Abbreviated version of the Bladder Health Scales for women's research.

Abstract

The Bladder Health Scales (BHS) 10 and Bladder Function Index (BFI) were developed and validated to assess the distribution of bladder health from poor to optimal among community-dwelling women.^– The BHS-10 evaluates the impact of the bladder on various aspects of health and wellbeing including an adaptive behaviors adjustment (ABA) and the BFI measures 6 elements of bladder function. We aimed to identify a shorter version of the BHS to decrease participant burden yet provide meaningful assessments of bladder health for use in population-based longitudinal studies. A prospective observational study of a random sample of community-dwelling females in 57 counties surrounding 9 US research sites was conducted. Participants completed the BHS-10 with ABA and BFI at baseline and again 1 year later. Analytically, 4 criteria were used to identify candidate scales for the abbreviated instrument: (1) retention of psychometric properties relative to the original instrument validation using Cronbach’s Alpha and Factor Analysis, (2) responsiveness to change relative to changes in the Lower Urinary Research Network-Symptom Index 10 bother question and total BFI scores, (3) discriminative ability as measured by receiver operator curve area under the curve for a single item summary of “better” vs “worse or same” from a year ago, and (4) content validity assessed by experts confirming relevant scales for longitudinal assessments. Of the 3375 with baseline data, 2310 (68%) completed 1-year follow-up. Psychometric screening demonstrated retention of internal relationships; however, replication of factor analyses identified 3 scales (Social-occupation, Travel, and Emotional) with inconsistent factor loading relative to the original instrument validation (Table 1). Table 1 demonstrates the change scores for the remaining 7 scales compared against the change scores in the Lower Urinary Research Network-Symptom Index 10 bother (RSq=0.09) and change in total BFI (RSq=0.25) where the Global and Holding retained statistically significant (<i>P</i><.05) betas. The receiver operator curve area under the curve for each scale calculated against overall change in perceived bladder health from baseline (better vs worse/same) were all between 0.54 and 0.59 (Table 1). Linear regression results (Table 1) demonstrate that the difference in variance explained in the outcomes did not vary dramatically between the 2, 3, and 7 scale instruments. The final step in scale retention selection rested on evaluation of the content of the scales by clinical experts who identified the Global, Holding, and Efficacy scales as being most relevant for community surveillance studies. We present a systematically developed, valid, abbreviated version of the BHS (BHS-3) to be used along with the ABA and BFI for community-based epidemiological cross-sectional and longitudinal research in women. The BHS-3 is 68% shorter than the BHS-10 (from 38 to 12 individual questions) which should decrease the time for completion to 4 to 6 minutes. While researchers may prefer the BHS-10 to measure bladder health related to a wide range of day-to-day activities and emotional factors, others may prefer the BHS-3 with ABA as a meaningful surveillance tool to evaluate 3 core measures of bladder health along with the bladder function. These instruments are free for use without special permission.