A Review of Condition-Specific Instruments to Assess the Impact of Urinary Incontinence on Health-Related Quality of Life
Introduction
Urinary incontinence is the ‘involuntary loss of urine, which is objectively demonstrable, and a social or hygienic problem’ [1]. Urinary incontinence can be defined as follows:
- •
Urinary urge incontinence (UUI): the involuntary loss of urine associated with a strong desire to void [1]. More recently, overactive bladder (OAB; urgency and frequency with or without urge incontinence), a relatively under-reported condition, has been used to describe a group of urinary incontinence symptoms related to UUI [2], [3].
- •
Stress incontinence (SI): precipitated when pressure is exerted on the abdomen, e.g. by coughing.
- •
Mixed incontinence: a mixture of urge and stress incontinence.
- •
Functional incontinence: physical difficulty in getting to a toilet, such as mobility problems, sedation, etc.
Assessment of the severity of the symptoms listed above has been the main indicator used to understand the burden of the patient’s condition. However, there is also an impact on the person’s health-related quality of life (HRQoL). Loss of urinary control can affect the social, psychological, domestic, occupational, physical and sexual aspects of patients’ lives [4]. The social and psychological consequences can be profound, leading to limitations in social activity, anxiety, embarrassment and isolation [5]. Incontinent patients are most likely to restrict their fluid intake, restrict physical activity and avoid places without easy access to toilets [6]. Most studies carried out in the past decade indicate that urge symptomatology (including OAB symptoms) impacts more on HRQoL than stress incontinence [1], [7], [8].
The prevalence of incontinence depends on the population surveyed (type of urinary incontinence, sex and age). Prevalence in older adults (60+ years) in the US was about 30%, with older women more likely to be affected [9], particularly by UUI [10]. In a British survey, incontinence was estimated to be over twice as prevalent in women (14%) than men (6.6%) [11].
Cost is also an issue. In a survey of incontinent patients aged ≥65 years, the cost was estimated to be $26.3 billion ($3565 per individual) [12]. These costs are likely to increase with a shift towards a larger elderly population.
Treatments for incontinence vary from behavioral therapy to pharmacotherapy. Urge, or OAB symptomatology, is probably the most prevalent condition and pharmacological agents are being developed for these symptoms. Studies on new and existing treatments should evaluate HRQoL as well as efficacy. However, the range of definitions of HRQoL can hinder its measurement. The general consensus is that physical health, social health and emotional well-being should be assessed. Disease-specific instruments are now more widely used and their suitability for assessing HRQoL in incontinent patients is presented.
Section snippets
Assessment of literature and analytical methods
Instruments were identified through a systematic literature search on Medline (1966–2000) and the On-Line Guide to Quality of Life Assessment (OLGA) database [13]. Only instruments that appeared in peer-reviewed journals were assessed.
Instruments were assessed on rigor of development and validation. Features assessed were based on the basic standards for developing and validating a new HRQoL instrument [14]. The psychometric properties of each instrument (reliability, validity and sensitivity
HRQoL instruments
Ten different instruments were identified and split into three categories: general urinary incontinence (five), UUI- or OAB-specific (four) and SI-specific (one).
Conclusions
There are a number of reliable and valid instruments for assessing the impact of incontinence symptomatology on HRQoL. Currently, the general instruments are the more psychometrically robust, particularly the KHQ [15] and I-QoL [24]. Of the specific UUI instruments, U-UIIQ [31] is a promising instrument for assessing HRQoL in OAB (or UUI) patients. The KHQ, a general incontinence questionnaire, is also an appropriate instrument for use in OAB patients. SII-SI, specifically developed for use in
References (33)
- et al.
Economic costs of urinary incontinence in 1995
Urology
(1998) - et al.
A review of the quality of life aspects of urinary urge incontinence
Pharmacoeconomics
(1996) - et al.
Quality of life aspects of the overactive bladder and the effect of treatment with tolterodine
BJU Int.
(1999) - et al.
The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society
Neurourol Urodyn
(2002) - et al.
Prevalence of urinary incontinence
BMJ
(1980) Urinary incontinence in women: a review for the pharmacist
J. Am. Pharm. Assoc.
(1996)- et al.
The impact of urinary incontinence on the quality of life of women
World J. Urol.
(1999) - et al.
The quality of life in women with urinary incontinence as measured by the Sickness Impact Profile
J. Am. Geriatr. Soc.
(1991) - et al.
Female urinary incontinence
Scand. J. Caring Sci.
(1993) - et al.
Prevalence and incidence of urinary incontinence in community-dwelling populations
J. Am. Geriatr. Soc.
(1990)
Urinary incontinence in the elderly: pharmacologic therapies
Am. Fam. Physician
Urinary incontinence in the community—analysis of a MORI poll
BMJ
A new questionnaire to assess the quality of life of urinary incontinent women
Br. J. Obstet. Gynaecol.
Validation of King’s Health Questionnaire in patients with symptoms of overactive bladder
Qual. Life Res.
Cited by (26)
“Bordeaux Neobladder”: First Evaluation of the Urodynamic Outcomes
2023, European Urology Open ScienceCitation Excerpt :All consenting patients were resubmitted to UDS evaluation in November 2021. At the same time point, the continence status was assessed and a frequency-volume chart, kidney ultrasound, incontinence quality of life (I-QoL) questionnaire evaluation [7], and a blood gas analysis were performed. Continence was classified into day- and nighttime, and clinically defined as the use of zero pads.
A multicenter, double-blind, randomized, placebo-controlled trial of the β3-adrenoceptor agonist solabegron for overactive bladder
2012, European UrologyCitation Excerpt :Epidemiologic studies in Europe and the United States have estimated OAB prevalence in the 11–16% range [2,3]. Although OAB is not a life-threatening condition, the loss of urinary control has a considerable negative impact on quality of life, quality of sleep, and mental health and hence on the social, psychological, domestic, occupational, physical, and sexual aspects of patients’ lives; these negative effects also create a major economic burden on society [4–6]. Muscarinic receptor antagonists are currently the primary form of medical OAB treatment [7,8].
Clinical diagnosis and evaluation of female urinary incontinence
2009, Journal de Gynecologie Obstetrique et Biologie de la ReproductionFemale sexual function before and after treatment of urinary incontinence
2006, Actas Urologicas EspanolasA systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence
2021, Neurourology and Urodynamics