Elsevier

European Urology

Volume 43, Issue 3, March 2003, Pages 219-225
European Urology

A Review of Condition-Specific Instruments to Assess the Impact of Urinary Incontinence on Health-Related Quality of Life

https://doi.org/10.1016/S0302-2838(03)00045-9Get rights and content

Abstract

To date, severity of symptoms of urinary tract conditions, such as overactive bladder (OAB) and stress incontinence, have been the main indicators used to understand the burden on the patient. However, there is also an impact on patients’ health-related quality of life (HRQoL) that should also be assessed. A literature search was conducted and all HRQoL instruments published in peer-reviewed journals were evaluated. Ten instruments were identified: general use (five); urinary urge (OAB) incontinence (four); and stress incontinence (one). Several were identified as valid instruments for assessing HRQoL in urinary incontinence patients.

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)

  • T Wagner et al.

    Economic costs of urinary incontinence in 1995

    Urology

    (1998)
  • W.R Lenderking et al.

    A review of the quality of life aspects of urinary urge incontinence

    Pharmacoeconomics

    (1996)
  • G Kolbelt et al.

    Quality of life aspects of the overactive bladder and the effect of treatment with tolterodine

    BJU Int.

    (1999)
  • P Abrams 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)
  • T.M Thomas et al.

    Prevalence of urinary incontinence

    BMJ

    (1980)
  • J.L Beizer

    Urinary incontinence in women: a review for the pharmacist

    J. Am. Pharm. Assoc.

    (1996)
  • L.V Swithinbank et al.

    The impact of urinary incontinence on the quality of life of women

    World J. Urol.

    (1999)
  • S Hunskaar et al.

    The quality of life in women with urinary incontinence as measured by the Sickness Impact Profile

    J. Am. Geriatr. Soc.

    (1991)
  • H Sandvick et al.

    Female urinary incontinence

    Scand. J. Caring Sci.

    (1993)
  • A.R Herzog et al.

    Prevalence and incidence of urinary incontinence in community-dwelling populations

    J. Am. Geriatr. Soc.

    (1990)
  • F.J Peggs

    Urinary incontinence in the elderly: pharmacologic therapies

    Am. Fam. Physician

    (1992)
  • J.C Brocklehurst

    Urinary incontinence in the community—analysis of a MORI poll

    BMJ

    (1993)
  • Erickson P. On-Line Guide to Quality of Life Assessment. www.olga-qol.com,...
  • McDowell G, Newell C. Measuring health: a guide to rating scales and questionnaires. 2nd ed. Oxford: Oxford University...
  • C Kelleher et al.

    A new questionnaire to assess the quality of life of urinary incontinent women

    Br. J. Obstet. Gynaecol.

    (1997)
  • A Pleil et al.

    Validation of King’s Health Questionnaire in patients with symptoms of overactive bladder

    Qual. Life Res.

    (2000)
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