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Pelvic Floor Impact Questionnaire

Pelvic Floor Impact Questionnaire

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Purpose

The PFIQ is a patient report designed to assess life impact of pelvic floor disorders on women.

Link to Instrument

Instrument Details

Acronym PFIQ-7

Area of Assessment

Activities of Daily Living
Depression
General Health
Life Participation
Quality of Life
Social Relationships
Incontinence

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • A seven question self-report measure assessing pelvic floor impact on QOL, daily activities and emotional health.
  • Previously, the 93-item PFIQ long form was used but the PFIQ–7 has been developed and demonstrated substantial validity and reliability.
  • This outcome is scored out of 300 with three 100-point subscales (lower scores indicate less effect on QOL).

Number of Items

7

Time to Administer

23 minutes

Average time taken for PFIQ and PFDI

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Elizabeth Buice, SPT, Stephanie Hare, SPT, Josh Holskey, SPT, Tash Kopecky, SPT, Daniel Chen, SPT, Chelsea Wolfe, SPT, Haley Carter, SPT, Kimberle Crastenberg, SPT, Justin Stambaugh, SPT, Brittany Torres, SPT, Keenan Whitesides, SPT, and Rebecca Schuck, SPT.

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion
General Health

Professional Association Recommendation

Originally, the PFIQ was 93-item patient report outcome. Subsequently a short form has been created with 7 items to decrease administration length. Upon assessment it was found that the long form and short form were substantially close in reliability and validity. The short form is more commonly used due to similar psychometric property values as well as decreased administration time.

Considerations

(Ali – Ross et al, 2009)

The examiners were not blinded in this study and as such further testing should be done involving blinding examiners to information relative to the test.

(Barber et al, 2011)

Limitations: the subjects did not complete both short form and long form questionnaires, so the researchers derived the short form scores from the responses to the original long form. This is a minor limitation because they could not make direct comparisons or evaluate issues of question order, question fatigue, or item grouping. Next, the measures of responsiveness partly depended on effectiveness of interventions used, so the responsiveness stats are likely conservative estimates.

(El-Azab et al, 2009)

Limitations: Short follow up time and no test of sexual function. However, the addition of the prayer component to the questionnaire had good test-retest reliability and was internally consistent. This article highlights the importance of being able to adapt questionnaires to various cultural norms and accurately translate them to different languages.

(Kaplan et al, 2012)

Currently, need translation and validation for utilization with other languages.

(Barber et al, 2005)

This study had a small sample size and wide variability of change in scores, these values need to be confirmed by larger studies.

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Non-Specific Patient Population

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Standard Error of Measurement (SEM)

Pelvic Disorders:

(Barber et al, 2005; n = 45 women with pelvic floor disorders who were scheduled to undergo surgery)

SEM

 

PFIQ - 7

29.7

IIQ - 7

11.8

POPIQ - 7

13.7

CRAIQ - 7

9.89

 

Minimal Detectable Change (MDC)

Pelvic Disorders: (Barber et al, 2005)

MDC

 

PFIQ - 7

64.8

IIQ - 7

28.3

POPIQ - 7

26.1

CRAIQ - 7

23.7

Minimally Clinically Important Difference (MCID)

Pelvic Disorders:

(Barber et al, 2005)

  • PFIQ - 7 = 36 points or 12% difference

Cut-Off Scores

Vaginal Reconstructive Sugery:

(Kaplan et al, 2012; n = 248 women with vaginal reconstructive surgery patients; Turkish women)

  • > 1.75 to discriminate prolapse from non-prolapse, > 19.0 as a summary score using area under ROC curve to discriminate pelvic organ prolapse 

 

Pelvic Disorders:

(Barber et al, 2005)

  • 0.88 area under the ROC curve represents the ability of the summary score to successfully discriminate between subjects who indicated that they were “worse” after surgery from those who indicated that they were “better”

Test/Retest Reliability

Pelvic Disorders:

(Barber et al, 2005)

  • Excellent test retest reliability:

 

PFIQ - 7

r = 0.77

IIQ - 7

r = 0.81

POPIQ - 7

r = 0.70

CRAIQ - 7

r = 0.81

 

Internal Consistency

Pelvic Disorders: 

(El-Azab et al, 2009; n = 20 Arabic Muslim women with symptomatic Pelvic Organ Prolapse to test the internal consistency and test retest reliability of the two questionnaires PFDI-20 and PFIQ-7; 78 Arabic Muslim women with Stage 2 symptomatic Pelvic Organ Prolapse awaiting surgical correction were recruited prospectively. Mean age = 42 (8) years)

  • Adequate Cronbach’s α = 0.78 

(Barber et al, 2005)

  • Excellent Cronbach’s α = 0.97 

 

Vaginal Reconstructive Surgery

(Kaplan et al, 2012)

  • Excellent Cronbach’s α for PFIQ-7 = 0.830 
  • Adequate Cronbach’s α for subscales: POPIQ-7 = 0.763; UIQ-7 = 0.800; CRAIQ-7 = 0.734

Criterion Validity (Predictive/Concurrent)

Prolapse Surgery: 

(Ali – Ross et al, 2009; n = 54 women between the ages of 55 - 66 who were admitted to St Mary's Hospital, Manchester for prolapse surgery who were capable of performing adequate physical activity)

  • Reported worsening of symptoms, higher PFDI and PFIQ scores and higher individual symptom scores were not associated with POPQ findings following physical activity 

 

Vaginal Reconstructive Surgery:

(Kaplan et al, 2012)

  • Adequate correlation between POP-Q and PFIQ-7 (r = 0.451, p < 0.001)
  • Excellent correlation between POP-Q and PFDI-20 (r = 0.721, p<0.001)
  • Prolapse vs. non-prolapse – prolapse found to have higher scores

Construct Validity

Pelvic Disorders:

(Barber et al, 2011; n = 1,006 subjects enrolled in 1 of 4 prospective studies: 316 women from CARE trial with pelvic organ prolapse, 140 from colpocleisis trial with pelvic organ prolapse, 435 from ATLAS trial with stress urinary incontinence, 115 from ABBI trial with fecal incontinence; average age of participants was 58.4 (14.7) years)

  • Excellent correlation between long and short form PFIQ, UIQ (r = 0.96; POPIQ r = 0.98; CRAIQ r = 0.98) 

(Barber et al, 2005)

  • Excellent correlation between long and short form PFIQ, IUQ (r = 0.96; POPIQ r = 0.94; CRAIQ r = 0.96)

*No correlation is shown for summary scores of the PFIQ-7 because, unlike the short forms, the PFIQ long forms do not have a summary score

Responsiveness

Pelvic Disorders:

(Barber et al, 2011)

SRM

3 Months

12 Months

UIQ

0.58

0.70

POPIQ

0.44

0.49

CRAIQ

0.37

0.36


(El - Azab et al, 2009)

 

Effect Size

 

PFIQ - 7

NA

IIQ

Large change: 0.78

POPIQ

Moderate change: 0.49

CRAIQ

Moderate change: 0.37

(Kaplan et al, 2012)

 

Effect Size

 

PFIQ - 7

Large change: 1.25

UIQ

Moderate change: 0.68

POPIQ

Large change: 1.45

CRAIQ

Moderate change: 0.26

(Barber et al, 2005)

 

 

Effect Size

 

PFIQ - 7

Moderate change: 0.67

IIQ

Moderate change: 0.68

POPIQ

Moderate change: 0.52

CRAIQ

Moderate change: 0.47

Bibliography

Ali-Ross, N. S., Smith, A. R., et al. (2009). "The effect of physical activity on pelvic organ prolapse." BJOG 116(6): 824-828.

Barber, M. D., Chen, Z., et al. (2011). "Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ)." Neurourol Urodyn 30(4): 541-546.

Barber, M. D., Walters, M. D., et al. (2005). "Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)." Am J Obstet Gynecol 193(1): 103-113.

El-Azab, A. S., Abd-Elsayed, A. A., et al. (2009). "Patient reported and anatomical outcomes after surgery for pelvic organ prolapse." Neurourol Urodyn 28(3): 219-224.

Kaplan, P. B., Sut, N., et al. (2012). "Validation, cultural adaptation and responsiveness of two pelvic-floor-specific quality-of-life questionnaires, PFDI-20 and PFIQ-7, in a Turkish population." Eur J Obstet Gynecol Reprod Biol 162(2): 229-233.