Outcomes in urinary incontinence: reconciling clinical relevance with scientific rigour

To aid clinicians in selecting an outcome measure for the assessment of urinary incontinence (UI), from the perspective of both scientific rigour and clinical utility.

We conducted a comprehensive review of the literature on outcome measures for the assessment of UI in adults. Tools were classified by instrument type (ie, subjective measures, objective measures, clinical observations, quality of life, and combined instruments) and assessed for scientific rigour based on their psychometric properties (reliability, validity, responsiveness). The clinical relevance of each tool was considered in terms of current usage and practicality.

The most rigorous validation processes were identified for quality-of-life questionnaires, including the Incontinence Impact Questionnaire, King's Health Questionnaire, Incontinence Quality of Life questionnaire, and Urogenital Distress Inventory. Bladder diaries, goal-attainment scales, and combined measures such as the International Consultation on Incontinence Questionnaire appear to be more practical for use in clinics. The Clinical Global Impression of Improvement is the outcome most widely used clinically, but least well validated.

To elevate the level of outcome assessment for UI to meet that of other urology specialties, it is necessary to reconcile the realities of clinical practice with the scientific rigour of UI research, and to mainstream outcome measures that are reciprocally translatable between the two settings.