Plain English summary
Background
Methods
Protocol and registration
Literature search
Eligible studies
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | Women with (recurrent) UTIs | Women with complicated UTIs; Women with other urological and gynecological lower reproductive tract infections |
Study design | PROM development and/or validation study | All other study designs |
Outcome | All patient-reported outcomes | Non-patient-reported outcomes, e.g., biomarkers, laboratory data |
Type of measurement instrument | PROM | All others |
Publication type | Articles with available full-text | Abstracts |
Study selection
Methodological assessment
Box 1 | PROM development | Content validity |
Box 2 | Content validity | |
Box 3 | Structural validity | Internal structure |
Box 4 | Internal consistency | |
Box 5 | Cross-cultural validity/measurement invariance | |
Box 6 | Reliability | Remaining measurement properties |
Box 7 | Measurement error | |
Box 8 | Criterion validity | |
Box 9 | Hypotheses testing for construct validity | |
Box 10 | Responsiveness |
Measurement property | Rating | Criteria |
---|---|---|
Structural validity | + | CTT CFA: CFI or comparable measure > 0.95 OR RMSEA < 0.06 OR SRMR < 0.08a IRT/Rasch No violation of unidimensionalityb: CFI or TLI or comparable measure > 0.95 OR RMSEA < 0.06 OR SRMR < 0.08 AND No violation of local independence: residual correlations among the items after controlling for the dominant factor < 0.20 OR Q3’s < 0.37 AND No violation of monotonicity: adequate looking graphs OR item scalability > 0.30 AND Adequate model fit IRT: χ2 > 0.001 Rasch: infit and outfit mean squares ≥ 0.5 and ≤ 1.5 OR Z-standardized values > -2 and < 2 |
? | CTT: not all information for ‘ + ’ reported IRT/Rasch: model fit not reported | |
- | Criteria for ‘ + ’ not met | |
Internal consistency | + | At least low evidencec for sufficient structural validityd” AND Cronbach’s alpha(s) ≥ 0.70 for each unidimensional scale or subscalee |
? | Criteria for “At least low evidencec for sufficient structural validityd” not met | |
- | At least low evidencec for sufficient structural validityd and Cronbach’s alpha(s) < 0.70 for each unidimensional scale or subscalee | |
Reliability | + | ICC or weighted Kappa ≥ 0.70 |
? | ICC or weighted Kappa not reported | |
- | ICC or weighted Kappa < 0.70 | |
Measurement error | + | SDC or LoA < MICd |
? | MIC not defined | |
- | SDC or LoA > MIC | |
Hypotheses testing for construct validity | + | The result is in accordance with the hypothesisf |
? | No hypothesis defined (by the review team) | |
- | The result is not in accordance with the hypothesisf | |
Cross-cultural validity/measurement invariance | + | No important differences found between group factors (such as age, gender, language) in multiple group factor analysis OR no important DIF for group factors (McFadden’s R2 < 0.02) |
? | No multiple group factor analysis OR DIF analysis performed | |
- | Important differences between group factors OR DIF was found | |
Criterion validity | + | Correlation with gold standard ≥ 0.70 OR AUC ≥ 0.70 |
? | Not all information for ‘ + ’ reported | |
- | Correlation with gold standard < 0.70 OR AUC < 0.70 | |
Responsiveness | + | The result is in accordance with the hypothesisf OR AUC ≥ 0.70 |
? | No hypothesis defined (by the review team) | |
- | The result is not in accordance with the hypothesisf OR AUC < 0.70 |
Results
Literature search
Characteristics of the included PROMs and study populations
ACSS | AIA | ICIQ-FLUTS | Symptom diary | UTISA | UTI-SIQ-8 | |
---|---|---|---|---|---|---|
Construct | Typical and differential symptoms and their severity, quality of life, and possible changes after therapy | Impact of UTI on work or other regular daily activities | Symptoms and bothersomeness | Symptom severity, bothersomeness and impact on daily activities | Symptoms and their severity, bothersomeness | Symptoms and their severity, bothersomeness |
Target population | Women with AUC | Women with uncomplicated UTI | Women with LUTS | Adult patients with UTI | Women with uncomplicated UTI | Women with UTI |
Mode of administration | Self-administered | Self-administered | Self-administered | Self-administered | Self-administered | Self-administered |
Recall period | 24 h | 24 h | 4 weeks | 7 days | 24 h | Respective day |
(Sub)scales (number of items) | 4 subscales (18 items): typical (6), differential (4), quality of life (3), additional (5) | 0 subscales (5 items) | 3 subscales (12 items, 2 questions each): filling symptoms (4), voiding symptoms (3), incontinence symptoms (5) | 3 subscales (43 items): symptom severity (18), bothersomeness (18), impact on daily activities (7) | 2 subscales (14 items): severity of symptoms (7 items), bothersomeness (7 items) | 0 subscales (8 items: 4 items each to assess severity and bothersomeness) |
Response options | 4-point Likert scale: 0 (‘no symptom’) to 3 (‘severe’), 'Additional' subscale: yes/no-questions | 5-point Likert scale: 0 (‘none of the time’) to 4 (‘all of the time’) | First question: 5-point Likert scale: 0 (‘none’) to 4 (‘four or more’) Second question: 11-point Likert scale: 0 (‘not at all’) to 10 (‘a great deal’) | 4-point Likert scale: 0 (‘none’) to 3 (‘a lot’) | 4-point Likert scale: 0 (‘did not have’) to 3 (‘severe’) | Symptom severity: 5-point Likert scale: 1 (‘not at all’) to 5 (‘very strong’) Bothersomeness: 5-point Likert scale 1 (‘not at all’) to 5 (‘very severe’) |
Range of scores/scoring | Typical subscale: 0–18 Differential subscale: 0–12 Quality of life subscale: 0–9 | Subscales 0-4; Overall score: 0 (no limitations) to 20 (maximum level of limitations) | Filling symptoms subscale: 0–16, Voiding symptoms subscale: 0–12, Incontinence symptoms subscale: 0–20 | n/a | 0–21 | Symptoms: 1 (no symptoms at all) to 5 (very strong symptoms) Bothersomeness: 1 (no impairment at all) to 5 (very strong impairment) |
Original language | Russian/Uzbek | English | English | Danish | English | German |
Available translations | Chinese, French, German, Greek, Hungarian, Italian, Polish, Portuguese, Romanian, Russian, Spanish, Swedish, Tajik, Ukrainian, US/UK English, Uzbek | English, French | Chinese, Czech, Danish, Dutch, Finnish, French, German, Greek, Hungarian, Italian, Japanese, Norwegian, Persian, Polish, Portuguese, Spanish, Swedish, Tamil, Thai, Turkish, US/UK English | Danish, English | 13 languages (no detailed data available) | English, German |
Instrument | Reference | Sample size | Age mean (SD) or median | Setting | Country (Language) | Measurement properties |
---|---|---|---|---|---|---|
ACSS | Alidjanov et al. [14] | 286 | M = 32.3 (± 12.3), range 15–73 years | Outpatient clinic | Uzbekistan (Uzbek), Russia (Russian) | PROM development, internal consistency, construct validity, responsiveness |
Alidjanov et al. [26] | 83 | M = 35.6 (± 13.7), range 19–83 years | Centre of Urology | Uzbekistan (Uzbek), Russia (Russian) | Content validity, internal consistency, construct validity, responsiveness | |
Alidjanov et al. [27] | 36 | Median = 40 (IQR = 21–59), range 18–90 years | Urological clinic | Germany (German) | Content validity, internal consistency, construct validity | |
Alidjanov et al. [28] | 63 | M = 30.7 (± 11.5), range 17–64 years | Outpatient clinic | Uzbekistan (Uzbek), Russia (Russian) | Internal consistency, responsiveness | |
Alidjanov et al. [29] | 18 | M = 48.4 (± 21.6), range 16–80 years | Urological practice | United Kingdom (English) | Content validity, internal consistency, construct validity | |
Alidjanov et al. [30] | 228 (follow-up: 48) | M = 31.49 (± 11.71) | Outpatient clinic | Uzbekistan (Uzbek), Russia (Russian) | Internal consistency, construct validity, responsiveness | |
Alidjanov et al. [31] | 48 | M = 31.10 (± 10.64), range 19–63 years | Outpatient clinic | Uzbekistan (Uzbek), Russia (Russian) | Internal consistency, responsiveness | |
Alidjanov et al. [32] | 134 | M = 36.28 (± 16.03), range 17–82 years | Data extraction: e-USQOLAT | German, Hungarian, Tajik, Uzbek | Responsiveness | |
Alidjanov et al. [33] | 167 | M = 36.8 (± 15.3), range 17–87 years | Clinical site | United States (English) | Internal consistency, construct validity, responsiveness | |
Alidjanov et al. [34] | 97 | Median = 41 (IQR = 28–57), range 17–83 years | Physician’s office | Switzerland (German) | Internal consistency, construct validity, responsiveness | |
Bruyère et al. [35] | 17 | Median = 46, range 20–85 years | NR | France (French) | Content validity | |
Choi et al. [46] | 50 (patients: 31, controls: 19) | M = 54.4 (± 15.5) | Clinical setting | Korea (Korean) | Content validity, internal consistency, construct validity | |
Di Vico et al. [36] | 100 (patients: 54, controls: 46) | Patients: median = 36 (IQ
R = 28–49) Controls: median = 38 (IQR = 29–45) | Outpatient office and fertility center | Italy (Italian) | Construct validity | |
Magyar et al. [37] | 68 (patients: 31, controls: 37) | Patients: median = 42, range 18–78 years Controls: median = 48, range 19–85 years | Urological outpatient clinic | Hungary (Hungarian) | Content validity, internal consistency, construct validity, responsiveness | |
Stamatiou et al. [38] | 30 | M = 23.84, range 22–89 years | NR | Greece (Greek) | Content validity | |
Stamatiou et al. [39] | 92 | M = 46.7 (± 16.6) | Clinical setting | Greece (Greek) | Internal consistency, construct validity, responsiveness | |
AIA | Wild et al. [40] | 276 | M = 33.0 (± 11.46), range 18–78 years | Clinical setting | United States (English) | Structural validity, internal consistency, construct validity, responsiveness |
Vincent et al. [41] | 50 | M = 44.6, range 20–52 | Clinical setting | France (French) | Content validity, structural validity, internal consistency, construct validity, responsiveness | |
ICIQ-FLUTS | Chattrakulchai et al. [43] | 283 (clinical population: 142, community population: 141) | Clinical population: M = 65.08 (± 11.68) Community population: M = 55.25 (± 12.76) | Urogynecology clinic | Thailand (Thai) | Content validity, internal consistency, reliability, construct validity |
Symptom diary | Holm et al. [44] | 451 | NR | Practitioner’s office | Denmark (Danish) | PROM development, content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance |
UTISA | Chang et al. [42] | 293 (patients: 169, controls: 124) | Patients: M = 44.0 (± 13.7) Controls: M = 44.6 (± 12.3) | Clinical setting | Taiwan (Chinese) | Structural validity, internal consistency, construct validity, responsiveness |
Clayson et al. [13] | 276 | M = 33.0 (± 11.46), range 18–78 years | Electronic format | United States (English) | Structural validity, internal consistency, construct validity, responsiveness | |
UTI-SIQ-8 | Gágyor et al. [45] | 120 | M = 43.3 (± 16.6) | Primary care practices | Germany (German) | PROM development, structural validity, internal consistency, reliability, construct validity, responsiveness |
Information on interpretability and feasibility
Measurement properties of instruments
Evaluation of content validity
Evaluation of the remaining measurement properties
PROM | Reference | Methodological quality (ratinga) | |||||
---|---|---|---|---|---|---|---|
Structural validityb | Internal consistencyb | Cross-cultural validity/ measurement invariance | Reliability | Hypotheses testing | Responsiveness | ||
ACSS | Alidjanov et al. [14] | Very good (+), Adequate (+) | Doubtful (+) | ||||
Alidjanov et al. [26] | Very good (+/+), Doubtful (+) | Inadequate (?) | |||||
Alidjanov et al. [27] | Very good (+/+) | ||||||
Alidjanov et al. [28] | Doubtful (+) | ||||||
Alidjanov et al. [29] | Adequate (+) | ||||||
Alidjanov et al. [30] | Doubtful (+) | ||||||
Alidjanov et al. [31] | Very good (+), Doubtful (+) | ||||||
Alidjanov et al. [32] | Doubtful (?) | ||||||
Alidjanov et al. [33] | Very good (+), Doubtful (–) | Very good (+) | |||||
Alidjanov et al. [34] | Very good (–), Adequate (–) | Very good (+) | |||||
Bruyère et al. [35] | |||||||
Choi et al. [46] | Very good (+), Doubtful(+) | ||||||
Di Vico et al. [36] | Very good (+) | ||||||
Magyar et al. [37] | |||||||
Stamatiou et al. [38] | |||||||
Stamatiou et al. [39] | Very good (+), Adequate (–) | Adequate (?) | |||||
AIA | Wild et al. [40] | Very good (?), Adequate (?) | Very good (?) | Very good (+), Adequate (+) | Very
good (+) | ||
Vincent et al. [41] | Adequate (?) | Doubtful (?) | Adequate (+), Doubtful (–) | Very good (–) | |||
ICIQ-FLUTS | Chattrakulchai et al. [43] | Doubtful (?) | Inadequate (?) | Very good (+) | |||
Symptom diary | Holm et al. [44] | Very good (?) | Very good (?) | Inadequate (+) | |||
UTISA | Chang et al. [42] | Adequate (?) | Doubtful (?) | Very good (+) | Adequate (+), Doubtful (+), Inadequate (?) | ||
Clayson et al. [13] | Adequate (?) | Very good (?) | Very good (+), Adequate (+/+) | Inadequate (+/+) | |||
UTI-SIQ-8 | Gágyor et al. [45] | Very good (+), Adequate (?) | Very good (+) | Doubtful (–) | Adequate (+) | Adequate (+) |
Summary of the findings and grading of the quality of evidence
PROM | Summary or pooled result | Overall rating | Quality of evidence |
---|---|---|---|
ACSS | |||
Internal consistency | Data not reported due to the formative measurement model | Quality not evaluated due to the formative measurement model | |
Hypotheses testing | 13 out of 17 hypotheses confirmed, sample size: 1461 | Sufficient | Moderate (due to inconsistency) |
Responsiveness | 7 out of 7 hypotheses confirmed, sample size: 684 | Sufficient | High |
AIA | |||
Structural validity | Not all information for sufficient rating reported, sample size: 326 | Indeterminate | – |
Internal consistency | Alpha = 0.93, no evidence for sufficient structural validity, sample size: 326 | Indeterminate | – |
Hypotheses testing | 1 out of 2 hypotheses confirmed, sample size: 326 | Inconsistent | High |
Responsiveness | 1 out of 1 hypothesis confirmed, sample size: 326 | Sufficient | High |
ICIQ-FLUTS | |||
Internal consistency | Alpha = 0.65–0.85, no evidence for sufficient structural validity, sample size: 283 | Indeterminate | – |
Reliability | Not all information for sufficient rating reported, sample size: 283 | Indeterminate | – |
Hypotheses testing | 1 out of 1 hypothesis confirmed, sample size: 283 | Sufficient | High |
Symptom diary | |||
Structural validity | Not all information for sufficient rating reported, sample size: 173–376 | Indeterminate | – |
Internal consistency | Alpha = 0.55–0.94, no evidence for sufficient structural validity, sample size: 173–376 | Indeterminate | – |
Cross-cultural validity/Measurement Invariance | No important differential item functioning, sample size: 173–376 | Sufficient | Very low (due to risk of bias) |
UTISA | |||
Structural validity | Not all information for sufficient rating reported, sample size: 445 | Indeterminate | – |
Internal consistency | Alpha = 0.72–0.87, no evidence for sufficient structural validity, sample size: 445 | Indeterminate | – |
Hypotheses testing | 4 out of 4 hypotheses confirmed, sample size: 569 | Sufficient | High |
Responsiveness | 4 out of 4 hypotheses confirmed, sample size: 338 | Sufficient | 10b. Low (due to risk of bias), 10c. Moderate (due to risk of bias), 10d. Low (due to risk of bias) |
UTI-SIQ-8 | |||
Structural validity | SRMR = 0.066, sample size: 120 | Sufficient | High |
Internal consistency | Alpha = 0.86–0.91, sample size: 120 | Sufficient | High |
Reliability | ICC = 0.32, sample size: 120 | Insufficient | Low (due to risk of bias) |
Hypotheses testing | 1 out of 1 hypothesis confirmed, sample size: 120 | Sufficient | Moderate (due to risk of bias) |
Responsiveness | 1 out of 1 hypothesis confirmed, sample size: 120 | Sufficient | Moderate (due to risk of
bias) |
Recommendation
PROM | Category A | Category C | Recommendation | |
---|---|---|---|---|
Sufficient content validity (any level) | At least low-quality evidence for sufficient internal consistency | High-quality evidence for an insufficient measurement property | ||
ACSS | ✓ | Not applicable | × | A |
AIA | × | × | × | B |
ICIQ-FLUTS | × | × | × | B |
Symptom diary | ✓ | × | × | B |
UTISA | × | × | × | B |
UTI-SIQ-8 | ✓ | ✓ | × | A |