title: Quality of life impact of urge incontinence in older persons: a new measure and conceptual structure.
abstract: OBJECTIVE
  To develop a condition-specific measure for assessing the impact of urge urinary incontinence (UI) on the quality of life (QoL) of older persons.
  
  
  METHODS
  A 32-item Urge Impact Scale (URIS) was drafted using content area data from focus groups composed of urge incontinent older persons. Pilot testing in 21 urge incontinent persons (mean age 67.7 years) resulted in the elimination of eight items by internal consistency, skew, and patient response criteria. The resulting scale (URIS-24) was tested for reliability (internal consistency and test-retest correlation) and construct validity (correlation with UI severity from voiding records) in a separate group of 27 urge incontinent persons (89% women, mean age 72 years). Factor analysis of URIS-24 data from the combined 48 persons was used to explore the conceptual structure underlying urge UI-related QoL.
  
  
  METHODS
  University-affiliated community-based practice and tertiary hospital.
  
  
  METHODS
  Community-dwelling women and men, older than age 60 and with urge incontinence at least twice weekly, recruited from newspaper, newsletter, and radio advertisements.
  
  
  RESULTS
  Cronbach's alpha for URIS-32 was 0.84, and for URIS-24 it was 0.94. When administered (mean +/- standard deviation) 9.2 +/- 5.1 days apart, URIS-24 had good test-retest reliability for total scores (interclass coefficient = .88, concordance coefficient = .88), and individual item scores at time 2 were within 1 point (on a 5-category Likert scale) of time 1 answers for 89% of responses. URIS-24 scores had modest but nearly significant correlation with the number of UI episodes (r = -0.39, P = .05). Factor analysis revealed a three component structure corresponding to psychological burden, perception of personal control, and self concept.
  
  
  CONCLUSIONS
  The URIS-24 is an internally-consistent, highly reproducible tool for the assessment of the QoL impact of urge UI on older persons. It can be used to evaluate QoL impact by specific items as well as by overall score. Compared with other UI-specific QoL measures, the URIS-24 had similar or superior internal consistency, test-retest reliability, and validity, but it is the first measure designed and tested specifically for older persons with urge UI. These results also highlight the multifactorial structure of urge UI-related QoL and the importance of its psychological dimensions.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: DuBeau
authors.forename: D K
authors.initials: DK
authors.lastname: Kiely
authors.forename: N M
authors.initials: NM
authors.lastname: Resnick
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D017281:Cost of Illness; D005163:Factor Analysis, Statistical; D005260:Female; D017144:Focus Groups; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012649:Self Concept; D018434:Sickness Impact Profile; D014549:Urinary Incontinence / Q000503:physiopathology / Q000523:psychology*