International Consultation on Incontinence Questionnaire - Short Form

Last Updated

July 25, 2012

Purpose

The ICIQ-SF is a subjective measure of severity of urinary loss and quality of life for those with urinary incontinence (UI).

The International Consultation on Incontinence developed an incontinence questionnaire (ICIQ) containing many long and short modules. They include ICIQ-VS for vaginal symptoms, ICIQ-OAB for overactive bladder, ICIQ-UAB for underactive bladder, ICIQ-MLUTS for male lower urinary tract symptoms (LUTS), ICIQ-FLUTS for female LUTS, ICIQ-MLUTS-SEX or ICIQ-FLUTS-SEX for LUTS gender specific sexual matters, and ICIQ-LUTSqol for LUTS related quality of life. Each short module of the ICIQ uses a similar question format and a 5-point Likert scale to assess the presence, severity and associated bother of symptoms. The earliest module to be developed and most common in usage is the International Consultation on Incontinence Modular Questionnaire – Short Form for Urinary Incontinence (ICIQ-UI Short Form). This is a 4-item subjective measure designed to assess the level, impact, and perceived cause of incontinence on quality of life in adult populations. This is the measure for which the psychometrics below are based upon.

Link to Instrument

instrument details

Acronym ICIQ-SF

Area of Assessment

Incontinence

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Can be used for clinical care and research for free. If used in research, permission required.

Non-Specific Patient Population

Mixed Populations

The ICIQ is a self-reported survey and screening tool for incontinence.
4 main items (of 6 total) ask for rating of symptoms in the past 4 weeks.
Take sum score of items 3, 4, 5 (items 1 and 2 are demographic) for the actual score.
The final item is a self diagnostic item that is un-scored.
Items (questions) 1 and 2 are demographic questions (DOB and gender). Item (3, 4, and 5) scores are summed for the total score on the ICIQ-UI SF
Scoring scale: 0-21, minimum 0, maximum 21. A higher score indicates greater impairment from incontinence.
Items regarding the average frequency and amount of leakage, the impact of leakage on quality of life (QOL), and the perceived cause of leakage over the past four weeks
Item-level scores vary but range from 0-10. Item (question) 6 (self-perceived cause) is unscored.
The instrument has been translated and validated into several languages. To see the availability of translations, visit https://iciq.net/translations

Number of Items

6 (4 relevant questions)

Survey form

Less than 5 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Krista Ferguson, PT, OCS in 9/2010

Updated by:

Rebecca Parr, PT, DPT, OCS

Jennie M. Le, MS, MB(ASCP), CGMBS

Tina Schmidt-McNulty, MS, CES, RN

ICF Domain

Body Function

Measurement Domain

General Health

Professional Association Recommendation

International Consultation on Incontinence recommendation grade A (Consistent Level 1 evidence i.e. randomized controlled trials [RCTs] or systematic reviews of RCTs) (Abrams et al., 2007).

Considerations

Urinary Incontinence: (Avery et al, 2004)

Score is 0 - 21 with a higher score indicating greater severity
Ability to detect change in males and females
With conservative management- significant change in all symptom related questions (items 3 and 4) but not in “overall quality of life”
With surgical management - significant change in all questions (items 3,4 and 5)
The ICIQ-UI SF has been translated and validated through the evaluation of adult patients with urinary incontinence in other countries. English, Chinese, Malay, Taiwanese, Italian, Greek, and Japanese versions were reviewed.

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Standard Error of Measurement (SEM)

Urinary Incontinence in Females: (Nystrom, Sjostrom, Stenlund, & Samuelsson, 2015; n = 250; age 49.24 (10.23); mean score (SD) 10.2 (3.17))

SEM = .21 (calculated from Nystrom et al., 2015) using SEM = Standard Deviation from the 1st test / (square root of (n) with n = 218)

Minimal Detectable Change (MDC)

UI in Females: (Nystrom et al., 2015)

MDC = .58 at 95% confidence interval (calculated from Nystrom et al.(2015) using MDC = 1.96 x calculated SEM x square root of 2)

Minimally Clinically Important Difference (MCID)

UI in Females: (Nystrom et al., 2015)

MCID = 2.52 (2.56) (calculated for n=218)

Cut-Off Scores

UI in Females: (Klovning et al., 2009; n = 1,812 women; mean age = 36.5 (11) years)

Slight = 1 - 5, Moderate = 6 - 12, Severe = 13 - 18, and Very severe = 19 - 21

UI in Females: (Karmakar, Mostafa and Abdel-Fattah, 2017; n = 432; age not reported)

6/21 minimum score associated with a 90% sensitive and 85% specific for success/failure after surgery with a high Cohen's kappa coefficient of 0.83 (95 % CI 0.74 - 0.89)

Normative Data

UI in Females: (Klovning et al., 2009)

Mean ICIQ-UI SF total score was 7.4 (3.6)

UI in Females: (Hajebrahimi et al., 2012; n=123 UI women, mean age 46.30 (13.14) years, 68% low literacy levels, Persian version of ICIQ-UI SF)

Mean ICIQ-UI SF total score was 16.6 (4.07)

UI in Females: (Nystrom et al., 2015)

Mean total score = 10.2 (3.17)

UI in Females: (Tubaro et al., 2006; n =50; age 21-24 years, Italian version)

Mean total score = 9.60 (5.810)

UI in Females: (Al-Shaikh et a.l, 2013; n=37; age 39(9.9) years, Arabic version)

Mean score = 11.5 and 11.3

UI in Females: (Karantanis et al., 2004; n = 95 women; mean age = 54 (12) years)

Mean score = 13 (4)

Test/Retest Reliability

Urinary Incontinence: (Hajebrahimi et al, 2004; n = 64 women consulting for UI; mean age = 59 (3.8) years)

Significant correlation at a 90% confidence interval (p = 0) between completion of the survey by:
- The patient in the office
- The physician in the office
- The patient at home
Adequate test retest reliability for frequency of leakage (kappa = 0.73)
Adequate test retest reliability for amount of leakage (kappa = 0.67)
Adequate test retest reliability for interference with everyday life (kappa = 0.74)

UI in Females: (Lim, Liong, Lau and Yuen, 2017; n = 139 SUI; mean age 52.2 ± 8.61 years; n = 145, English, Chinese, and Malay versions tested)

Excellent test-retest reliability indicated by ICIQ-UI SF intra-class correlation (ICC)

ICIQ-UI SF Test-Retest Reliability in Scale Versions
Scale Version	Test-Retest Reliability	ICC*
English (n = 46)	Excellent	.95
Chinese (n = 60)	Excellent	.91
Malay (n = 33)	Excellent	.96
*Intra-class correlation

UI in Females: (Gotoh, Homma, Funahashi, Matsukawa and Kato, 2009; n=122; median age = 62 (53-70) years, Japanese version)

Excellent test-retest reliability for the total score (ICC=.91) as well as individual questions
- How often do you leak urine (k=.61)
- How much urine do you think leaks (k=.62)
- How much does urine leaking interfere with your daily life (ICC=.90)

UI in Pregnant Females: (Chang, Chen, Chang and Lin, 2011; n=108 pregnant women, age 31.9 (3.18), mean gestational age 26.94 (7.93) weeks, test-retest done with a subsample of n=55 women tested 4 weeks later, Taiwanese version)

Excellent test-retest reliability (r-0.75 for total score)
- How often do you leak urine (k=.62, p=1.0)

- How much urine do you think leaks (k=.78, p=0.41)
- How much does urine leaking interfere with your daily life (k=.58, p=.76)
- When does urine leak – never (k=.82, p=.18)
- Leaks when you cough or sneeze (k=.78, p=.10)
- Leaks when you are physically active/exercising (k=.65, p=.16)
- Leaks when you have finished urinating and are dressed (k=-.02, p=1.0)
- Leaks for no obvious reason (k=.66, p=.32)

UI in Females: (Tubaro et al., 2006; n =50; age 21-24 years, Italian version)

Excellent Test-Retest r=0.96

UI in Females: (Huang et al., 2008; n = 42; mean age 53.5 (33-75) years).

Adequate test-retest reliability (k=0.72-0.93, p<0.001)

UI in Females: (Al-Shaikh et a.l, 2013; n=37; age 39(9.9) years)

Excellent test-retest reliability for items (k=0.72-0.81)

UI in Adults: (Avery et al., 2004; n = 634; mean age = 57.2 (23.4 - 101.3) years).

Adequate to Excellent test-retest reliability for items (k=0.58-0.90)

Interrater/Intrarater Reliability

UI in Females: (Hajebrahimi et al., 2012)

Excellent intra-class correlation coefficient of .84 for Persian version of ICIQ-UI SF

UI in Females: (Tubaro et al., 2006; n =42; age 21-24 years, Italian version)

Excellent Intra-class correlation coefficients were .93 and .96 respectively for total score and quality of life item on Italian version of ICIQ-UI SF

Internal Consistency

UI in Females: (Lim et al., 2017)

Adequate internal consistency for English, Chinese, and Malay versions.

ICIQ-UI SF Internal Consistency in Scale Versions
Scale Version	Internal Consistency	α*
English	Adequate	.60
Chinese	Adequate	.61
Malay	Adequate	.76
*Cronbach’s Alpha

UI in Females: (Huang et al., 2008; n = 42; mean age 53.5 (33-75) years).

Adequate internal consistency with Cronbach’s alpha = .71

UI in Females: (Al-Shaikh et a.l, 2013; n=37; age 39(9.9) years)

Excellent Internal consistency for Arabic version with Cronbach’s alpha = .97

UI in Females: (Gotoh, et al., 2009)

Adequate Internal consistency for Japanese version with Cronbach’s alpha = .78

UI in Females: (Hajebrahimi et al., 2012)

Adequate Internal consistency for Persian version with Cronbach’s alpha = .75

UI in Females: (Tubaro et al., 2006)

Excellent Internal consistency for Italian version with Cronbach’s alpha = .90

UI in Pregnant Females: (Chang et al., 2011)

Excellent Internal consistency studied on pregnant Taiwanese women with Cronbach’s alpha = .80

UI in Adults: (Avery et al., 2004; n = 634; mean age = 57.2 (23.4 - 101.3) years).

Excellent Internal consistency with Cronbach’s alpha = .92

Criterion Validity (Predictive/Concurrent)

Urinary Incontinence: (Twiss et al, 2007; n = 26 men with urodynamically confirmed stress incontinence; mean age = 67.5 (1.6) years)

Excellent correlation between Patient Global Impression of Improvement in men after perineal sling (r = -0.81)

Concurrent Validity

UI in Females: (Karantanis et al., 2004; n = 95 women; mean age = 54 (12) years)

Adequate correlation (r = .458) with 24-hour pad test
Fair correlation with mean frequency of leagage episodes in urinary diary (Kendall’s tau b=0.399, p =0.002)
Poor correlation (P=0.2) with Stamey grade

UI in Females: (Klovning et al., 2009)

Excellent correlation (r = .62) between ICIQ-UI SF and the Incontinence Severity Index

UI in Females: (Gotoh et al., 2009)

Excellent to Adequate correlations with KHQ

Concurrent Validity: Correlations with KHQ
Categories	Correlation	Spearman’s rank (ρ)
Severity measures	Excellent	.74*
Impact of incontinence	Excellent	.68*
Limitations in functional ability	Excellent	.68*
Physical limitations.	Excellent	.68*
Social limitations	Adequate	.59*
Emotions	Adequate	.55*
KHQ = King’s Health Questionnaire * p < 0.05

Construct Validity

Convergent Validity:

UI in Females: (Karmakar, Mostafa and Abdel-Fattah, 2017; n = 432; age not reported)

Excellent correlation between ICIQ-SF and Patient Global Impression of Improvement (ρ=0.629)

UI in Females: (Hajebrahimi et al., 2012)

Excellent correlation between ICIQ-SF and urodynamic study r=0.93.

UI in Females: (Tubaro et al., 2006; n =50; age 21-24 years, Italian version)

Fair correlation with Short Form-36 (ρ=0.485)

UI in Adults: (Avery et al., 2004; n = 634; mean age = 57.2 (23.4 - 101.3) years).

Convergent validity varies from poor to excellent between ICIQ-UI-SF, ICmale SF, BFLUTS, and KHQ

Convergent Validity of ICIQ-UI-SF
Score	Correlation	Pearson's (r)
ICSmaleSF incontinence score	Excellent	0.74*
ICSmaleSF voiding score	Poor	0.26**
BFLUTS incontinence factor	Excellent	0.84*
BFLUTS quality of life factor	Excellent	0.6*
KHQ	Excellent	0.72*
BFLUTS = Bristol Female Lower Urinary Tract Symptoms KHQ = King’s Health Questionnaire p-value ≤ .001, *p-value = .20

Convergent Validity on perceived cause of leakage between ICIQ-UI-SF and ICSmale SF

Convergent Validity between ICIQ UI SF and ICSmale Short Form
Category	Correlation	Pearson’s correlation (r)
Before reaching the toilet	Adequate	.24 (p = .23)
When coughing or sneezing	Adequate	.58 (p = .001)
When asleep	Adequate	.50 (p = .008)
After urinating and dressing	Adequate	.45 ( p = .023)
With no obvious reason	Adequate	.24 (p = .23)
ICSmale SF = ICmale short form to access perceived cause of leakage

Convergent Validity between ICIQ UI SF and BFLUTS
Category	Correlation	Pearson’s correlation (r)
Frequency of leakage	Excellent	.86*
Usual amount of leakage	Adequate	.53*
Perceived cause of leakage: Before reaching the toilet	Adequate	.35***
Perceived cause of leakage: When coughing or sneezing	Adequate	.44*
Perceived cause of leakage: When asleep	Adequate	.49*
Perceived cause of leakage: When active or exercising	Poor	.29 **
Perceived cause of leakage: No obvious reason	Adequate	.55*
p-value < .001, p-value = .002, ** p-value = .0001

UI in Females: The Patient Global Impression of Improvement (PGI_I) (Nystrom et al., 2015):

Adequate correlation (r = .547 (p < .0001)) between PGI_I with ICIQ-UF-SF

UI in Females: King’s Health Questionnaire (KHQ): (Gotoh et al., 2009):

Poor to Excellent correlation with total scores between KHQ and ICIQ UI SF

Convergent Validity between ICIQ UI SF and Kings Health Questionnaire (KHQ)
KHQ subscale	Correlation	Pearson’s correlation (r)
General health perception	Poor	.09
Incontinence impact	Excellent	.68*
Role limitations	Excellent	.68*
Physical limitations	Excellent	.68*
Social limitations	Adequate	.59*
Personal relationships	Adequate	.31*
Emotions	Adequate	.55*
Sleep/energy	Poor	.28*
Severity measures	Excellent	.74*
*p-value <.05

UI in Females: (Avery et al., 2004)

IQ di¡erentiated between males and females, with women reporting more incontinence than men (58.9%and 25.2% respectively, P < 0.001)
detected a lower prevalence of incontinence in the community sample than in urology clinic attendees (44.7% and 9 7.2 % respectively, P < 0.001)

demonstrated a clear association between sex and the perceived causes of incontinence in both the clinic and the community samples (P < 0.0 01)

Content Validity

Urinary Incontinence: (Abrams, Cardozo and Wein, 2012)

The ICIQ was developed by 24 individual committees, comprised of experts on the subject. The Third International Consultation on Incontinence provided the ICIQ a grade ‘A’ rating and indicated it should be used for the basic evaluation of a patient’s perspective of urinary incontinence.

UI in Females: (Hajebrahimi et al., 2012)

The weighted Kappa Index between the results of the initial questionnaire and the translated version was 0.70

Face Validity

UI in Females: (Huang et al, 2008)

There were missing data < 2.0% of items, indicating patients interpreted all items as relevant, which has been proposed as a measure of face validity.

UI in Females: (Avery et al., 2004)

Low level of missing data (mean 1.6%)

Floor/Ceiling Effects

UI in Females: (Gotoh et al., 2009)

Excellent: Japanese version of ICIQ-SF numbers for floor effect were reported as .8% to 4.1% and ceiling effect was reported as 7.5% to 23.1% indicating no particular floor or ceiling effects

Responsiveness

UI in Females: (Lim et al., 2017)

Large effect sizes (>.8) were present for each individual item score as well as the total score

ICIQ-UI SF Responsiveness
Scale Version	Effect size	Standardized Response Mean
English (n = 46)	1.49	1.41
Chinese (n = 60)	2.12	2.07

UI in Females: (Gotoh et al., 2009)

The scores for all of the ICIQ‐SF items and the total scores decreased significantly after treatment with surgery (Study 1, n = 15) or pharmaceutical agents (Study 2, n = 58). As expected, considerably larger improvements were noted in the scores of all of the patients who received surgery (median changes for items 1 and 2: −3.0 and −4.0, respectively; mean changes for item 3 and the total score: −6.3 and −12.1, respectively; P < 0.05) than in those of patients who received pharmaceutical treatment (median changes for items 1 and 2: −1.0 and −2.0, respectively; mean changes for item 3 and the total score: −2.3 and −5.2, respectively; P < 0.05).

Bibliography

Abrams, P., Andersson, K. E., Brubaker, L., Cardozo, A, Cottenden, L.,and the members of the committee. (2007). “3rd International Consultation on Incontinence, Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence.” Health Publications, 21, 1589-1630. Find it here.

Al-Shaikh, G., Al-Badr, A., Al Maarik, A., Cotterill, N., & Al-Mandeel, H. M. (2013). “Reliability of Arabic ICIQ-UI short form in Saudi Arabia”. Urology Annals, 5(1), 34-38. Find it on PubMed

Avery, K., Donovan, J., Peters, T. J., Shaw, C., Gotoh, M., & Abrams, P. (2004). “ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence”. Neurourology and Urodynamics, 23(4), 322-330. Find it on PubMed

Chang, S. R., Chen, K. H., Chang, T.C., & Lin, H.H. (2011). “A Taiwanese version of the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form for pregnant women: Instrument validation.” Journal of Clinical Nursing, 20, 714-722. Find it on PubMed

Gotoh, M., Homma, Y., Funahashi, Y., Matsukawa, Y., & Kato, M. (2009). “Psychometric validation of the Japanese version of the International Consultation on Incontinence Questionnaire-Short Form.” International Journal of Urology, 16, 303-306. Find it on PubMed

Hajebrahimi, S., Corcos, J., & Lemieux, M. C. (2004). “International consultation on incontinence questionnaire short form: a Comparison of physician versus patient completion and immediate and delayed self-administration.” Urology, 63(6), 1076-1078. Find it on PubMed

Hajebrahimi, S., Nourizadeh, D., Hamedani, R., & Pezeshki, M. Z. (2012). “Validity and reliability of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and its correlation with urodynamic findings.” Urology Journal, 9(4), 685-690. Find it on PubMed

Huang, L., Zhang, S. W., Wu, S. L., Ma, L., & Deng, X. H. (2008). “The Chinese version of ICIQ: A useful tool in clinical practice and research on urinary incontinence.” Neurourology and Urodynamics, 27(6), 522-524. Find it on PubMed

Karantanis, E., Fybes, M., Moore, K. H., & Stanton, S. L. (2004). “Comparison of the ICIQ-SF and 24-hour pad test with other measures for evaluating the severity of urodynamic stress incontinence.” International Urogynecology Journal of Pelvic Floor Dysfunction, 15(2), 111-116. Find it on PubMed

Karmakar, D., Mostafa, A., & Abdel-Fattah, M. (2017).” A new validated score for detecting patient-reported success on postoperative ICIQ-SF: A novel two-stage analysis from two large RCT cohorts.” International Urogynecology Journal, 28(1), 95–100. Find it on PubMed

Klovning, A., Avery, K., Sandvik, H., & Hunskaar, S. (2009). “Comparison of two questionnaires for assessing the severity of urinary incontinence: The ICIQ-UI SF versus the incontinence severity index.” Neurourology Urodynamics, 28(5), 411-415. Find it on PubMed

Lim, R., Liong, M. L., Lau, Y. K., & Yuen, K. H. (2017). “Validity, reliability, and responsiveness of the ICIQ‐UI SF and ICIQ‐LUTSqol in the Malaysian population.” Neurourology and Urodynamics, 36(2), 438-442. Find it on PubMed

Nyström, E., Sjöström, M., Stenlund, H., & Samuelsson, E. (2015). “ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence.” Neurourology and Urodynamics, 34(8), 747-751.Find it on PubMed

Tubaro, A., Zattoni, F., Prezioso, D., Scarpa, R. M., Pesce, F., Rizzi, C. A., Santini, A. M., Simoni, L., Artibani, W., & The Flow Study Group (2006). “Italian validation of the International Consultation on Incontinence Questionnaires.” BJU International, 97, 101-108. Find it on PubMed

Twiss, C. O., Fischer, M. C., & Nitti, V. W. (2007). “Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal sling.” Neurourology Urodynamics, 26(1), 8-13. Find it on PubMed

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Number of Items

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Minimally Clinically Important Difference (MCID)

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Content Validity

Face Validity

Floor/Ceiling Effects

Responsiveness

Bibliography

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