Urge incontinence: New health-related quality of life measures

OBJECTIVES: To develop and evaluate the psychometric properties of two new urge incontinence-specific instruments that measure quality of life and symptom annoyance. DESIGN: New instruments were developed and validated in racially, ethnically, and age-diverse community-dwelling women with urge or mixed incontinence with a primary urge component. MEASUREMENTS: A total of 83 women with a minimum of six urge losses per week were sequentially recruited. We began with the previously developed Incontinence Impact Questionnaire and Urogenital Distress Inventory and added information from focus groups, expert clinical opinion, and literature review. Final selection of questions was based on a combination of factor analysis, item-scale analysis, and reliability of scales to identify the best performing questions from the preliminary instruments. Both convergent and divergent validity were evaluated using established health-related quality of life measures, frequency of incontinence episodes, global ratings of interference with daily activities and effect on feelings, and overall severity. RESULTS: Mean age of subjects was 63.8 years, 37% were non-white, 23% had a high school education or less, and 24% had a household income of less than $10,000/year. Ten percent reported urge incontinence alone, with the remainder having mixed incontinence. Six domains were identified for the Urge-IIQ and one domain for the Urge-UDI. All domains had adequate reliability (Cronbach's alpha 0.74 - 0.95) and test-retest reliability (intraclass correlations greater than or equal to 0.59). CONCLUSIONS: The newly developed Urge-Incontinence Impact Questionnaire and Urge-Urinary Distress Inventory are reliable, and evidence of validity was found in a diverse population. These instruments are available for use in trials of new therapeutic interventions for urge incontinence.