Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Am J Obstet Gynecol. 2018 Jan;218(1):119.e1-119.e8. doi: 10.1016/j.ajog.2017.09.022. Epub 2017 Oct 6.
Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established.
The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores.
This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence.
Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values -0.26 to -0.57), and prolapse, bladder, and bowel subscales (r values -0.16 to -0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001).
The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.
盆腔器官脱垂是一种常见病症，常伴有尿失禁和粪失禁。脱垂对生活质量的影响通常通过特定于疾病的生活质量工具来衡量。效用偏好评分是一种标准化的通用健康相关生活质量衡量标准，可将发病率从 0（死亡）到 1（最佳健康）进行量化。效用偏好评分可量化疾病的严重程度和负担，并广泛应用于成本效益研究。盆腔器官脱垂女性的效用偏好工具的有效性尚未得到证实。
本研究旨在评估通用生活质量工具测量盆腔器官脱垂女性效用评分的结构效度。我们的假设是，患有多种盆底功能障碍的女性比仅患有盆腔器官脱垂的女性（更低）效用评分更差，而患有所有 3 种盆底功能障碍的女性（更低）效用评分最差。
这是一项来自女性盆底医学和重建外科参考实践的 286 例盆底功能障碍女性的前瞻性观察性研究。所有女性均完成了以下一般健康相关生活质量问卷：健康效用指数 Mark 3、EuroQol 和简短表格 6D，以及视觉模拟量表。通过盆底窘迫量表和盆底影响问卷分别测量盆底功能障碍的严重程度和特定于疾病的生活质量。我们测量了效用评分与特定于疾病的生活质量评分之间的关系，并比较了 4 组女性的效用评分：（1）仅盆腔器官脱垂，（2）盆腔器官脱垂和压力性尿失禁，（3）盆腔器官脱垂和急迫性尿失禁，以及（4）盆腔器官脱垂、尿失禁和粪便失禁。
在纳入的 286 名女性中，有 191 名（67%）患有盆腔器官脱垂；平均年龄为 59 岁，73%为白种人。在患有脱垂的女性中，有 30 名（16%）还患有压力性尿失禁，39 名（20%）患有急迫性尿失禁，42 名（22%）患有粪便失禁。对于健康效用指数 Mark 3、EuroQol 和简短表格 6D，发现效用评分的模式在脱垂+尿失禁+粪便失禁组中最低（最差）（0.73-0.76），其次是脱垂+急迫性尿失禁组（0.77-0.85），而仅脱垂组的效用评分最高（最佳）（0.80-0.86）。除视觉模拟量表外，所有通用仪器的效用评分均与盆底窘迫量表和盆底影响问卷总分（r 值-0.26 至-0.57）以及脱垂、膀胱和肠亚量表（r 值-0.16 至-0.50）显著相关。除视觉模拟量表外，所有仪器的效用评分彼此高度相关（r=0.53-0.69，P<.0001）。
健康效用指数 Mark 3、EuroQol 和简短表格 6D，但不是视觉模拟量表，可提供盆腔器官脱垂和相关盆底功能障碍女性效用评分的有效测量，可用于成本效益研究。
