Voiding DysfunctionDesign and Validation of a New Screening Instrument for Lower Urinary Tract Dysfunction: The Bladder Control Self-Assessment Questionnaire (B-SAQ)
Introduction
Lower urinary tract symptoms (LUTS) are distressing and debilitating, and have a significant impact on an individual’s health and quality of life. The associated stigma of bladder problems, a false belief that they are an inevitable consequence of ageing and childbirth, embarrassment, and uncertainty regarding the availability of treatment can prevent people from seeking help [1].
Patients develop elaborate strategies and altered lifestyles to cope with their symptoms. A European study (SIFO) [2] investigating the prevalence of overactive bladder (OAB) symptoms found that only 60% of people with symptoms had ever consulted a doctor, although a higher proportion of patients reported that their symptoms had an effect on daily living. A similar prevalence of OAB was found in the American (NOBLE) OAB study [3].
It has been estimated that people suffering with LUTS will wait an average of 4 years before seeking help [4]. Women are less likely to seek help than men for bothersome LUTS. Awareness of prostatic problems amongst male patients may prompt them to seek reassurance that there is no serious underlying pathology [5].
The challenge for health care providers is to educate and empower patients about their bladder symptoms, to allow them to differentiate what is normal from abnormal, and to determine when to seek medical help. We also need to help busy clinicians to identify patients who have bladder symptoms and may benefit from medical intervention. Often in clinic consultations, time is at a premium, and bladder symptoms may not be discussed. Screening instruments aim to identify undetected or unreported disease in the community and increase public awareness of a health condition.
The financial costs of LUTS, both direct and indirect, are already significant and likely to increase as the population ages [6]. Identification of patients with early or less troublesome urinary symptoms may help us to intervene earlier and perhaps improve overall treatment efficacy. Early intervention with simple measures such as lifestyle advice and behavioural therapy may reduce the need for initiating more complex and costly treatment in a proportion of patients. Earlier detection and treatment of LUTS may reduce complications such as skin ulceration, urinary tract infection, and falls and fractures, particularly in the elderly population [7].
The aim of this study was to design and validate a self-administered screening questionnaire that is simple to understand, complete, and interpret: the bladder control self-assessment questionnaire (B-SAQ). A questionnaire to assess symptoms and associated bother, and to guide the patient, if necessary, to seek treatment is not available elsewhere. A self-assessment questionnaire would contribute to raising awareness of bladder problems within society and prompt people to seek earlier intervention. Hopefully this will result in earlier referral, treatment, and improvement in quality of life.
Section snippets
Instrument development
The B-SAQ questionnaire was developed by a European panel of experts in lower urinary tract dysfunction, who used a standardised multistep method. The aim was to develop a concise questionnaire that would identify the presence and bother of symptoms, and guide treatment-seeking behaviour.
Item selection and reduction
The initial pool of questions was generated following literature review and expert panel opinion. Three pilot versions of the questionnaire were tested. The initial version was significantly longer than the
Results
Three hundred and twenty-nine women of different ethnic origin took part in the study (Table 1). The mean age of the participating women was 47 years (range: 18–83). Two hundred and ninety-three (89%) women correctly completed and returned the B-SAQ; 226 (77%) women correctly and fully completed the KHQ. Clinical diagnosis from the doctor’s evaluation sheet defined 102 (31%) participants as asymptomatic controls.
Discussion
Our findings support the view that the B-SAQ is a psychometrically robust instrument with good reliability and validity, and is ideal for opportunistic screening for LUTS amongst women. Studies are ongoing to validate the B-SAQ amongst men. The high internal consistency of the B-SAQ reflects good correlation between questionnaire items, which together form a reliable measure of the presence and burden of LUTS. Test-retest analysis shows repeat scores to be highly correlated and in good
Conclusions
This study confirms that the B-SAQ questionnaire is a valid screening tool for the presence and bother of LUTS in women. The design and format of the questionnaire is concise and comprehensible, with easily interpretable scores. It provides a reliable means of rapid assessment of LUTS, particularly overactive bladder and urinary incontinence, within a health service where delivery of care is restricted by time constraints and an ever-increasing workload. Validation of the B-SAQ with male
Conflicts of interest
R. Basra and E. Cortes have no conflicts of interest and no affiliations.
The followings authors are members of the European Overactive Bladder Forum sponsored by Astellas. The data was collected and analysed independently by the authors.
Kelleher C, Artibani W, Cardozo L, Castro-Diaz D, Chapple C, De Ridder D, Espuna Pons M, Haab F, Hohenfellner M, Kirby M, Milsom I, Van Kerrebroeck P, Vierhout M, Wagg A.
This work was sponsored by Astellas.
References (16)
- et al.
Statistics notes: Cronbach’s alpha
BMJ
(1997) - Abrams P, Cardozo L, Khoury S, et al. Incontinence, vol 1. Basics and evaluation. 3rd International Consultation on...
- et al.
How widespread are the symptoms of overactive bladder and how are they managed? A population-based prevalence study
BJU Int
(2001) - et al.
Prevalence and burden of overactive bladder in the United States
World J Urol
(2003) - et al.
Clinical manual of incontinence in women
(2005) - et al.
Barriers to help seeking in people with urinary symptoms
Fam Pract
(2001) - et al.
The current and future burden and cost of overactive bladder in five European countries
Euro Urol
(2006) - et al.
Overactive bladder: evaluation and management in primary care
Cleve Clin J Med
(2005)