Incontinence Impact Questionnaire rehab measure
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  2. Incontinence Impact Questionnaire

Incontinence Impact Questionnaire

Purpose

The Incontinence Impact Questionnaire (IIQ) is a 30-item self-report intended to measure disease-specific quality of life in women with stress urinary incontinence [Shumaker et al., 1994].

Link to Instrument

Instrument Details

Acronym IIQ

Area of Assessment

Incontinence
General Health
Life Participation
Patient Satisfaction
Quality of Life
Activities of Daily Living
Stress & Coping

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$250.00

Cost Description

One-time administrative fee for use of questionnaire

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Non-Specific Patient Population

Key Descriptions

  • 30 items divided into four domains (physical activity [6 items], travel [6 items], social relationships [10 items], emotional health [8 items]). Item-level scores are rated on a four-point Likert scale (where 1=not at all and 4=greatly), determined by self-reported impact of symptoms related to urinary incontinence.
  • A mean score is derived from each domain, then transformed to give equal weight to each subscale. Subscale scores range from 0-100. The total IIQ score is calculated by adding the four subscale scores with a range of 0-400 possible (Shumaker et al., 1994).
  • A short form (IIQ 7) is also available with seven items, the same Likert scale and the same domains.

Number of Items

30

Equipment Required

  • IIQ Paper Questionnaire
  • Writing Utensil

Time to Administer

6-30 minutes

Required Training

No Training

Instrument Reviewers


Colleen Cobey, PT, MS Ex Phys

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion
General Health

Professional Association Recommendation

  • Listed as an outcome measure on the APTA Section on Women’s Health website
  • Listed as an outcome measure by the Committee on Gynecologic Practice and the American Urogynecologic Society. 

 

Considerations

 
  • Appears to be a reliable and valid instrument for assessing the impact on quality of life of general incontinence symptoms in women.
  • The IIQ does not correlate well with objective measures of incontinence. (Harvey et al, 2001; van der Vaart et al, 2003)
  • The IIQ was developed to be used along with the Urogenital Distress Inventory (UDI) (Shumaker et al, 1994)
  • There are short forms of both questionnaires available (IIQ-7 and UDI-6) (Uebersax et al., 1995) Fifth subscale regarding embarrassment was identified in van der Vaart et al., 2003 Validated in French, Arabic, and Turkish versions

Non-Specific Patient Population

back to Populations

Cut-Off Scores

Stress urinary incontinence: (Corcos et al., 2002; n = 69; Mean Age = 56.6 (11.2); Mean Duration of Incontinence = 117.5 (115.5) months)

  • IIQ score of <50 indicates good quality of life
  • IIQ score between 50-70 indicates moderate quality of life
  • IIQ score >70 indicates poor quality of life

Where “good” signifies a score about the population mean and “poor” signifies a score below the population mean

Test/Retest Reliability

Urinary incontinence: (Hagen, Hanley & Capewell, 2002; n = 237; Mean Age = 76 (12) for community sample (n=79); Mean Age = 50 (14) for clinical sample (n=75); Mean Age = 50 (12) for surgery sample (n=83); Mean Retest Time = 5 days; Scottish sample)

  • Mean difference in total IIQ score = -9.7 (95% CI, -15.5 to -3.9, p=0.001)

  • Kappa statistic for individual questions varied from 0.732 to 0.381

Internal Consistency

Urinary incontinence: (van der Vaart et al., 2003; n = 2043; Mean Age = 46.5 (0.3); Community sample where 79.5% report at least one positive incontinence symptom; Dutch sample)

  • Excellent (Cronbach’s alphas 0.83 to 0.93

Urinary incontinence: (Harvey et al., 2001; n = 155; Mean Age = 55 (11.8); Women with urinary incontinence recruited in community and through urogynecology referral)

  •  Excellent (Cronbach’s alpha 0.95)

Criterion Validity (Predictive/Concurrent)

Urogenital dysfunction: (van der Vaart et al., 2003; Mean Age = 46.5 (0.3) in a community sample of women (n = 2043); Mean Age = 54.7 in a clinical sample of women (n = 196) with urogenital dysfunction; Dutch sample)

  • Significant concurrent validity: The clinical sample of women had significantly higher scores, indicating lower quality of life, compared with the sample of women from the community on all IIQ subscales (p<0.0001)

 

Urinary incontinence: (Hagen, Hanley & Capewell, 2002)

  • Significant concurrent validity between total IIQ score, weight of urine leaked and subject group severity (Adjusted R2 = 0.22)

  • Significant predictive validity in all groups where increased number of incontinence episodes and increased weight of urine leaked separately predicted higher total IIQ score (Adjusted R2=0.22)

  • Significant predictive validity in all groups where HADS anxiety predicted total IIQ score

Construct Validity

Urinary incontinence: (Hagen, Hanley & Capewell, 2002)

  • Significant convergent validity between total IIQ score and all of the expected SF-36 subscores: physical functioning (p<0.05), role-physical, general health, social functioning, and mental health (all p<0.0001)

Urogenital dysfunction: (van der Vaart et al., 2003)

  • Poor to adequate convergent validity between IIQ mobility, physical, emotional, social functioning and embarrassment subscales with RAND-36 scores (r=0.14-0.45)

Incontinence Impact Questionnaire (r)

Rand 36

Mobility

Phys Function

Social Function

Emotional Health

Embarrassment

Phys Func.

-0.42**

-0.45**

-0.30*

-0.38**

-0.27*

Social Func.

-0.31**

-0.35**

-0.26*

-0.34**

-0.23*

Role Limits Physical

-0.30*

-0.33**

-0.22*

-0.32**

-0.21*

Role Limits Emotional

-0.21*

-0.25*

-0.17*

-0.27*

-0.21*

Vitality

-0.27*

-0.32**

-0.18*

-0.32**

-0.20*

Mental Health

-0.22*

-0.31**

-0.18*

-0.35**

-0.23*

Pain

-0.29*

-0.37**

-0.14*

-0.32**

-0.17*

General Health

-0.26*

-0.34**

-0.23*

-0.34**

-0.18*

**adequate correlation

  *poor correlation

Face Validity

Urinary incontinence: (Shumaker et al., 1994; n = 162; Mean Age = 61.3 (10.2) years in a community sample of women with stress incontinence and/or detrusor instability)

  • “Examination of item and subscale content, and the methods used for their construction, provides reasonable assurance of face validity for the UDI and IIQ

Floor/Ceiling Effects

Urinary incontinence: (Shumaker et al., 1994; n = 150 after 12 week follow-up period; Mean Age = 61.3 (10.2) years in a community sample of women with stress incontinence and/or detrusor instability. Includes women from three clinical study groups: behavioral intervention, estrogen replacement therapy, surgical treatment)

  • Significant changes in all variables except pad test after 12 week follow-up period

 

n

Mean change

STD

t test p value

sign rank p value

IIQ Activity

150

6.8

19.5

0.0001

0.0001

IIQ Social

150

4.8

14.8

0.0001

0.0001

IIQ Travel

150

5.9

18.0

0.0001

0.0001

IIQ Emotional

150

10.9

18.8

0.0001

0.0001

IIQ Total

150

28.5

59.5

0.0001

0.0001

Changes in episodes

146

4.3

13.4

0.0002

0.0001

Changes in pad test

131

10.6

84.9

0.1548

0.0720
  •  Significant correlations between changes in all IIQ subscales and changes in number of episodes
 

Pearson correlations

# episodes (n = 146)

 

r

p

IIQ Activity

0.45

0.0001

IIQ Social

0.39

0.0001

IIQ Travel

0.36

0.0001

IIQ Emotional

.031

0.0001

IIQ Total

0.46

0.0001

Urinary incontinence: (Hagen, Hanley & Capewell, 2002)

  • Mean Change in Total IIQ = -83.00 (95% CI, -100.39 to -65.58; p<0.001) from Day 1 to post-intervention
  • Highly significant positive relationship between decrease in total IIQ score and decrease in total number of incontinence episode

Bibliography

Corcos J, Behlouli H, Beaulieu S.  Identifying cut-off scores with the neural networks for interpretation of the Incontinence Impact Questionnaire.  Neuro and Urodyn. 2002;21:198-203.

Hagen S, Hanley J, Capewell A. Test-retest reliability, validity, and sensitivity to change of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire. Neuro and Urodyn. 2002;21:534-539.

Harvey M-A, Kristjansson B, Griffith D, Versi E.  The Incontinence Impact Questionnaire and the Urogenital Distress Inventory: A revisit of the validity in women without a urodynamic diagnosis. Am J of Obst and Gyn. 2001;185(1):25-30.

Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fanti JA.  Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Qual Life Res. 1994;3(5):291-306.

Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess left quality and symptom distress for urinary incontinence in women: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourol Urodyn. 1995;14:131-139.

van der Vaart CH, de Leeuw JR, Roovers JP, Heintz AP.  Measuring health-related quality of life in women with urogenital dysfunction: The urogenital distress inventory and incontinence impact questionnaire revisited.  Neurourol Urodyn. 2003;22(2):97-104.

 

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