Abstract
BackgroundUrinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities for adult patients with suspected urinary tract infection in primary care; or, in the absence of such a PROM, to test items identified from existing PROMs for coverage and relevance in single and group interviews and to psychometrically validate the resulting PROM.MethodsThe literature was searched for existing PROMs covering the three domains. Items from the identified PROMs were tested in single and group interviews. The resulting symptom diary was psychometrically validated using the partial credit Rasch model for polytomous items in a cohort of 451 women participating in two studies regarding UTI.ResultsNo existing PROM fulfilled the inclusion criteria. Content validation resulted in one domain concerning symptom severity (18 items), one concerning bothersomeness (18 items), and one concerning impact on daily activities (7 items). Psychometrical validation resulted in four dimensions in each of the first two domains and one dimension in the third domain.ConclusionsDomains were not unidimensional, which meant that we identified dimensions of patient-experienced UTI that differed substantially from those previously found. We recommend that future studies on UTI, in which PROMs are to be used, should ensure high content validity of their outcome measures and unidimensionality of the included dimensions.
Highlights
Urinary tract infection (UTI) is a common condition in primary care
If the Patient-reported outcome measure (PROM) encompasses domains of items, these should be psychometrically validated in a larger sample of the target population using item response theory (IRT) models to ensure unidimensionality of the domains allowing for sum scores [11]
The aims of this study were to 1) Perform a literature search to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities over time for adult patients with uncomplicated and complicated UTI in primary care; or 2) in the absence of such a PROM, to test items identified from existing PROMs for relevance in single and group interviews with patients who had experienced UTI; and 3) to psychometrically validate the resulting PROM using Rasch models
Summary
Urinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities for adult patients with suspected urinary tract infection in primary care; or, in the absence of such a PROM, to test items identified from existing PROMs for coverage and relevance in single and group interviews and to psychometrically validate the resulting PROM. Urinary tract infection (UTI) is a common condition and accounts for about 2% of consultations in general practice in Denmark [1] It mainly affects women, one in every two women experiences a UTI at least once in her life-time [2]. Patient-reported outcome measures (PROMs) are important both for the evaluation of the extent to which an intervention can improve the diagnosis and treatment of UTI, and for following the patient’s experience of symptoms and recovery. A number of PROMs exist, but to our knowledge none of them have been tested for both content validity and unidimensionality of domains using IRT models [6, 17,18,19]
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