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Stress urinary incontinence and quality of life: a reliability study of a condition-specific instrument in paper and web-based versions
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Jämtland Cty Council, Res Unit, S-83157 Östersund, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Jämtland Cty Council, Res Unit, S-83157 Östersund, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
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2012 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 31, no 8, 1242-1246 p.Article in journal (Refereed) Published
Abstract [en]

Aims Quality of life is an important outcome measure in studies of urinary incontinence. Electronic collection of data has several advantages. We examined the reliability of the Swedish version of the highly recommended condition-specific quality of life questionnaire International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), in paper and web-based formats in women with stress urinary incontinence.

Methods Women aged 1870 years, with stress urinary incontinence at least once weekly, were recruited via the project's website and answered the ICIQ-LUTSqol questionnaire. Respondents completed either the paper version twice (n?=?78), or paper and web-based versions once each (n?=?54). The ICIQ validation protocol was followed.

Results The mean interval between answers was 18.1 (SD?=?3.1) days in the paper versus paper setting and 15.0 (SD?=?7.8) days in the paper versus web-based setting. Internal consistency was excellent, with Cronbach's alpha coefficients of 0.87 for the paper version and 0.86 for the web-based version. There was a high degree of agreement of overall scores with intraclass correlations in the paper versus paper and paper versus web-based settings: 0.95 (P?<?0.001) and 0.92 (P?<?0.001), respectively. The mean of each individual item's weighted kappa value was 0.61 in both settings.

Conclusions The questionnaire is reliable in women with stress urinary incontinence, and it can be used in either a paper or a web-based version.

Neurourol. Urodynam. 31:12421246, 2012. (C) 2012 Wiley Periodicals, Inc.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012. Vol. 31, no 8, 1242-1246 p.
Keyword [en]
Internet, quality of life, stress urinary incontinence, validation study
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-61768DOI: 10.1002/nau.22240ISI: 000310062700009OAI: oai:DiVA.org:umu-61768DiVA: diva2:572446
Projects
tät.nu
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2012-11-27 Created: 2012-11-26 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
Open this publication in new window or tab >>Internet-based treatment of stress urinary incontinence: treatment outcome, patient satisfaction, and cost-effectiveness
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment.

Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI.

Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire.

Results Participants in both intervention groups achieved highly significant improvements (p<0.001) with large effect sizes (>0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p<0.001).

Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.”

The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935.

The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p<0.001).

Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 86 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1621
Keyword
Stress urinary incontinence, Internet, randomised controlled trial, pelvic floor muscle training, self care, quality of life, qualitative research, cost-utility analysis, validation study
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-84405 (URN)978-­91-­7459-­778-­3 (ISBN)
Public defence
2014-01-31, Hörsalen Snäckan (Aulan), hus 16, ingång 6, Östersunds sjukhus, Östersund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-01-10 Created: 2014-01-06 Last updated: 2015-04-29Bibliographically approved

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