Neurourology and Urodynamics 27:522–524 (2008)

The Chinese Version of ICIQ: A Useful Tool inClinical Practice and Research on Urinary Incontinence

Liang Huang,1 Song-wen Zhang,2 Shi-liang Wu,3 Le Ma,1 and Xiao-hong Deng1*1Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China

2Beijing Maternal and Child Health Care Hospital, Beijing, China3The First Hospital, Peking University, Beijing, China

Aims: In China, more and more research on the management of urinary incontinence (UI) is being conducted; arobust questionnaire to evaluate the symptoms and impact of UI will be very helpful. Thus, the Chinese version ofThe International Consultation on Incontinence Questionnaire (ICIQ) was developed. Methods: Initial translationand back translation of the ICIQ-UI short form, the ICIQ-FLUTS, the ICIQ-FLUTS long form, the ICIQ-LUTSqol,and the ICIQ-FLUTSsex were completed by native Chinese and English speaker, respectively. Then, thepsychometric properties of the Chinese version of the five ICIQ modules, including the content/face validity,internal consistency, and test–retest reliability were examined. Results: The back translation of the questionnaireswas consistent with the original English questionnaires. The Chinese version of the five ICIQ modules was easilycompleted, and the missing data were less than 2.5%. The Cornbach’s alpha coefficient was 0.71–0.96. In the test–retest, the agreement rate of the two tests exceeded 95% and the kappa values were 0.72–0.93 (P < 0.001).Conclusions: The Chinese version of the five ICIQ modules was easily understood, and had adequate internalconsistency and reliability. It can be used in the study of Chinese-speaking groups around the world. Neurourol.Urodynam. 27:522–524, 2008. � 2008 Wiley-Liss, Inc.

Key words: Chinese; ICIQ; translation; urinary incontinence; validation

INTRODUCTION

Urinary incontinence (UI), defined by the InternationalContinence Society (ICS) as the complaint of any involuntaryleakage of urine,1 is a common and distressing condition infemales. Although not life-threatening, the symptoms ofincontinence can be severely incapacitating, causing consid-erable impairment to various aspects of an individual’s lifeand ultimately reducing the quality of life (QOL). UI is one ofthe lower urinary tract symptoms (LUTS). In the clinicalpractice and epidemiologic research on UI, it has beenrecommended to include measures of QOL and LUTS otherthan UI.2 It was also recommended that epidemiologicinvestigation with validated questionnaires in developingcountries should be encouraged.2

An increasing number of Chinese women complainabout their symptoms of UI, and are not satisfied thattheir QOL is diminished by UI. Many Chinese physiciansand scientists are conducting research on the treatmentof UI, and need a tool to evaluate the symptoms andimpact of UI. A validated questionnaire will be veryhelpful in evaluating UI. There have been few epidemiologicinvestigations using a validated questionnaire in China. Aninternational used questionnaire would facilitate the com-parison of the epidemiologic findings from China with othercountries.

The International Consultation on Incontinence Question-naire (ICIQ) was developed as a universally applicable ques-tionnaire across international populations and has beentranslated into many languages for local use.3 The ICIQincludes different modules aimed at evaluating differentaspects of the symptoms and impact of LUTS. Since thereis no official Chinese version of the ICIQ, we decided todevelop the Chinese version of the ICIQ, aimed to supply auseful tool to researchers and physicians in Chinese-speakingarea.

MATERIALS AND METHODS

From all the ICIQ modules, we chose five modules todevelop the Chinese version: the ICIQ-UI short form, the ICIQ-FLUTS, the ICIQ-FLUTS long form, the ICIQ-LUTSqol, and theICIQ-FLUTSsex. The ICIQ-UI short form, the ICIQ-FLUTS, and theICIQ-FLUTS long form address the symptoms of LUTS. The ICIQ-UI short form includes four items: incontinence frequency,amount and impact of incontinence alone, and a self-diagnostic item to indicate the perceived cause of incon-tinence. The ICIQ score, derived from the ICIQ-UI short form, isthe sum of the scores from incontinence frequency, and theamount and impact of incontinence. The ICIQ-FLUTS is basedon the BFLUTS short form and encompasses wider urologicsymptoms and the perceived impact of these symptoms. The Fscore, V score, and I score are derived from the ICIQ-FLUTS,respectively, indicating the storage symptoms, voiding symp-toms, and incontinence symptoms. Thus, the ICIQ-UI shortform and the ICIQ-FLUTS can be used to evaluate thesymptoms of UI and LUTS in a quantitative form.45 TheICIQ-FLUTS long form is based on the BFLUTS and encompasseswider urologic symptoms and the impact of the symptoms.6

The ICIQ-FLUTS long form does not score all the items, so it issuitable for an epidemiologic survey. The ICIQ-LUTSqol isbased on the King’s Health Questionnaire,7 and is designed toevaluate the QOL specific to the LUTS. The main consequence

No conflict of interest reported by the author(s).Linda Brubaker led the review process.All work was performed in the Beijing Obstetrics and Gynecology Hospital.*Correspondence to: Xiao-hong Deng, Beijing Obstetrics and GynecologyHospital, Capital Medical University, Yao Jia Yuan Road 251, Chaoyang District,Beijing 100026, China. E-mail: xhdeng@bjhb.gov.cnReceived 28 July 2007; Accepted 25 October 2007Published online 19 March 2008 in Wiley InterScience(www.interscience.wiley.com)DOI 10.1002/nau.20546

� 2008 Wiley-Liss, Inc.

of UI is the decrease in the levels of QOL. Thus, the evaluationof the QOL is very important, and the numerical value of QOLcan be used to compare prior treatment and post-treatment.The ICIQ-FLUTSsex is also based on the BFLUTS, and focuses onsex life as a function of LUTS. It includes four items that are notparticularly embarrassing to Chinese females and should beencouraged to be used in evaluation of the impact of UI.

The original English questionnaire was supplied by NikkiGardener, a member of the ICIQ Advisory Board. The develop-ment of the Chinese version of the ICIQ was done according tothe validation protocol on the ICIQ website (www.iciq.net). Wehave completed the translation and primary tests. The trans-lation process involved the following steps:

1. The initial translation of the five modules was undertakenby a bilingual native Chinese speaker and was translatedinto Mandarin, which is the official Chinese languageand can be understood by most Chinese people. In theprocess of translation, the translator adapted the question-naires to the cultural context and lifestyle of China. Aftertranslation, two urologists and two gynecologists correctedthe questionnaires.

2. Back translation from Chinese into English was carried outby a native English speaker who was fluent in Chinese.

3. After the back translation was reviewed by the ICIQ group,we adjusted the Chinese questionnaires according to theirsuggestion.

4. Pre-testing for equivalence was accomplished by inter-viewing with 10 patients in the Beijing Obstetrics andGynecology Hospital. Two experts interviewed 10 patientsin a consultation room individually and completed thequestionnaires. The 10 patients came from differentsocioeconomic backgrounds and with different types anddegrees of UI. The two experts and 10 patients all thoughtthe questionnaires were intelligible.

The primary tests included an assessment of the content/face validity, internal consistency, and test–retest reliabilityof the five modules. Sixty-one patients (43 females and18 males) with LUTS joined in the primary test (Table I). Theyall completed the ICIQ-LUTSqol, and the 43 females alsocompleted the ICIQ-FLUTS, the ICIQ-FLUTS long form, and theICIQ-FLUTSsex. Among the 61 patients, 42 patients (33 femalesand 9 males) with UI also completed the ICIQ-UI shortform. Two weeks later, all the patients completed the samequestionnaires again. All the patients had LUTS beyond3 months and all the questionnaires were self-administered.Then, the following three aspects of the questionnairepsychometric properties were assessed:

1. Content/face validity is the assessment of whether thequestionnaire makes sense to those being measured and toexperts in the clinical area. The levels of missing data wereused as an indicator of inappropriate or badly wordedquestions.

2. Internal consistency refers to the extent to whichitems within the questionnaire are related to each other.Internal consistency was assessed by Cronbach’s alphacoefficient.

3. Test–retest reliability is important for questionnaire, andindicates whether the questionnaire measures the samesorts of things in the same person over a period of time.Test–retest reliability was assessed by a 2 week test–retestanalysis, agreement between test and retest were analyzedby the weighted kappa statistic.

RESULTS

Below are the results for the three aspects of the five ICIQmodules’ psychometric properties. Because all the items of thefive modules were so exhaustive, we only listed the range ofsome results:

1. Content/face validity: Missing data were less than 2.0% forall items in the five modules, indicating that all items werewell interpreted.

2. Internal consistency: The Cronbach’s alpha coefficient ofthe five modules were 0.71 (ICIQ-UI short form), 0.95 (ICIQ-FLUTS), 0.95 (ICIQ-FLUTS long form), 0.96 (ICIQ-LUTSqol),and 0.86 (ICIQ-FLUTSsex). All the Cronbach’s alpha coef-ficient exceeded 0.70, indicating adequate internal consis-tency.

3. Test–retest reliability: All the items of the five modulesdemonstrated excellent test–retest reliability for the agree-ment rate of the two tests exceeds 96%. After statisticalanalysis, the kappa values were 0.72–0.93 (P < 0.001),indicating adequate test–retest reliability.

DISCUSSION

Many Chinese physicians are conducting research on themanagement of UI; an increasing number of people cannottolerate the effects of UI. A validated questionnaire to evaluatethe symptoms and impact of UI will be very helpful toresearch on the management of UI. There have been fewepidemiologic surveys of UI in China, especially using avalidated questionnaire. The epidemiologic surveys on UI areabundant in developed countries, but the reported prevalenceof UI varies.8 This variation is thought to be partially due tothe use of different questionnaires. The ICIQ was developed fora universally applicable questionnaire across internationalpopulations, and based on the past questionnaires that hadbeen used extensively.3 The ICIQ has been translated intomany languages for local use and facilitates the comparison ofepidemiologic results among different countries. The ICIQ canalso be used in clinical practice and research. It can be used toevaluate the symptoms and impact of UI and LUTS in aquantitative form. So, the numerical value of the question-naire can be used to compare between prior treatment andpost-treatment. Consequently, the Chinese version of the

Neurourology and Urodynamics DOI 10.1002/nau

TABLE I. The Total Number, Sample Source, and Mean Age of the Patients for Each Module of the Validation Process

Modules Sample source N Male Female Mean age (range)

ICIQ-UI short form Patients with UI 42 9 33 53.5 (33–73)

ICIQ-FLUTS Patients with LUTS 43 0 43 52.8 (35–73)

ICIQ-FLUTS long form Patients with LUTS 43 0 43 52.8 (35–73)

ICIQ-LUTSqol Patients with LUTS 61 18 43 49.0 (30–73)

ICIQ-FLUTSsex Patients with LUTS 43 0 43 52.8 (35–73)

The Chinese Version of ICIQ 523

ICIQ should be encouraged to be used in a Chinese-speakingarea.

Further research is also required to explore the psychometricproperties of the Chinese version of the five ICIQ modules. Weonly completed the translation and primary test because wewanted to put the five modules into use early. The constructvalidity, criterion validity, and responsiveness of the Chineseversion of the five ICIQ modules should be undertaken in thefuture. The validation study of the five Chinese versions shouldbe applied to more samples, especially the community-basedsample. Furthermore, the validation study of the five Chineseversions should be used in other Chinese-speaking areas,especially in Taiwan and Hong Kong.

Development of the ICIQ to Chinese will enable cross-cul-tural comparisons to be made and allow a standard measureto be used to aggregate date from different cultures. In China,with a population of 1.3 billion, the Chinese version of the ICIQwill facilitate research and clinical practice on UI.

CONCLUSIONS

The Chinese version of ICIQ is consistent with the Englishversion and has an adequate content/face validity, internalconsistency, and test–retest reliability. It is a useful tool inclinical practice and research on UI and enables a moreconsistent and unified approach to the assessment of UI andits impact on peoples’ lives. Anyone who wants access to the

Chinese version of ICIQ should contact Professor Xiao-hongDeng.

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Neurourology and Urodynamics DOI 10.1002/nau

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