The purpose of this section is to provide clinicians and researchers with a list (and the actual reference) of measurement tools that have been researched. In addition, the reliability of the instrument will be listed.

This section is a dynamic section and will be continually updated. Anyone who has a measurement tool that they use, and that has been researched, can e-mail Ann Marie Flores (2006-2009) . Please include the entire reference.

1. Brink CA, Sampselle CM, Wells TJ, Diokno AC, Gillis GL. A digital test for pelvic muscle strength in older women with urinary incontinence. Nursing Research, 1989;38:196-199.

Subjects: 338 noninstitutionalized women with urinary incontinence, ages 55-90

Methods: “The examiner’s gloved index and middle fingers were lubricated and gently introduced 4-6 cms into the vaginal canal and turned so that the fingers rested in a supine position ready to assess a lateral (L) or a perceived right to left muscle contraction. Patients were told that after a count of three, they would be instructed to squeeze the pelvic muscles and hold the contraction for as long as possible. The examining fingers were then rotated 90 degrees counter clockwise to assume a vertical position with the index finger resting on top of the middle finger. The patient was again instructed, after a count of three and on command, to squeeze around the examining fingers, thus enabling the examiner to assess the anteroposterior (AP) or top to bottom contraction. In those patients with vaginal stenosis, the index or middle finger was used to determine muscle strength. The rating scale ranged from 0 where no muscle activity was felt despite patient effort, to 4 where the contraction was strong enough to pull the fingers in and up snugly. The duration of the contraction, as a simple function of time, was documented as well as the extent to which the vertical plane of the examining fingers was altered, i.e., compressed and drawn in.”

Results: Test-retest measures were recorded for both the digital L and AP procedures 4 to 6 weeks apart. The correlations were r = .65, and r = .65.

Interrater reliability figures were, r = .90 and r = .91.

Validity: The digital test was also compared to data derived using a vaginal myography unit (perineometry). “Muscle strength was measured in microvoltage units from 1-60, increased voltage indicating greater strength. While there were no published reliability or validity data for this surface electromyography (EMG) instrument, it represented considerable advancement as an objective measurement tool at the time when the Kegel perineometer was no longer commercially available.”
The comparisons between the digital test and the perineometer resulted in significant correlations – ranging from r = .53 to r = .59.

Conclusions: “These findings support the validity of a digital measure of pelvic muscle strength in incontinent older women. The wide array of variables that demonstrated the predicted relationship with the digital measure is compelling. Not only were there significant positive correlations found between perineometer and digital scores of pelvic muscle strength but also significant relationships with such variables as ability to control urine stream and age.”

2. Bo K. Reproducibility or instruments designed to measure subjective evaluation of female stress urinary incontinence. Scand J Urol Nephrol. 1994; 28: 97-100.

Subjects 14 women (ages 18-56) with clinically proven stress urinary incontinence.

Methods: Leakage test: “This index contains thirteen types of physical exertions which trigger urinary leakage in women with SUI: laughing, coughing, sneezing, rising from lying to a sitting position, walking on the level, walking uphill, walking downhill, jumping with legs together, jumping with legs in subsequent ab- and adduction, running, lifting, and sudden and rapid movements.
The patients were asked to record the degree of SUI for each parameter on a five point scale (1 = never, 2 = seldom, 3 = sometimes, 4 = often, 5 = always). The mean was calculated as an overall index.”

Social activity index: “Nine social situations were chosen to represent situations in which SUI women have problems in participating: at work, while dancing, at the cinema, theatre, etc., while hiking, in group exercise, in a general social setting, during sexual activity, attending educational courses and on a bus, train, etc.
Their perceived ability to participate in each of these situations was recorded on a 10cm visual analogue scale (0 = impossible to participate, 10 = no problem to participate). The mean was calculated as an overall index of the women’s perceived ability to participate in social situations.”

Results: The test and retest were conducted one hour apart. The correlation coefficient for the leakage index was r = .92. the value for the social activity index was r = .94

Conclusion: “Measssured with the mean, 95% confidence intervals and correlation analysis, both the leakage index and the social activity index proved to be reproducible methods to quantify how women experience SUI”

3. Potter NA, Rothstein JM. Intertester reliability for selected clinical tests of the sacroiliac joint. Physical Therapy, 1985; 65: 1671-1675.

Subjects: 17 patients (who presented with unilateral buttock pain and reported that the pain was present for not longer than one year) and 8 physical therapist evaluators.

Methods: Thirteen tests commonly categorized and sacroiliac joint testes were performed on each patient by two physical therapists. These were:
1. palpation of iliac crest levels (in standing)
2. palpation of iliac crest levels (in sitting)
3. palpation of PSIS levels (in standing)
4. palpation of PSIS levels (in sitting)
5. palpation of ASIS levels (in standing)
6. palpation of ASIS levels (in sitting)
7. Gillet test
8. standing flexion test
9. sitting flexion test
10. supine iliac gapping test
11. side-lying iliac compression test
12. supine-long sit test
13. prone knee flexion test

Results: “results showed intertester reliability was generally poor for all tests except the iliac gapping and compression tests, which achieved about 90% and 70% agreement, respectively.”

“…the iliac gapping and compression tests were the only two tests examined that relied solely on the patient’s response to the therapist’s actions. When the therapist performed the test, the patient stated whether pain occurred.”

4. Graham CW, Dmochowski RR. Questionnaires for women with urinary symptoms. Neurourology and Urodynamics, 2002;21:473-481.

This paper is a review of the questionnaires that have been designed and tested by other authors. There is also a brief description of the concepts of validity and reliability. This article is a good source of references. Following is the title of several of the tests, a couple relevant references, and the statistical reliability data.

A. The Detrusor Instability Score – designed to distinguish stress versus urge
incontinence. The DIS demonstrated a positive predictive score of 0.82
regarding the individuals who would be shown NOT to have detrusor
instability.

Kujansuu E, Kauppila A. Scored urological history and urethrocystometry in
the differential diagnosis of female urinary incontinence. Ann Chir Gynaecol.
1982;71:197-202.

Klovning A, Hunskaar S, Eriksen BC. Validity of a scored urological history
in detecting detrusor instability in female incontinence. Acta Obstet Gynecol
Scand. 1996;75:941.

B. The Stress Incontinence Questionnaire – designed to evaluate whether 18
specific activities were predictive of the diagnosis of stress urinary
incontinence. The reliability was good (test-re-test = 0.60-0.87).

Nochajski TH, Burns PA, Pranikoff K et al. Dimensions of urine loss among
older women with genuine stress incontinence. Neurorurol Urodyn.
1993;12:223-233.

C. Bristol Female Lower Urinary Tract Symptoms Questionnaire – designed to
assess the severity of incontinence, symptoms associated with incontinence,
quality of function and sexual function. The questionnaire was compared to
results of voiding diaries (r = 0.85-0.97) and pad tests (r = 0.31-0.67). Test
re-test reliability was r = 0.86.

Jackson S, Donovan J, Kent L et al. The reliability and validity of a new
female urinary symptoms questionnaire. Neurourol Urodyn., 1995;5:536-537.

D. Interstitial Cystitis Symptom Index and Problem Index – designed to measure
the severity and the impact of interstitial cystitis symptoms. Test-re-test
reliability was researched and found to be r = 0.91 and 0.92.

O’Leary MP, Sant GR, Fowler FJ Jr et al. The interstitial cystitis symptom
index and problem index. Urology, 1997;49:58-63.

E. Incontinence Quality of Life Measure – validation with objective measures of incontinence has not been published (per this article). A 1996 study showed reliability to be r = 0.95.

Wagner TH, Patrick DL, Bavendam TG et al. Quality of life of persons with urinary incontinence: development of a new measure. Urology, 1996;47:67-71.

Bellin P, Smith J, Poll W. et al. Results of a multicenter trial of the CapSure (Re/Stor) Continence shield on women with stress urinary incontinence. J Urol., 1998;51:697-706.

F. The Incontinence Impact Questionnaire and the Urogenital Distress Inventory.
The authors report these to be paired symptom questionnaires designed to measure the Impact and level of distress of lower urinary tract symptoms on women. They report that correlations were found to be low with final diagnosis, pad test results and voiding diaries. However, the data”performed well” with other questionnaires.

A shorter form was constructed and testes in 1995 and was found to be useful in predicting urodynamic problems in women.

Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3: 291-306.

Uebersax JS, Wyman JF, shumaker Sa et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14:131-139.

The authors stated, “No one questionnaire is comprehensive. The DIS seems to be useful for initial patient screening to discriminate between stress and urge symptoms. The IIQ-7 and the UDI-6 have high validity for and are excellent for evaluating the effect of incontinence on the patient, and they are applicable to patients with stress and UUI. Albeit longer than many others, the BFLUTS is comprehensive and widely used. Longer symptom appraisal instruments provide utility to clinical research in understanding specific facets of disease presentation and the impact of therapeutic interventions on those symptoms.”

5. Hagen S, Hanley J, Capewell A. Test-retest reliability, validity, and
sensitivity to change of the urogenital distress inventory and the incontinence
impact questionnaire. Neurourol Urodyn. 2002;21:534-539.

This study evaluated the test-retest reliability, concurrent and construct validity, and sensitivity to post-intervention results, of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire. The groups included women with stabilized urinary incontinence who were not receiving any treatment, a group of women diagnosed with stress, urge or mixed incontinence who were going to be treated conservatively, and one group of women who were scheduled for a surgical procedure.

Results indicated the following:
1. There was poor reliability for only one question of the UDI (pain when urinating)
and two questions on the IIQ (urine leakage with specific social events).
2. There was a strong relationship between amount of urine leakage, number of
episodes of incontinence and increased UDI scores.
3. The total IIQ score increased in concert with the weight of urine leakage.
4. There were significant correlations between the total IIQ score and the SF-36 scores (p<0.005).
5. There was high correlation between a decreased UDI score and an actual decrease in the number of incontinence episodes (p<0.001).

** The following is a nicely written review of the SF-36 survey.

Ware JE. SF-36 Health Survey update. Spine. 2000;25: 3130-3139.

The authors reported that, “The UDI appeared to be a valid measure of bothersomeness with good evidence that scores were significantly and positively related to the severity of incontinence. As the IIQ is intended to measure the impact of UI on daily living and the individual’s feelings, it also should be associated with the severity of the condition and, in addition, possibly with levels of depression./anxiety and general health a measured on standard generic scales. These hyporthese were supported and validity of the IIQ appeared good.”

6. Bo K. Reproducibility of instruments designed to measure subjective evaluation of female stress urinary incontinence. Scand J Urol Nephrol. 1994;28:97-100.

Bo tested the reproducibility of a leakage test (degree of incontinence during 13 physical activities), and a social activity questionnaire. One hour was allowed between each test (a short amount of time). She reported Pearson correlations of r = .92 and r = .94.

7. Riddle DL, Freburger JK. Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study. Phys Ther. 2002;82:772-781.

65 patients that were identified to have low back pain and unilateral buttock pain served as subjects for this study. A physical therapist (mean of 10.1 years of experience of treating patients that reported low back pain) performed the fours tests (listed below) and then a second physical therapist repeated the tests. If 3 of the 4 tests were found to be positive, the patient was said to have “SIJ region dysfunction”. The four tests were: 1. standing flexion test, 2. prone knee flexion test, 3. supine long sitting test, 4. sitting PSIS test.

The authors determined the following:
1. “ …the extent of agreement when paired therapists rated 3 or more tests as positive or negative.”,
2. “… whether therapists agreed on 1 of the following 3 judgements: 2 or more tests were negative, 3 or more tests indicated dysfunction on the right side, or 3 or more tests indicated dysfunction on the left side.”
3. “…the extent of agreement for a 5-category scale (anteriorly rotated on the right side, anteriorly rotated on the left side, negative, posteriorly rotated on the right side, posteriorly rotated on the left side.)”

The authors concluded, “The intertester reliability of assessments of the presence of SIJ region dysfunction using a composite of 4 diagnostic tests was poor and was not dependent on the method of classifying the nature of the test results.”. 1998;11: 341-345.

They also stated, “We believe that therapists who use the 4 tests we examined to identify the type of dysfunction or the side of involvement are likely to deliver interventions to individuals who do not have a dysfunction or to deliver interventions incorrectly (either the proper technique will not be chosen or the intervention will be applied to the wrong side.)”

The authors offered helpful information when they wrote, “Tests designed to provoke a patient’s pain appear to have more support for use in identifying patients who may have SIJ region dysfunction than do tests presumed to measure SIJ alignment or movement.” After this statement they cite the following reference:

Broadhurst NA, Bond MJ. Pain provocation tests for the assessment of sacroiliac joint dysfunction. J Spinal Disorders