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Incontinence Symptom Index-Pediatric: development and initial validation of a urinary incontinence instrument for the
Caleb P Nelson1, John M Park, David A Bloom
1Department of Urology, University of Michigan, Ann Arbor, Michigan, USA. caleb.nelson@childrens.harvard.edu
Insights
A new pediatric survey effectively measures urinary incontinence symptoms and bother in children aged 11-17. This validated tool offers objective, reproducible patient-reported data for pediatric incontinence assessment.
Area of Science:
- Pediatric Urology
- Clinical Measurement
- Patient-Reported Outcomes
Background:
- Urinary incontinence is prevalent in children, yet validated patient-reported outcome measures are lacking.
- Existing assessment tools do not adequately capture symptom severity and bother in pediatric populations.
- There is a need for reliable instruments to evaluate urinary incontinence in children.
Purpose of the Study:
- To develop and validate a patient-reported survey for measuring urinary incontinence symptoms and bother in children.
- To establish the psychometric properties of a new pediatric incontinence instrument.
- To provide a tool for objective and reproducible assessment of urinary incontinence in pediatric patients.
Main Methods:
- The Incontinence Symptom Index-Pediatric (ISI-P), an 11-item survey, was developed with domains for impairment and symptom severity.
- The survey included subdomains for various incontinence types (stress, urge, insensate, nocturnal) and pad use.
- The ISI-P was administered twice, two weeks apart, to children aged 11-17 with and without urinary incontinence.
Main Results:
- The ISI-P demonstrated good internal consistency (Cronbach's alpha = 0.84) and excellent test-retest reliability (r = 0.97).
- Discriminative validity was strong, with significant differences in scores between children with incontinence and controls.
- The urge urinary incontinence domain showed the most substantial difference between groups.
Conclusions:
- The Incontinence Symptom Index-Pediatric is a validated instrument for assessing urinary incontinence in children and adolescents aged 11-17.
- This survey provides objective and reproducible patient-reported data on urinary incontinence.
- The ISI-P can be utilized in clinical settings for improved pediatric incontinence management.
Purpose:
Although urinary incontinence is common in children, no validated pediatric instruments exist for measuring urinary incontinence symptoms and bother. We developed and validated a patient reported pediatric survey for urinary incontinence measurement.
Materials And Methods:
The Incontinence Symptom Index-Pediatric is an 11-item instrument comprising 2 domains, that is 1) impairment and 2) symptom severity, including subdomains for stress urinary incontinence, urge urinary incontinence, insensate urinary incontinence, nocturnal urinary incontinence and pad use. The survey was self-administered twice, 2 weeks apart, to boys and girls ages 11 to 17 years. Children completed the survey independently. Cases consisted of patients presenting to pediatric urology clinic with the chief complaint of urinary incontinence. Controls consisted of healthy children presenting for evaluation up at a general pediatric practice. Formal validation analysis was performed.
Results:
A total of 19 subjects per arm completed at least 1 survey. Internal consistency was good with a Cronbach's alpha of 0.84 for the complete instrument. Item-scale correlations were greater than 0.60 for all except 1 item. Test-retest reliability was also good (r = 0.97, p <0.0001). Discriminative validity was good with a total severity scale score of 9.3 in wet children and 0.7 in controls (p <0.0001). Impairment scale scores differed by 2.2 points (p <0.0001). Mean scores differed significantly between subscales for all domains except pad use. The most dramatic difference was in the urge urinary incontinence domain, which differed by a mean of 3.6 points (p = 0.0002).
Conclusions:
This pilot study provides initial validation of a survey instrument for urinary incontinence in children and adolescents. This instrument can be used in children ages 11 to 17 years to objectively and reproducibly measure patient reported urinary incontinence.
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