume. J Urol. 1998;159:1909–1911.CrossRefPubMedGoogle Scholar
  76. 76.
    Haab F, Zimmern PE, Leach GE. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management. J Urol. 1996;156:3–17.CrossRefPubMedGoogle Scholar
  77. 77.
    McGuire EJ, Cespedes RD, O’Connell HE. Leakpoint pressures. Urol Clin North Am. 1996;23:253–262.CrossRefPubMedGoogle Scholar
  78. 78.
    Hsu TH, Rackley RR, Appell RA. The supine stress test: a simple method to detecturethral sphincter dysfunction. J Urol. 1999;162:460–463.CrossRefPubMedGoogle Scholar
  79. 79.
    Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3:291–306.CrossRefPubMedGoogle Scholar
  80. 80.
    Uebersax JS, Wyman JF, Shumaker SA, et al. 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. 1995; 14:131–139.CrossRefPubMedGoogle Scholar
  81. 81.
    Kelleher CJ, Cardozo LD, Khullar V, et al. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104:1374–1379.PubMedGoogle Scholar
  82. 82.
    Donovan JL, Badia X, Corcos J, et al. Symptom and Quality of Life Assessment. Report of World Health Organisation Consensus Conference: “Incontinence”, Eds: Abrams P, Cardozo L, Koury S, Wein A. Health Publications Ltd., Plymouth; 2001:965–983.Google Scholar
  83. 83.
    Hu TW, Moore KH, Subak L, et al. “The economics of incontinence”. Report of World Health Organisation, Editors: Abrams P, Cardozo L, Koury S, Wein A. Plymouth, UK: Health Publications Ltd., Plymouth; 2001;14:965–983.Google Scholar
  84. 84.
    Dowell CJ, Bryant CM, Moore KH et al. Calculation of the direct costs of urinary incontinence: the DBICI, a new test instrument. Br J Urol. 1999; 83:596–606.Google Scholar
  85. 85.
    Simons AM, Dowell CJ, Bryant CM, et al. Use of the Dowell Bryant incontinence cost index as a post-treatment outcome measure. Neurourol Urodyn. 2001;20:85–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2008

Authors and Affiliations

  • Kate H. Moore
    • 1
  • Emmanuel Karantanis
    • 2
  1. 1.Department of UrogynaecologyUniversity of New South Wales St George HospitalSydneyAustralia
  2. 2.St George HospitalSydneyAustralia

Personalised recommendations