Questionnaires for Several Recommended Outcome Measures for Women with Pelvic Floor Disorders

Appendix D Sample Questionnaires for Several Recommended Outcome Measures for Women with Pelvic Floor Disorders



INTERNATIONAL CONSULTATION ON INCONTINENCE QUESTIONNAIRE-SHORT FORM (ICIQ-SF)


(From Avery K, Donovan J, Peters TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004;23:322.)



UROGENITAL DISTRESS INVENTORY-6 AND INCONTINENCE IMPACT QUESTIONNAIRE-7


(From Ubersax JS, Wyman JF, Shumaker SA, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn 1995;14:31.)



INCONTINENCE QUALITY OF LIFE INSTRUMENT (I-QOL)


(From Patrick DL, Martin ML, Bushnell DM, et al. Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument [I-QOL]. Urology 1999;53:71.)



PELVIC FLOOR DISTRESS INVENTORY-SHORT FORM 20


(From Barber MD, Bump RC, Walters MD. Short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders. Am J Obstet Gynecol 2005; 193:103.



PELVIC FLOOR IMPACT QUESTIONNAIRE-SHORT FORM 7


(From Barber MD, Bump RC, Walters MD. Short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders. Am J Obstet Gynecol 2005; 193:103.)



PELVIC ORGAN PROLAPSE/URINARY INCONTINENCE SEXUAL FUNCTION QUESTIONNAIRE (PISQ-12)


(From Rogers RG, Coates KW, Kammerer-Doak D, et al. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire [PISQ-12]. Int Urogynecol J 2003;14:164.)





ICIQ-SF


Many people leak urine some of the time. We are trying to find out how many people leak urine, and how much this bothers them. We would be grateful if you could answer the following questions, thinking about how you have been, on average, over the PAST FOUR WEEKS.



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Urogenital Distress Inventory −6 (UDI-6)



1. Do you experience, and, if so, how much are you bothered by frequent urination?

2. Do you experience, and, if so, how much are you bothered by urine leakage related to a feeling of urgency?

3. Do you experience, and, if so, how much are you bothered by urine leakage related to physical activity, coughing, or sneezing?

4. Do you experience, and, if so, how much are you bothered by small amounts of urine leakage (drops)?

5. Do you experience, and, if so, how much are you bothered by difficulty emptying your bladder?

6. Do you experience, and, if so, how much are you bothered by pain or discomfort in the lower abdominal or genital area?

Response levels for all items are: (0) not at all; (1) slightly; (2) moderately; (3) greatly



Incontinence Impact Questionnaire −7 (IIQ-7)


Has urine leakage and/or prolapse affected your:


1. Ability to do household chores (cooking, housecleaning, laundry)?

2. Physical recreation such as walking, swimming, or other exercise?

3. Entertainment activities (movies, concerts, etc.)?

4. Ability to travel by car or bus more than 30 minutes from your home?

5. Participation in social activities outside your home?

Related posts:

Epidemiology and Psychosocial Impact of Pelvic Floor Disorders Urethral Injection of Bulking Agents for Intrinsic Sphincter Deficiency Laparoscopic Surgery for Stress Urinary Incontinence and Pelvic Organ Prolapse Surgical Treatment of Vaginal Vault Prolapse and Enterocele Urethral Injection of Bulking Agents for Intrinsic Sphincter Deficiency Bladder Drainage and Urinary Protective Methods

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Mar 10, 2016 | Posted by in Reconstructive surgery | Comments Off on Questionnaires for Several Recommended Outcome Measures for Women with Pelvic Floor Disorders

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