Volume 96, Issue 3 p. 350-359

Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire

Darren Clayson

Darren Clayson

Oxford Outcomes Ltd,

Search for more papers by this author
Diane Wild

Corresponding Author

Diane Wild

Oxford Outcomes Ltd,

Diane Wild, Director, Oxford Outcomes Ltd, Old Barn, Jericho Farm, Cassington, Oxford OX29 4SZ, UK.
e-mail: [email protected]Search for more papers by this author
Helen Doll

Helen Doll

Department of Public Health, University of Oxford, Oxford, UK,

Search for more papers by this author
Karen Keating

Karen Keating

Bayer HealthCare Pharmaceuticals Global Health Economics and Outcomes Research, West Haven CT, USA

Search for more papers by this author
Kathleen Gondek

Kathleen Gondek

Bayer HealthCare Pharmaceuticals Global Health Economics and Outcomes Research, West Haven CT, USA

Search for more papers by this author
First published: 24 July 2005
Citations: 75

Abstract

OBJECTIVE

To develop and validate a self-administered questionnaire to assess the ‘severity’ and ‘bothersomeness’ of the most frequently reported signs and symptoms of uncomplicated urinary tract infection (uUTI).

SUBJECTS AND METHODS

The UTI Symptoms Assessment questionnaire (UTISA) is a 14-item instrument asking about the severity and bothersomeness of seven key uUTI symptoms. It was developed after comprehensive literature and data review and administration in draft form to a sample of 30 women with uUTI. The final questionnaire was completed by 276 women with uUTI who participated in a noncomparative clinical trial of ciprofloxacin. The women completed the questionnaire in electronic format at baseline (before the first dose of ciprofloxacin once-daily), at 3-h and 8-h intervals until all UTI symptoms were resolved, and at the test-of-cure visit. Baseline scores on the King's Health Questionnaire (KHQ) were used to assess convergent and divergent validity; responses to the Global Rating of Change (GRC) were used to assess both responsiveness and the ‘minimally important difference’. Discriminant validity and responsiveness were assessed by comparing UTISA scores with a clinical evaluation of UTI symptoms performed by the investigator at baseline and at the test-of-cure visit.

RESULTS

The UTISA was found to comprise three four-item domains named ‘urination regularity’, ‘problems with urination’, and ‘pain associated with UTI’. Two questions asking about haematuria loaded on a fourth factor. The three domains were homogeneous (with high inter-item correlations) and internally consistent. Convergent validity was shown by high correlations between similar UTISA and KHQ domains (all rs > 0.40), and divergent validity by small correlations between unlike domains (all rs < 0.15). In general, the UTISA domains showed excellent discriminant validity, with scores on selected domains discriminating between women with different clinical evaluations. The responsiveness of the UTISA was also excellent, with high correlations between changes in domain scores and the clinical evaluation and GRC items. Symptom improvement was highest in the first 3 h, leading to greater responsiveness and minimally important difference during this period. However, the UTISA could detect even small subsequent changes.

CONCLUSION

The three-domain UTISA has excellent psychometric properties and it is likely to prove an excellent tool for assessing uUTI outcome from a patient's perspective, both in research and clinical settings.