Abstract
This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.
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References
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
(1990) The standardization of terminology of lower urinary tract function. Br J Obstet Gynaecol 97(Suppl 6):1–16
Lose G, Fantl JA, Victor A, Walter S, Wells TL, Wyman JF et al (1998) Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourol Urodyn 17:255–262
Corcos J, Beaulieu S, Donovan J, Naughton MJ, Gotoh M, members of the symptom and quality of life assessment committee of the first international consultation on incontinence (2002) Quality of life assessment in men and women with urinary incontinence. J Urol 168:896–905
Symonds T (2003) A review of condition-specific instruments to assess the impact of urinary incontinence on health-related quality of life. Eur Urol 43:219–225
Graham CW, Dmochowski RR (2002) Questionnaires for women with urinary symptoms. Neurourol Urodyn 21:473–481
Naughton MJ, Donovan J, Badia X, Corcos J, Gotoh M, Kelleher CJ et al (2004) Symptom severity and QOL scales for urinary incontinence. Gastroenterology 126:S114–S123
Clark TJ, Khan KS, Foon R, Pattison H, Bryan S, Gupta JK (2002) Quality of life instruments in studies of menorrhagia: a systematic review. Eur J Obstet Gynecol 104:96–104
McFall SL, Yerkes AM, Cowan LD (2000) Outcomes of a small group educational intervention for urinary incontinence: health-related quality of life. J Aging Health 12:301–317
Brubaker L, Benson JT, Bent A, Clark A, Shott S (1997) Transvaginal electrical stimulation for female urinary incontinence. Am J Obstet Gynecol 177:536–540
Fujishiro T, Takahashi S, Enomoto H, Ugawa Y, Ueno S, Kitamura H (2002) Magnetic stimulation of the sacral roots for the treatment of urinary frequency and urge incontinence: an investigational study and placebo controlled trial. J Urol 168:1036–1039
Bent A, Foote A, Siegel SW, Faerber G, Chao R, Gormley EA (2001) Collagen implant for treating stress urinary incontinence in women with urethral hypermobility. J Urol 166:1354–1357
Sugaya K, Owan T, Hatano T, Nishijima S, Miyazato M, Mukouyama H et al (2003) Device to promote pelvic floor muscle training for stress incontinence. Int J Urol 10:416–422
Ushiroyama T, Ikeda A, Ueki M (2001) Clinical efficacy of clenbuterol and propiverine in menopausal women with urinary incontinence: improvement in quality of life. J Med 31:311–319
Lightner D, Calvosa C, Andersen R, Klimberg I, Brito CG, Snyder J (2001) A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, double-blind study of Durasphere. Urology 58:12–15
Nilsson CG (2000) Effectiveness of the conveen continence guard (a disposable vaginal device) in the treatment of complicated female stress incontinence. Acta Obstet Gynecol Scand 79:1052–1055
Rodriguez LV, Berman J, Raz S (2001) Polypropylene sling for treatment of stress urinary incontinence: an alternative to tension-free vaginal tape. Tech Urol 7:87–89
Lukacz ES, Luber KM, Nager CW (2004) The effects of the tension-free vaginal tape on voiding function: a prospective evaluation. Int Urogynecol J Pelvic Floor Dysfunct 15:32–38
Jeyaseelan SM, Haslam EJ, Winstanley J, Roe BH, Oldham JA (2000) An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial. Clin Rehabil 14:631–640
Versi E, Griffiths DJ, Harvey MA (1998) A new external urethral occlusive device for female urinary incontinence. Obstet Gynecol 92:286–291
Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF et al (1996) Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group. Am J Obstet Gynecol 175:326–333
Versi E, Harvey MA (1998) Efficacy of an external urethral device in women with genuine stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 9:271–274
Wyman JF, Fantl JA, McClish DK, Bump RC (1998) Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol 179:999–1007
Fantl JA, Bump RC, Robinson D, McClish DK, Wyman JF (1996) Efficacy of estrogen supplementation in the treatment of urinary incontinence. The Continence Program for Women Research Group. Obstet Gynecol 88:745–749
O’Sullivan RJ, Simons A, Prashar S, Anderson P, Louey M, Moore KH (2003) Is objective cure of mild undifferentiated incontinence more readily achieved than that of moderate incontinence? Costs and 2-year outcome. Int Urogynecol J Pelvic Floor Dysfunct 14:193–198
Moore KH, O’Sullivan RJ, Simons A, Prashar S, Anderson P, Louey M (2003) Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up. Br J Obstet Gynaecol 110:649–657
Hung MJ, Liu FS, Shen PS, Chen GD, Lin LY, Ho ES (2004) Analysis of two sling procedures using polypropylene mesh for treatment of stress urinary incontinence. Int J Gynaecol Obstet 84:133–141
Bent AE, Tutrone RT, McLennan MT, Lloyd LK, Kennelly MJ, Badlani G (2001) Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent. Neurourol Urodyn 20:157–165
Woodman PJ, Misko CA, Fischer J (2001) The use of short-form quality of life questionnaires to measure the impact of imipramine on women with urge incontinence. Int Urogynecol J Pelvic Floor Dysfunct 12:312–315
Corcos J, Behlouli J, Beaulieu S (2002) Identifying cut-off scores with neural networks for interpretation of the incontinence impact questionnaire. Neurourol Urodyn 21:198–203
Kelleher CJ, Pleil AM, Reese PR, Burgess SM, Brodish PH (2004) How much is enough and who says so? The case of the King’s Health Questionnaire and overactive bladdef. Br J Obstet Gynaecol 111:605–612
Beaulieu S, Collet JP, Tu LM, Macrammalla E, Wood-Dauphinee S, Corcos J (1999) Performance of the incontinence impact questionnaire in Canada. Can J Urol 6:692–699
Hagen S, Hanley J, Capewell A (2002) Test-retest reliability, validity, and sensitivity to change of the urogenital distress inventory and the incontinence impact questionnaire. Neurourol Urodyn 21:534–539
Handa VL, Massof RW (2004) Measuring the severity of stress urinary incontinenceusing the incontinence impact questionnaire. Neurourol Urodyn 23:27–32
van der Vaart CH, de Leeuw JR, Roovers JP, Heintz AP (2003) Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22:97–104
Robinson D, Pearce KF, Preisser JS, Dugan E, Suggs PK, Cohen SJ (1998) Relationship between patient reports of urinary incontinence symptoms and quality of life measures. Obstet Gynecol 91:224–228
FitzGerald MP, Kenton K, Shott S, Brubaker L (2001) Responsiveness of quality of life measurements to change after reconstructive pelvic surgery. Am J Obstet Gynecol 185:20–24
Harvey M-A, Kristjansson B, Griffith D, Versi E (2001) The incontinence impact questionnaire and the urogenital distress inventory: a revisit of their validity in women without urodynamic diagnosis. Am J Obstet Gynecol 185:25–31
Lemack GE, Zimmern PE (1999) Predictability of urodynamic findings based on the urogenital distress inventory-6 questionnaire. Urology 54:461–466
Yalcin I, Bump RC (2003) Validation of two global impression questionnaire for incontinence. Am J Obstet Gynecol 189:98–101
Koyama W, Koyanagi A, Mihara S, Kawazu S, Uemura T, Nakano H et al (1998) Prevalence and conditions of urinary incontinence among the elderly. Methods Inf Med 37:151–155
Tamanini JT, D’Ancona CA, Tadini V, Netto NR (2003) Macroplastique implantation system for the treatment of female stress urinary incontinence. J Urol 169:2229–2233
Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) 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 3:291–306
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 14:131–139
Soroka D, Drutz HP, Glazener CMA, Hay-Smith EJC, Ross S (2002) Perineal pad test in evaluating outcome of treatments for female incontinence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct 13:165–175
Amarenco G, Arnould B, Carita P, Haab F, Labat J-J, Richard F (2003) European psychometric validation of the CONTILIFE® : a quality of life questionnaire for urinary incontinence. Eur Urol 43:391–404
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23:322–330
Brown JS, Posner SF, Stewart AL (1999) Urge incontinence: new health-related quality of life measures. J Am Geriatr Soc 47:980–988
Black N, Griffiths J, Pope C (1996) Development of a symptom severity index and a symptom impact index for stress incontinence in women. Neurourol Urodyn 15:630–640
Minassian V, Drutz HP, Al-Badr A (2003) Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet 82:327–338
Dmochowski RR, Avon M, Ross J, Cooper JM, Kaplan R, Love B et al (2003) Transvaginal radio frequency treatment of the endopelvic fascia: a prospective evaluation for the treatment of genuine stress urinary incontinence. J Urol 169:1028–1032
Laycock J, Brown J, Cusack C, Green S, Jerwood D, Mann K (2001) Pelvic floor reeducation for stress incontinence: comparing three methods. Br J Community Nurs 6:230–237
Sung MS, Choi YH, Back SH, Hong JY, Yoon H (2000) The effect of pelvic floor muscle exercises on genuine stress incontinence among Korean women–focusing on its effects on the quality of life. Yonsei Med J 41:237–251
Richardson DA, Miller KL, Siegel SW, Karram MM, Blackwood NB, Staskin DR (1996) Pelvic floor electrical stimulation: a comparison of daily and every-other-day therapy for genuine stress incontinence. Urology 48:110–118
Galloway NT, El Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ (1999) Extracorporeal magnetic innervation therapy for stress urinary incontinence. Urology 53:1108–1111
Galloway NT, El Galley RE, Sand PK, Appell RA, Russell HW, Carlin SJ (2000) Update on extracorporeal magnetic innervation (EXMI) therapy for stress urinary incontinence. Urology 56:82–86
Almeida FG, Bruschin iH, Srougi M (2004) Urodynamic and clinical evaluation of 91 female patients with urinary incontinence treated with perineal magnetic stimulation: 1-year followup. J Urol 171:1571–1574
Sand PK, Richardson DA, Staskin DR, Swift SE, Appell RA, Whitmore KE et al (1995) Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial. Am J Obstet Gynecol 173:72–79
Sung MS, Hong JY, Choi YH, Baik SH, Yoon H (2000) FES-biofeedback versus intensive pelvic floor muscle exercise for the prevention and treatment of genuine stress incontinence. J Korean Med Sci 15:303–308
Bo K, Talseth T, Vinsnes A (2000) Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand 79:598–603
Davila GW, Neal D, Horbach N, Peacher J, Doughtie JD, Karram M (1999) A bladder-neck support prosthesis for women with stress and mixed incontinence. Obstet Gynecol 93:938–942
Mukherjee K, Constantine C (2001) Urinary stress incontinence in obese women: tension-free vaginal tape is the answer. BJU Int 167:586–590
Gateau T, Faramarzi-Roques R, Le Normand L, Glemain P, Buzelin JM, Ballanger P (2003) Clinical and urodynamic repercussions after TVT procedure and how to diminish patient complaints. Eur Urol 44:372–376
Manca A, Sculpher MJ, Ward K, Hilton P (2003) A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. Br J Obstet Gynaecol 110:255–262
Ward K, Hilton P, UK and Ireland TVT TRial Group (2004) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 190:324–331
deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanese-Benamour L, Fernandez H (2004) A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 190:602–608
Jackson S, Shepherd A, Brookes S, Abrams P (1999) The effect of oestrogen supplementation on post-menopausal urinary stress incontinence: a double-blind placebo-controlled trial. Br J Obstet Gynaecol 106:711–718
Norton P, Karram M, Wall LL, Rosenzweig B, Benson JT, Fantl JA (1994) Randomized double-blind trial of terodiline in the treatment of urge incontinence in women. Obstet Gynecol 84:386–391
Norton P, Zinner NR, Yalcin I, Bump RC (2002) Duloxetine versus placebo in the treatment of stress urinary incontinence. Am J Obstet Gynecol 187:40–48
Bump RC, Norton P, Zinner N, Yalcin I, Duloxetine urinary incontinence study group (2004) Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol 102:76–83
Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC et al (2003) Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. J Urol 170:1259–1263
Homma Y, Paick JS, Lee JG, Kawabe K, Japanese and Korean Tolterodine study group (2003) Clinical efficacy and tolerability of extended-release tolterodine and immediate-release oxybutynin in Japanese and Korean patients with an overactive bladder: a randomized, placebo-controlled trial. BJU Int 92:741–747
Millard RJ, Moore KH, Rencken R, Yalcin I, Bump RC, Duloxetine urinary incontinence study group (2004) Duloxetine versus placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial. BJU Int 93:311–318
Rufford J, Hextall A, Cardozo L, Khullar V (2003) A double-blind placebo-controlled trial on the effects of 25 mg estradiol implants on the urge syndrome in postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct 14:78–83
van Kerrebroeck PE, Abrams P, Lange R, Slack M, Wyndaele JJ, Yalcin I et al (2004) Duloxetine versus placebo in the treatment of European and Canadian women with stress urinary incontinence. Br J Obstet Gynaecol 111:249–257
Wyman JF, Fantl JA, McClish DK, Harkins SW, Uebersax JS, Ory MG (1997) Quality of life following bladder training in older women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 8:223–229
Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR et al (1991) Efficacy of bladder training in older women with urinary incontinence. JAMA 265:609–613
Sampselle CM, Wyman JF, Thomas KK, Newman DK, Gray M, Dougherty M et al (2000) Continence for women: a test of AWHONN’s evidence-based protocol in clinical practice. Association of women’s health obstetric and neonatal nurses. J Obstet Gynecol Neonatal Nurs 29:18–26
Lee PS, Reid DW, Saltmarche A, Linton L (1995) Measuring the psychosocial impact of urinary incontinence: the York incontinence perceptions scale (YIPS). J Am Geriatr Soc 43:1275–1278
Goode PS, Burgio KL, Locher JL, Roth DL, Umlauf MG, Richter HE et al (2003) Effect of behavioral training with or without pelvic floor electrical stimulation on stress incontinence in women: a randomized controlled trial. JAMA 290:345–352
Alewijnse D, Metsemakers J, Mesters I, van den Borne B (2003) Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Neurourol Urodyn 22:284–295
Dougherty MC, Dwyer JW, Pendergast JF, Tomlinson BU, Boyington AR, Vogel WB et al (1998) Community-based nursing: continence care for older rural women. Nurs Outlook 46:233–244
Dougherty M, Dwyer JW, Pendergast JF, Boyington AR, Tomlinson BU, Coward RT (2002) A randomized trial of behavioural management for continence with older rural women. Res Nurs Health 25:892–899
Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE et al (2004) Behavioural training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 288:2293–2299
Bellin P, Smith J, Poll W, Bogojavlensky S, Knoll D, Childs S et al (1998) Results of a multicenter trial of the CapSure (Re/Stor) Continence shield on women with stress urinary incontinence. Urology 51:697–706
Shinopulos NM, Dann JA, Smith JJ III (1999) Patient selection and education for use of the CapSure (Re/Stor) continence shield. Urol Nurs 19:135–140
Moore KH, Simons A, Dowell C, Bryant C, Prashar S (1999) Efficacy and user acceptability of the urethral occlusive device in women with urinary incontinence. J Urol 162:464–468
Sand PK, Staskin D, Miller J, Diokno A, Sant GR, Davila GW et al (1999) Effect of a urinary control insert on quality of life in incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 10:100–105
Sander P, Thyssen H, Lose G, Andersen JT (1999) Effect of a vaginal device on quality of life with urinary stress incontinence. Obstet Gynecol 93:407–411
Bergstrom K, Carlsson CP, Lindholm C, Widengren R (2000) Improvement of urge- and mixed-type incontinence after acupuncture treatment among elderly women—a pilot study. J Auton Nerv Syst 79:173–180
Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP (1996) Quality of life of persons with urinary incontinence: development of a new measure. Urology 47:67–71
Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. Br J Urol 77:805–812
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379
Renck-Hooper U, McKenna SP, Whalley D (1998) Measuring quality of life in female urge urinary incontinence: development and psychometric properties of the IQoLI. J Drug Assess 1:41–48
Wyman JF, Harkins SW, Choi SC, Taylor JR, Fantl JA (1987) Psychosocial impact of urinary incontinence in women. Obstet Gynecol 70:378–381
Norton C (1982) The effects of urinary incontinence in women. Int Rehabil Med 4:9–14
Patrick DL, Martin ML, Bushnell DM, Yalcin I, Wagner TH, Buesching DP (1999) Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 53:71–76
Patrick DL, Martin ML, Bushnell DM, Marquis P, Andrejasich CM, Buesching DP (1999) Cultural adaptation of a quality-of-life measure for urinary incontinence. Eur Urol 36:427–435
Brookes S, Donovan J, Wright M, Jackson S, Abrams P (2004) A scored form of the Bristol female lower urinary tract symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol 191:73–82
Homma Y, Uemura S (2004) Use of the short form of King’s Health Questionnaire to measure quality of life in patients with an overactive bladder. BJU Int 93:1009–1013
Reese PR, Pleil AM, Okano GJ, Kelleher C (2003) Multinational study of reliability and validity of the King’s health questionnaire in patients with overactive bladder. Qual Life Res 12:427–442
Uemura S, Homma Y (2004) Reliability and validity of King’s health questionnaire in patients with symptoms of overactive bladder with urge incontinence in Japan. Neurourol Urodyn 23:94–100
Tamanini JT, Dambros M, D’Ancona CA, Palma PCR, Botega NJ, Rios LAS et al (2004) Concurrent validity, internal consistency and responsiveness of the Portuguese version of the King’s health questionnaire (KHQ) in women after stress urinary incontinence surgery. Int Braz J Urol 30:479–486
Girod I, McCarthy C, Marrel A, de la Loge C, Marquis P (1999) Development and psychometric validation of a quality of life questionnaire in urinary incontinence (Contilife). Qual Life Res 7:658
Herzog AR, Diokno AC, Brown MB, Fultz NH, Goldstein NE (1994) Urinary incontinence as a risk factor for mortality. J Am Geriatr Soc 42:264–268
McKenna SP, Willamson T, Renck-Hooper U, Whalley D (1997) The development of UK and Canadian English versions of the incontinence quality of life index (IQoLI). J Outcomes Res 1:9–16
Kelleher CJ (1997) Quality of life. In: Cardozo L (ed) Urogynecology. Churchill Livingstone, NewYork, pp 673–688
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Ross, S., Soroka, D., Karahalios, A. et al. Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review. Int Urogynecol J 17, 272–285 (2006). https://doi.org/10.1007/s00192-005-1357-7
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DOI: https://doi.org/10.1007/s00192-005-1357-7