Abstract
Objectives
As in Greek settings there is a need to develop validated patient-reported outcomes
(PROs) for pelvic floor dysfunction, this study’s aim was to cross-culturally adapt
and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item
PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse
and sexual function.
Study design
Cross-cultural translation was completed through official multistage forward and back-translation
process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting
Greek community-based healthcare settings. International Consultation on Incontinence
Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered.
Comparison between women with and without pelvic floor dysfunction (symptomatic versus
control) was also undertaken for exploring discriminatory validity. Test-retest reliability
was explored by re-administering APFQ_GR 10–15 days following initial testing and
internal consistency was explored against each domain separately as well as total
items’ score.
Results
Greek APFQ translation was successfully performed and piloted to a women sample with
varying levels of education for comprehensibility, thus, satisfying the questionnaire’s
face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of
which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic.
There were no ceiling effects. Floor effects were detected for women without symptoms.
Moderate to very strong correlations were yielded between APFQ_GR total score and
bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403–0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate
correlations were yielded for the sexual function domain with APFQ_GR total score
and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire’s scores (p < 0.001),
indicating good discriminatory validity between symptomatic and asymptomatic women.
Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items’ score
(Cronbach’s α = 0.714–0.924).
Conclusions
The Greek APFQ was proven appropriate, comprehensible, valid and reliable for women
with urinary incontinence and can thus, be used across Greek healthcare settings.
Prolapse and bowel domains merit further research.
Keywords
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References
- Pelvic floor disorders.Obstet Gynecol Clin North Am. 2019; 46: 527-540
- Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth.Int Urogynecol J. 2015; 26: 1115-1121
- Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal (AI) incontinence.in: Abrams P. Cardozo L. Khoury S. Wein A. Incontinence. Health Publications, Paris2013
- Prevalence and trends of symptomatic pelvic floor disorders in U.S. women.Obstet Gynecol. 2014; 123: 141-148
- The epidemiology of pelvic floor disorders and childbirth: an update.Obstet Gynecol Clin North Am. 2016; 43: 1-13https://doi.org/10.1016/j.ogc.2015.10.008
- Pelvic-floor function, dysfunction, and treatment.Eur J Obstet Gynecol Reprod Biol. 2021; 265: 143-149
- Patient reported outcomes: the ICIQ and the state of the art.Neurourol Urodyn. 2010; 29: 645-651https://doi.org/10.1002/nau.20911
- Patient-reported outcome measures (PROMs) in pelvic floor disorders.Curr Urol Rep. 2019; 20: 22
- Patient-reported outcome measures for pain in women with pelvic floor disorders: a systematic review.Int Urogynecol J. 2022;
- An interviewer-administered validated female pelvic floor questionnaire for community-based research.Menopause. 2008; 15: 973-977
- Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research.Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 149-158
- A validated self-administered female pelvic floor questionnaire.Int Urogynecol J. 2010; 21: 163-172
- Submaximal pelvic floor muscle contractions: similar bladder-neck elevation, longer duration, less intra-abdominal pressure.Int Urogynecol J. 2018; 29: 1681-1687
- The minimal important difference of the Australian Pelvic Floor Questionnaire.Int Urogynecol J. 2019; 30: 115-122
- Arabic translation, cultural adaptation, and validation of Australian Pelvic Floor Questionnaire in a Saudi population.BMC Womens Health. 2021; 21: 6
- Validation of the Australian Pelvic Floor Questionnaire in Chinese pregnant and postpartum women.Eur J Obstet Gynecol Reprod Biol. 2020; 245: 102-106
- Translation, cultural adaptation, and validation of Australian pelvic floor questionnaire in a Turkish population.Eur J Obstet Gynecol Reprod Biol. 2019; 234: 71-74
- Cross-cultural adaptation and validation of the Serbian version of the Australian pelvic floor questionnaire.Int Urogynecol J. 2015; 26: 131-138
- Spanish cross-cultural adaptation and validation of the Australian Pelvic Floor Questionnaire in running women.Sci Rep. 2022; 12: 8325
- Validation and translation of the Hungarian version of the Australian Pelvic Floor Questionnaire (APFQ-H).Int Urogynecol J. 2022; ([Online ahead of print. PMID: 35972523 (not full)])https://doi.org/10.1007/s00192-022-05322-2
- Urinary incontinence, the hidden health problem of Cretan women: report from a primary care survey in Greece.Women Health. 2000; 31: 59-66
- Epidemiology of female urinary incontinence in the Greek population: EURIG study.Int Urogynecol J. 2010; 21: 217-222
- Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.J Eval Clin Pract. 2011; 17: 268-274
- The validation of international consultation on incontinence questionnaires in the Greek language.Neurourol Urodyn. 2012; 31: 1141-1144
- ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence.Neurourol Urodyn. 2004; 23: 322-330
- Quality criteria were proposed for measurement properties of health status questionnaires.J Clin Epidemiol. 2007; 60: 34-42
- The impact of urinary incontinence on sexual function: a systematic review.Sex Med Rev. 2020; 8: 393-402
Article info
Publication history
Published online: November 01, 2022
Accepted:
October 26,
2022
Received in revised form:
October 21,
2022
Received:
August 27,
2022
Identification
Copyright
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