Urdu translation and validation of the Urogenital Distress Inventory (UDI-6) in women with urinary incontinence.

ARAB JOURNAL OF UROLOGY 2019, VOL. 17, NO. 3, 212–215 https://doi.org/10.1080/2090598X.2019.1618523 VOIDING DYSFUNCTION/FEMALE UROLOGY: ORIGINAL ARTICLE Urdu translation and validation of the Urogenital Distress Inventory (UDI-6) in women with urinary incontinence Nuzhat Faruqui a , Novera Chughtaib and Jamil Ahmeda a Department of Urology, Aga Khan University, Karachi, Pakistan; bDepartment of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan ABSTRACT ARTICLE HISTORY Objective: To provide an Urdu translation of the six-item version of the Urogenital Distress Inventory (UDI-6) and its validation in patients with urinary incontinence (UI), as the UDI-6 is a recognised, useful disease-specific questionnaire for the evaluation of UI in women. Patients and methods: We used a multi-step linguistic translation of the UDI-6, which comprised backward and forward translations coordinated by clinical investigators, followed by a pre-test in 10 patients. The final version was completed by a larger sample of women (n = 200), of which 100 had UI for the last 3 months and 100 had no UI. To appraise test– retest reliability the patients with UI were re-tested after 2 weeks. To test the questionnaire’s capacity to discriminate between women with or without UI, both cases (patients) and controls were included and assessed. The reliability of the UDI-6 was evaluated by internal consistency and was calculated using the Wilcoxon signed-rank test with P values, and test– retest reliability assessed by Spearman’s coefficient with P values. Results: The reliability of the UDI-6 was assessed for internal consistency and test–retest reliability was evaluated by Spearman’s coefficient, which showed significant P values. Conclusion: The present Urdu version of the UDI-6 is a linguistically valid instrument that can be reliably used in clinical practice and research. Received 11 March 2019 Accepted 27 April 2019 KEYWORDS Urdu; questionnaire translation; urogenital distress inventory (UDI); urinary incontinence; validation Abbreviations: IIQ-7: seven-item version of the Incontinence Impact Questionnaire; IQR: interquartile ranges; QoL: quality of life; UDI-6: six-item version of the urogenital distress inventory; UI: urinary incontinence Introduction According to the recommendations of the ICS/ International Urogynecological Association (IUGA) joint report 2010, urinary incontinence (UI) is defined as ‘complaint of involuntary loss of urine’ [1]. The global prevalence of UI is ~49% for stress UI, 22% for urge UI, and 29% for mixed UI. UI is a very common disorder affecting females of all ages [2]. In a study from Pakistan involving 180 female patients, 44% of females reported significant UI, of which 17.2% and 16.1% complained of stress or mixed UI, respectively, with 9.7% complaining of urge UI only [3]. Various generic and disease-specific quality-of-life (QoL) questionnaires, such as the six-item version of the Urogenital Distress Inventory (UDI-6) and sevenitem version of the Incontinence Impact Questionnaire (IIQ-7), are used to evaluate women presenting with UI in the West. Generic questionnaires use non-specific questions and are lengthy and complexity restricted. Therefore, it has been postulated that the simultaneous use of generic and disease- specific questionnaires will improve the sensitivity to assess the impact of UI on the QoL of women [4]. This sensitivity is increased if the questionnaire used is translated into the population’s native language, as confirmed by various studies, and therefore validated questionnaires, like the UDI-6 and IIQ-7, have been translated into various languages including: Arabic, Dutch and Turkish [5–8]. The national language of Pakistan is Urdu and many Pakistanis’ are unfamiliar with even basic English language. There is no validated QoL instrument in the Urdu language that can measure the impact of UI. Therefore, the aim of our present study was to provide an Urdu version of the UDI-6 questionnaire and validate its use in an Urdu-speaking population. As UI is considered as a social taboo, a questionnaire validated in the patient’s own language will help them report their issues accurately and comfortably, and also provide a platform for future research. The objective of the present study was to provide an Urdu translation of the UDI-6 and its validation in female patients with UI. CONTACT Nuzhat Faruqui Department of Surgery, Aga Khan University, Stadium Road, P.O Box 3500, Karachi 74800, Pakistan Supplemental data for this article can be accessed here. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ARAB JOURNAL OF UROLOGY Patients and methods Study design A cross-sectional study was conducted at the outpatient urology clinic over a 4-month period. Patients (cases) were asked to complete the questionnaire at baseline and 2 weeks later, so as to evaluate the test– retest reliability. The controls were assessed only once, as in patients with LUTS their symptoms would be seen again for clinical reasons, whilst in controls they would not. Therefore, the test–retest reliability was performed on patients only. During the study period, the questionnaires were completed by the patients as well as the controls. However, the translation process itself took 6–7 months prior to use. The UDI includes 18 items; thus, a sample of 180 patients would be ideally required, so we included 200. The sample size of 200 was adequate to fulfill the above criteria and objective measures of urinary symptoms. The inclusion criteria of the study were all female patients aged ≥18 years reporting UI for the last 3 months. These were the cases. The controls were all healthy subjects with no UI for the last 3 months. The exclusion criteria included all those whose education status was below primary level, those with psychiatric diseases, and those with incomplete forms. We also excluded those patients with language barriers. These were patients from distant places or from other countries who did not understand Urdu or English, and needed to have a translator present for history taking and to follow various instructions during examination. 213 original UDI-6 were compared, and the first version was revised. (5) A pilot test was done, to assess whether the UDI-6 was clear to the target population, in 10 patients (i.e., women with urological problems) [10]. The number of patients who had problems in correctly understanding the questions and pre-coded answers were recorded and discussed. (6) The final Urdu version of the UDI-6 was devised. The questionnaire was first introduced at the patient’s initial visit to the clinic and then at the first follow-up visit (...truncated)