Abstract
Objective
To assess the validity and reliability of the Turkish version of the King’s Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS).
Material and methods
Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS.
Results
Both the internal consistency (Cronbach’s alpha coefficient: 0.68–0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69–0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34<r<0.76, p<0.05) were found. The comparison of patients with SCI and patients with MS in terms of KHQ revealed that patients with SCI had significantly higher scores in some of the subscales of KHQ (p<0.05). These higher scores represented the worst health state, and the uppermost limit was determined as 100 points.
Conclusion
The KHQ scale is an internally consistent, reliable, and valid scale for people with SCI. In addition, bladder-related quality of life was poorer in patients with SCI than in MS patients.
Keywords: Bladder problems, King’s Health Questionnaire, reliability, spinal cord injury, validity
Introduction
Individuals with spinal cord injuries (SCIs) experience considerable physical and psychological changes, which may affect their quality of life.[1] One of the frequently encountered physical changes among patients with SCI is urinary problems.[2] There are different types of neurogenic bladder dysfunction according to the involvement of different neurological levels in people with SCI. There are three main types of neurogenic bladder dysfunction in SCI: (1) failure to store urine from a hyperreflexic detrusor or a decrease in sphincter resistance, (2) failure to empty urine from an areflexive bladder or an increase in sphincter resistance, and (3) detrusor sphincter dyssinergia. As a result, voiding dysfunction is associated with an increase in the number of complications. The major cause of complications is frequent urinary tract infections (UTIs). UTIs increase the risk of autonomic dysreflexia, spasticity and the need for hospitalization.[3] Neurogenic bladder dysfunction also causes poor quality of life due to embarrassment and reluctance to socialize.[3] This causes greater risk of depression in patients with SCI.[1] Urological problems created by neurogenic bladder may contribute to the development of renal disease, which has been identified as a risk factor for mortality among patients with SCI.[4]
Similar to SCI, urinary tract dysfunction is also common during the course of multiple sclerosis (MS). It has been reported that 50–90% of patients with MS have urinary problems.[5] A systematic review reported that the most common urodynamic findings in MS are neurogenic detrusor overactivity and detrusor-sphincter dyssynergia (DSD).[6] In contrast to SCI, DSD is rarely associated with upper urinary deterioration in patients with MS.[1] It has been found that patients with MS have poorly sustained detrusor contractions and a lesser degree of DSD.[7]
Although life expectancy has improved due to advances in medical care[7], urinary disorders have a significantly negative impact on the quality of life in both SCI and MS patients.[8,9] Urinary problems affect the patient on a psychological, occupational, physical and sexual level and become the most socially debilitating and embarrassing aspect of the disease. Therefore, it was important to investigate urinary problems using scales specific to those problems when diagnosing bladder disorders and initiating treatment in neurological diseases.
In a study by Krause and Kjorsvig, quality of life was found to be a good predictor of survival 15 years after an injury, which made it imperative to investigate the quality of life among patients with SCI.[10] It has been reported that bladder problems often cause a lower quality of life in patients with SCI.[11] Urinary disorders affect both patients with SCI and MS but there is evidence to indicate that it is less of a problem for patients with MS.[12] To our knowledge, there are few studies comparing disease-specific quality of life in relation to urinary problems in patients with SCI and MS.[12,13]
It is a necessity to have a reliable questionnaire in the Turkish population because of a high prevalence of SCI and MS. It has been reported that 1.69/100,000 individuals are diagnosed with SCI annually and that the prevalence of MS is 51/100,000 in Turkey.[14,15]
One of the most common quality of life measures for urinary dysfunction is the King’s Health Questionnaire (KHQ).[16] One reason for adapting the King’s Health Questionnaire in Turkish for SCI patients is its shortness and ease to complete. More importantly, the KHQ is designed to sensitively measure the effects of the symptoms of urinary incontinence on the quality of life, and it can be used to grade the improvement after treatment.[17] In addition, the KHQ is one of the most valid and widely used questionnaires that target the quality of life in patients with urinary incontinence (Crohnbach’s alpha 0.76–0.89; ICC 0.80–0.96). It has also been translated into many languages with great success.[18] Australian English, German, American English, Portuguese and Japanese versions exceeded the 0.60 criteria for Cronbach’s alpha on all domains in KHQ.[19–21]
The validity and reliability of the KHQ in various languages has been demonstrated, and it is frequently used in determining the effects of both overactive bladder (urge incontinence) and stress incontinence on one’s quality of life.[19–21] In addition, the KHQ is often used in determining urinary problems in people with SCI.[22,23] Although the Turkish version of the questionnaire has been shown to be reliable and valid in people with MS,[24] its validity and reliability have not been reported yet for patients with SCI. For this reason, the primary aim of this study was to assess the validity and reliability of the Turkish version of the KHQ among patients with SCI. The secondary aim of our study was to compare the KHQ scores of patients with SCI and MS.
Material and methods
Participants
With the approval of the Ethics Committee of Ege University School of Medicine (dated 24.05.2010, number: 10–4/11), 35 patients with SCI and 57 patients with MS were included in the study. We evaluated all of these patients in the Physical Medicine and Rehabilitation department in our medical school. The inclusion criteria were as follows: the ability to read or speak Turkish; presence of a time interval of at least 6 months between the onset of lower urinary tract symptoms diagnosis of MS or SCI; definite presence of MS[24] (according to Poser criteria) or traumatic SCI. The exclusion criteria for people with SCI and MS included presence of a concomitant neurological illness, unstable urinary disorder, urinary disorders unrelated to MS or SCI, and difficulty answering the questionnaire because of language or cognitive limitations. All patients with SCI and MS completed the KHQ scale. All of the patients were given necessary informations about the study and before the patients completed the consent forms.
Translation
The KHQ was translated into Turkish by three Turkish physical medicine and rehabilitation doctors proficient in English. They met to determine the translation that best reflected the meaning of the English items. English back-translations from Turkish were performed separately by two official linguists who were uninformed regarding the original version (a native English speaker who also speaks Turkish and a teacher of English literature who lived in England for 15 years). Finally, all five gathered to discuss and decide on the translations. The final version was compared with the original English version; both appeared to be equivalent. The questionnaire was applied to a limited number of patients (n=10) as a pilot study, and required no further revisions. In our former study we administered the Turkish version of the KHQ to 37 patients with MS, after learning that the Turkish version of the KHQ was valid and reliable for patients with MS.[24]
Demographic (age, gender) and clinical (neurological level; complete or incomplete injury) data were recorded from patient files and in face-to-face interviews during the first visit.
Thirty-five patients completed the KHQ, the Short Form 36 (SF-36) and the Qualiveen scale during their first examination after we obtained their informed consent.
Intra-rater reliability
Intra-rater reliability was assessed through a comparison of KHQ scores obtained one week apart. A time interval of one week was chosen to reduce the likelihood that participants would remember their initial responses, yet it would be close enough in time to the original assessment to maximize stability of bladder function between assessments.
Construct validity
Construct validity of the KHQ was assessed via comparison of scores for two measures: the SF-36 (a general measure of perceived health and health related quality of life), and the Qualiveen (a measure specific to urinary function). A greater correlation with the Qualiveen relative to the SF-36 was expected and interpreted as an indication that the KHQ measures construct were relevant to urinary function.
Outcome measures
The measures used for patient evaluation were as follows:
The King’s Health Questionnaire (KHQ)
The KHQ is comprised of 21 questions divided into eight categories including: general health perception (one item), incontinence impact (one item), role limitations (two items), physical limitations (two items), social limitations (two items), personal relationships (three items), emotions (three items), and sleep/energy (two items). Furthermore, it has two independent scales as urinary symptoms and symptom severity. The scale has four options, which are as follows: “not at all”, “a little”, “moderately” and “a lot”; or “never”, “sometimes”, “often” and “always”. The exceptions were the domain general health perception with five choices (“very good”, “good”, “fair”, “bad” and “very bad”) and domain personal relationships (“not applicable”, “not at all”, “a little”, “moderately” and “a lot”). In the KHQ, a minimum possible score of zero was assigned to the best health and a maximum possible score of 100 was assigned to the worst health. The 0–100 scale was used for each item and each subscale separately.[25,26]
MOS of the 36-Item Short-Form Health Survey (SF-36)
The SF-36 is one of the most widely used scales for evaluating quality of life. It is a set of general and comprehensible quality-of-life measures containing eight categories. These categories include ten items related to physical functioning, 4 items for role limitations caused by physical health problems, 2 items for bodily pain, 5 for general health perception, 4 for vitality, 2 for social functioning, 3 for role limitations due to emotional problems and 5 for mental health. Each category provides a score ranging from zero (poor health) to 100 (perfect health).[27,28]
Qualiveen scale
The Qualiveen is divided into two major sections: Specific Impact of Urinary Problems on Quality of Life (SIUP) and General Quality of Life (GQoL). The first part, specific to urinary problems, is divided into four categories: inconvenience, restrictions, fears, and impact on daily life, with a total of 30 questions (9, 8, 8, and 5 questions, respectively). Response options are framed as 5-point Likert-type scales with ‘0’ indicating no impact of urinary problems on HRQL and ‘4’ indicating a high adverse impact of urinary difficulties on HRQL. The average for each category is calculated and used to reach the final SIUP score (average of all categories), also ranging from ‘0’ to ‘4’, with ‘4’ being the greatest negative impact. The second section, GQoL, has nine questions, also with a five-category ordinal Likert scale, ranging from very badly to very well, with values ranging from −2 to +2, respectively. The final general QoL value is calculated as the average of the nine questions, which also range from −2 to +2.[29]
Statistical analysis
Data were entered into the Statistical Package for the Social Sciences (SPSS Inc.; Chicago, IL, USA), version 16.0. Descriptive statistics were used to characterize the sample.
Cronbach’s alpha coefficient was used to determine the internal consistency of the scales. Test-retest reliability was evaluated by use of intraclass correlation (ICC). For comparison among KHQ, Qualiveen and SF-36 results, the Pearson’s correlation coefficient was utilized. Correlations from 0 to 0.25 indicate little or no relationship, those from 0.25 to 0.50 a fair degree of relationship, those from 0.50 to 0.75 a good relationship and those greater than 0.75 indicate a very good to excellent relationship. In addition, the Mann-Whitney U test was used to compare groups. A p-value below 0.05 was considered statistically significant.
Results
The demographic and clinical characteristics of both groups of patients with either SCI or MS are shown in Table 1. As indicated, patients with SCI were significantly younger than patients with MS (p<0.05). There were no statistical differences in the other demographic and clinical data between the patient groups (p>0.05).
Table 1.
Demographic and clinical data of MS and SCI patients
| MS patients (n=57) | SCI patients (n=35) | |
|---|---|---|
| Age (mean±SD, years) | 41.8±13.28 | 34.4±10.92* |
| Gender (n, male/female) | 47/10 | 9/26 |
| Type of MS (relapsing, remitting n, (%) | 39/69.6 | |
| Disease duration (mean±SD, year) | 9.3±6.03 | 3.9±5.89 |
| EDSS score (mean±SD) | 3.4±1.88 | |
| EDSS bladder score (mean±SD) | 1.8±1.28 | |
| Severity of injury (n) | ||
| Complete | 20 | |
| Incomplete | 15 | |
| Neurological level (n) | ||
| Cervical | 6 | |
| Thoracic | 22 | |
| Lumbar | 7 | |
p<0.05,
EDSS: Expanded Disability Status ScaleMS: multiple sclerosis; SCI: spinal cord injury
Both internal consistency (Crohnbach’s alpha score: 0.68–0. 93) and test-retest reliability (intraclass correlation coefficient: 0.69–0.94) of the KHQ were found to be high (Table 2). Intraclass correlation coefficients for most subscales of KHQ exceeded 0.84 with the exception of the subscales for incontinence impact (intraclass correlation coefficient: 0.69) and personal relations (intraclass correlation coefficient: 0.79) (Table 2).
Table 2.
Test-retest reliability and internal consistency (Crohnbach’s alpha) of the Turkish version of the King’s Health Questionnaire
| KHQ | ICC (95% CI) | Cronbach’s alpha |
|---|---|---|
| General health perception | 0.88 (0.77–0.94) | 0.89 |
| Incontinence impact | 0.69 (0.37–0.84) | 0.68 |
| Role limitations | 0.84 (0.68–0.92) | 0.84 |
| Physical limitations | 0.88 (0.77–0.94) | 0.88 |
| Social limitations | 0.94 (0.86–0.97) | 0.93 |
| Personal relations | 0.79 (0.22–0.92) | 0.75 |
| Emotional problems | 0.86 (0.67–0.92) | 0.85 |
| Sleep and energy disturbances | 0.90 (0.71–0.95) | 0.90 |
| Urinary symptoms | 0.91 (0.82–0.95) | 0.91 |
| Symptom severity | 0.93 (0.86–0.96) | 0.93 |
KHQ: King’s Health Questionnaire; ICC: Intraclass correlation coefficient, CI: confidence interval
A weak correlation was found between the subscores of the KHQ scale and the subscores of the SF-36 questionnaire (p<0.05) (Table 3), whereas a significant correlation was found between the KHQ sub-scales and the majority of the sub-scores of the Qualiveen scale (p<0.05) (Table 4).
Table 3.
Content validity: The correlations (r, Pearson’s correlation coefficient) between the Turkish version of the King’s Health Questionnaire and SF-36 Health Survey
| KHQ | SF-36 Scale | |||||||
|---|---|---|---|---|---|---|---|---|
| Physical functioning | Role limitation due to physical problems | Bodily pain | General health | Energy/Fatigue | Social functioning | Emotional well-being | Mental health | |
| General health perception | −0.26 | −0.47* | −0.44* | −0.47* | 0.08 | −0.48* | −0.12 | −0.06 |
| Incontinence impact | 0.65 | −0.30 | −0.25 | −0.52* | 0.04 | −0.39* | −0.29 | −0.10 |
| Role limitations | −0.13 | −0.38* | −0.42* | −0.34 | 0.01 | −0.21* | −0.29 | 0.08 |
| Physical limitations | −0.15 | −0.40 | −0.31 | −0.45 | −0.51 | −0.33 | −0.36 | −0.22 |
| Social limitations | −0.21 | −0.39 | −0.28 | −0.46 | 0.04 | −0.49* | −0.32 | −0.12 |
| Personal relations | −0.23 | −0.23 | −0.59* | −0.04 | 0.02 | −0.32 | 0.49* | 0.10 |
| Emotional problems | −0.14 | −0.20 | −0.25 | −0.38* | −0.16 | −0.24 | −0.20 | −0.16 |
| Sleep and energy disturbances | 0.00 | −0.29 | −0.25 | −0.36 | −0.16 | −0.32 | −0.24 | −0.21 |
| Urinary symptoms | −0.17 | −0.32 | −0.42* | −0.26 | −0.19 | −0.54* | −0.03 | −0.11 |
| Symptom severity | 0.09 | −0.25 | −0.25 | −0.190 | 0.01 | −0.35* | −0.09 | −0.08 |
p<0.05.
KHQ: Kings Health Questionnaire; SF-36: Short Form 36
Table 4.
Content validity: The correlations (r, Pearson’s correlation coefficient) between the Turkish version of the King’s Health Questionnaire and the Qualiveen Questionnaire
| KHQ | The Qualiveen Questionnaire | |||||
|---|---|---|---|---|---|---|
| Inconvenience | Restrictions | Fears | Impact of daily life | SIUP index | General quality of life | |
| General health perception | 0.54** | 0.57** | 0.49** | 0.59** | 0.64** | −0.64** |
| Incontinence impact | 0.52** | 0.38* | 0.44* | 0.50** | 0.572** | −0.57** |
| Role limitations | 0.40* | 0.49** | 0.46** | 0.34* | 0.54** | −0.58** |
| Physical limitations | 0.45** | 0.42* | 0.45* | 0.34* | 0.51* | −0.60** |
| Social limitations | 0.39* | 0.62** | 0.40* | 0.46** | 0.57** | −0.76** |
| Personal relations | 0.45 | 0.55* | 0.57* | 0.55* | 0.61* | −0.75** |
| Emotional problems | 0.57** | 0.39* | 0.42* | 0.50** | 0.61** | −0.65** |
| Sleep and energy disturbances | 0.65** | 0.35* | 0.61** | 0.52** | 0.66** | −0.60** |
| Urinary symptoms | 0.39* | 0.36* | 0.34* | 0.31 | 0.47** | −0.34* |
| Symptom severity | 0.40* | 0.15 | 0.51** | 0.34* | 0.42* | −0.34* |
p<0.05,
p<0.01.
KHQ: Kings Health Questionnaire
The comparison KHQs of patients with SCI and patients with MS revealed that patients with SCI had significantly high scores in some of the subgroups of KHQ (incontinence impact, social limitations, emotional problems, incontinence severity measures, and symptom severity) (Table 5, p>0.05).
Table 5.
Comparison of SCI and MS Patients Based on King’s Health Questionnaire
| KHQ (Mean±SD) | MS (n=57) | SCI (n=35) |
|---|---|---|
| General health perception | 48.3±21.1 | 45.1±23.3 |
| Incontinence impact | 43.6±39.3 | 78.1±26.8* |
| Role limitations | 43.6±39.3 | 60.5±35.0 |
| Physical limitations | 49.2±38.4 | 63.2±35.01 |
| Social limitations | 25.1±27.7 | 62.4±34.0* |
| Personal relations | 24.3±24.5 | 46.1±35.6 |
| Emotional problems | 37.0±34.0 | 56.5±32.2* |
| Sleep and energy disturbances | 34.8±35.4 | 39.5±27.4 |
| Urinary symptoms | 35.9±27.9 | 57.51±28.16* |
| Symptom severity | 12.0±18.0 | 41.5±27.5* |
p<0.05.
KHQ: Kings Health Questionnaire; MS: multiple sclerosis; SCI: spinal cord injury; SD: standard deviation
Discussion
In our study, we concluded that the KHQ scale was an internally consistent and valid questionnaire for patients with SCI. Additionally; it was observed in our study that bladder-related quality of life was poorer in patients with SCI than in patients with MS.
Whilst developing the KHQ, Kelleher et al.[26] have demonstrated internal consistency (Cronbach’s alpha) ranging from 0.725 to 0.892 across all categories of this instrument among women with urinary incontinence. Similar to the original study, internal consistency in other studies was observed to be >0.60 in patients with overactive bladder/stress incontinence.[18,19,30] In one study where only people with SCIs were included, the Cronbach’s alpha score was found to demonstrate good internal consistency (0.91).[30] In parallel with other studies we found that ICC’s for most subscales of KHQ exceeded 0.84 with the exception of the subscales for incontinence impact (0.69) and personal relations (0.79). The reason for that was the quality of life in patients with SCI was disturbed in all aspects including sexual life, family life, etc and therefore the bladder problem was not their only problem affecting their quality of life.
In the original study, we found a weak correlation between KHQ and SF-36 (0.34–0.65) and they were close to the range of correlations found in the present study.[30] The KHQ correlated weakly or strongly (r=0.01–0.73) with the SF-36 when conducted in patients experiencing stress incontinence.[18,19,30] To assess the validity of the KHQ in our study, we investigated the relationship between the KHQ and the general quality of life questionnaire (SF-36), together with the Qualiveen questionnaire, which is a quality of life survey that focuses on problems of the urinary system. Its validity and reliability had been demonstrated in patients with MS.[30] Our study revealed that the correlation between the KHQ and the SF-36 was quite low, whereas the Turkish KHQ correlated fairly strongly with the Qualiveen questionnaire, which is a urinary system-related questionnaire. We believe that this situation indicates that urinary incontinence is a specific problem that might be missed by a general health questionnaire; because general health questionnaires do not contain bladder-related questions. Although the SF-36 provides a reliable assessment of one’s general quality of life, it does not focus on urinary symptoms, and lacks the means to measure them. The KHQ, on the other hand, is a condition-specific quality of life measurement that assesses the unique impact of health-related quality of life associated with urinary problems.[1] In fact, Reese and colleagues found a strong correlation between KHQ and the efficacy measures (urinary incontinence episodes, urgency, and bladder conditions), but they also found a weaker correlation between SF-36 and the efficacy measures.[19] Moreover, some studies demonstrated that KHQ was more responsive to changes from pre to post-treatment than the SF-36.[17,18]
In our clinical practice, patients with MS are not concerned with bladder problems because these patients are more mobile than patients with SCI. Therefore, it is difficult to persuade patients with MS to use bladder emptying methods (such as clean intermittent catheterization). In contrast to this, patients with SCI are more compliant with clean intermittent catherization because they are less mobile than patients with MS. Therefore, our aim was to compare the bladder-related quality of life parametres between patients with MS and SCI. In our study, comparison of patients with SCI to patients with MS in terms of the KHQ showed that the KHQ scores of patients with SCI were worse than those of the patients with MS. The reason for this was that the patients of both groups showed different characteristics. In the SCI group, patients were younger and disability often continued lifelong. On the other hand, the majority of the patients in the MS group encountered differing degrees of disability during relapses, and when these relapses disappeared, the mobility was improved but neurogenic bladder complaints may have continued even though the relapses disappeared. In this respect it was appropriate to assess both of these diseases based on the KHQ, which was found to be a valid and reliable questionnaire to assess quality of life of the patients.
The weakness of our study was that the generalization of these results may have been limited and may not reflect a naturalistic setting. The sample was predominantly male, limiting a generalization to females. Another limitation of our study was that the SCI people were not analyzed according to the urodynamic findings. Information on urodynamic findings would have provided an objective measure of bladder dysfunction severity, and these findings could then have been compared between patients with MS and SCI (to verify that people with SCI had a worse functional state) and could have been correlated with the quality of life scores, with the expectation that worse urodynamic findings would have been detected in these patients. The KHQ is mainly used in female patients with urinary incontinence. In our study most patients were male.
More data from other populations of males with neurological disorders is needed, as a result, we have determined that the Turkish version of the KHQ is a reliable and valid questionnaire for patients with SCIs. We have also concluded that the KHQ can be used in our country to determine the effects of urinary incontinence on the quality of life among SCI patients. It is recommended that future studies will show the sensitivity of the KHQ for bladder rehabilitation programs conducted among patients with SCI.
King’s Yaşam KalitesiAnketi
Footnotes
You can reach the questionnaire of this article at https://doi.org/10.5152/tud.2018.45556
Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committee of Ege University School of Medicine (dated 24.05.2010, number: 10-4/11).
Informed Consent: Written informed consent was obtained from patients who participated in this study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept - Y.A., H.K.; Supervision - Y.A., H.K., S.E.; Literature Search - Y.A., H.K., S.E., G.T.; Writing Manuscript - H.K., Y.A., G.T.; Critical Review - Y.A., H.K., S.E., G.T.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study has received no financial support.
References
- 1.Ku JH. The management of neurogenic bladder quality of life in spinal cord injury. BJU Int. 2006;98:739–45. doi: 10.1111/j.1464-410X.2006.06395.x. [DOI] [PubMed] [Google Scholar]
- 2.Hicken BL, Putzke JD, Richards JS. Bladder management and quality of life after spinal cord injury. Am J Phys Med Rehabil. 2001;80:916–22. doi: 10.1097/00002060-200112000-00008. [DOI] [PubMed] [Google Scholar]
- 3.Cardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil. 2004;85:1757–63. doi: 10.1016/j.apmr.2004.03.016. [DOI] [PubMed] [Google Scholar]
- 4.Fonte N. Urological care of the spinal cord-injured patient. J Wound Ostomy Continence Nurs. 2008;35:323–31. doi: 10.1097/01.WON.0000319132.29478.17. [DOI] [PubMed] [Google Scholar]
- 5.Cao Y, Selassie AW, Krause JS. Risk of death after hospital discharge with traumatic spinal cord injury: a population-based analysis, 1998–2009. Arch Phys Med Rehabil. 2013;94:1054–61. doi: 10.1016/j.apmr.2013.01.022. [DOI] [PubMed] [Google Scholar]
- 6.Giannantoni A, Scivoletto G, Di Stasi SM, Grasso MG, Vespasiani G, Castellano V. Urological dysfunctions and upper urinary tract involvement in multiple sclerosis patients. Neurourol Urodyn. 1998;17:89–98. doi: 10.1002/(sici)1520-6777(1998)17:2<89::aid-nau2>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
- 7.Çetinel B, Tarcan T, Demirkesen O, Özyurt C, Şen İ, Erdoğan S, Siva A. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourol Urodyn. 2013;32:1047–57. doi: 10.1002/nau.22374. [DOI] [PubMed] [Google Scholar]
- 8.Gonor SE, Carroll DJ, Metcalfe JB. Vesical dysfunction in multiple sclerosis. Urology. 1985;25:429–31. doi: 10.1016/0090-4295(85)90508-4. [DOI] [PubMed] [Google Scholar]
- 9.D’Ancona CA, Tamanini JT, Botega N, Lavoura N, Ferreira R, Leitão V, et al. Quality of life of neurogenic patients: translation and validation of the Portuguese version of Qualiveen. Int Urol Nephrol. 2009;41:29–33. doi: 10.1007/s11255-008-9402-3. [DOI] [PubMed] [Google Scholar]
- 10.Krause JS, Kjorsvig JM. Mortality after spinal cord injury: A four-year prospective study. Arch Phys Med Rehabil. 1992;73:558–63. [PubMed] [Google Scholar]
- 11.Brillhart B. Studying the quality of life and life satisfaction among persons with spinal cord injury undergoing urinary management. Rehabil Nurs. 2004;29:122–6. doi: 10.1002/j.2048-7940.2004.tb00328.x. [DOI] [PubMed] [Google Scholar]
- 12.Tapia CI, Khalaf K, Berenson K, Globe D, Chancellor M, Carr LK. Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review. Health Qual Life Outcomes. 2013;11:13. doi: 10.1186/1477-7525-11-13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Khan F, Pallant JF, Shea TL, Whishaw M. Multiple sclerosis: prevalence and factors impacting bladder and bowel function in an Australian community cohort. Disabil Rehabil. 2009;31:1567–76. doi: 10.1080/09638280802639566. [DOI] [PubMed] [Google Scholar]
- 14.Karamehmetoğlu SS, Nas K, Karacan I, Sarac AJ, Koyuncu H, Ataoglu S, et al. Traumatic spinal cord injuries in southeast Turkey: an epidemiological study. Spinal Cord. 1997;35:531–3. doi: 10.1038/sj.sc.3100404. [DOI] [PubMed] [Google Scholar]
- 15.Börü UT, Taşdemir M, Güler N, Ayık ED, Kumaş A, Yıldırım S, Duman A, Sur H, Kurtzke JF. Prevalence of multiple sclerosis: door-to-door survey in three rural areas of coastal Black Sea regions of Turkey. Neuroepidemiology. 2011;37:231–5. doi: 10.1159/000334316. [DOI] [PubMed] [Google Scholar]
- 16.Patel DP, Elliott SP, Stoffel JT, Brant WO, Hotaling JM, Myers JB. Patient reported outcomes measures in neurogenic bladder and bowel: A systematic review of the current literature. Neurourol Urodyn. 2016;35:8–14. doi: 10.1002/nau.22673. [DOI] [PubMed] [Google Scholar]
- 17.Vij M, Srikrishna S, Robinson D, Cardozo L. Quality assurance in quality of life assessment--measuring the validity of the King’s Health Questionnaire. Int Urogynecol J. 2014;25:1133–5. doi: 10.1007/s00192-014-2370-5. [DOI] [PubMed] [Google Scholar]
- 18.Bjelic-Radisic V, Dorfer M, Tamussino K, Greimel E. Psychometric properties and validation of the German-language King’s Health Questionnaire in women with stress urinary incontinence. Neurourol Urodyn. 2005;24:63–8. doi: 10.1002/nau.20092. [DOI] [PubMed] [Google Scholar]
- 19.Reese PR, Pleil AM, Okano GJ, Kelleher CJ. Multinational study of reliability and validity of the King’s Health Questionnaire inpatients with overactive bladder. Qual Life Res. 2003;12:427–42. doi: 10.1023/A:1023422208910. [DOI] [PubMed] [Google Scholar]
- 20.Viana R, Viana S, Neto F, Mascarenhas T. Adaptation and validation of the King’s Health Questionnaire in Portuguese women with urinary incontinence. Int Urogynecol J. 2015;26:1027–33. doi: 10.1007/s00192-015-2628-6. [DOI] [PubMed] [Google Scholar]
- 21.Uemura S, Homma Y. Reliability and validity of King’s Health Questionnaire in patients with symptoms of overactive bladder with urge incontinence in Japan. Neurourol Urodyn. 2004;23:94–100. doi: 10.1002/nau.10169. [DOI] [PubMed] [Google Scholar]
- 22.Hollingworth W, Campbell JD, Kowalski J, Ravelo A, Girod I, Briggs A, et al. Exploring the impact of changes in neurogenic urinary incontinence frequency and condition-specific quality of life on preference-based outcomes. Qual Life Res. 2010;19:323–31. doi: 10.1007/s11136-010-9590-z. [DOI] [PubMed] [Google Scholar]
- 23.Sánchez Raya J, Romero Culleres G, González Viejo MA, Ramírez Garcerán L, García Fernández L, Conejero Sugrañes J. Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques. Actas Urol Esp. 2010;34:537–42. doi: 10.1016/S2173-5786(10)70126-8. [DOI] [PubMed] [Google Scholar]
- 24.Akkoc Y, Karapolat H, Eyigor S, Yesil H, Yuceyar N. Quality of life in multiple sclerosis patients with urinary disorders: Reliability and validity of the Turkish version of King’s Health Questionnaire. Neurol Sci. 2011;32:417–21. doi: 10.1007/s10072-011-0484-9. [DOI] [PubMed] [Google Scholar]
- 25.Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. BrJ Obstet Gynaecol. 1997;104:1374–9. doi: 10.1111/j.1471-0528.1997.tb11006.x. [DOI] [PubMed] [Google Scholar]
- 26.Kelleher C. Quality of life. In: Cardozo L, editor. Urogynecology. Churchill Livingstone; New York: 1997. pp. 673–88. [Google Scholar]
- 27.Medical Outcomes Trust. How to Score the Medical Outcomes Trust, SF-36 Health Survey. Boston: Medical Outcomes Trust; 1994. [Google Scholar]
- 28.Koçyiğit H, Aydemir Ö, Ölmez N, Memiş A. Kısa. Form-36(KF-36)’nın Türkçe Versiyonunun. Güvenilirliği ve Geçerliliği. İlaç ve Tedavi Dergisi. 1999;12:102–6. [Google Scholar]
- 29.Bonniaud V, Jackowski D, Parratte B, Paulseth R, Grad S, Margetts P, et al. Quality of life in multiple sclerosis patients with urinary disorders: discriminative validation of the English version of Qualiveen. Qual Life Res. 2005;14:425–31. doi: 10.1007/s11136-004-0686-1. [DOI] [PubMed] [Google Scholar]
- 30.Karapolat H, Eyigör S, Akkoc Y, Yesil H, Sagduyu A. Quality of Life in Multiple Sclerosis Patients With Urinary Disorders: Reliability and Validity of the Turkish Version of Qualiveen. 2010;27:43–9. doi: 10.1007/s10072-011-0484-9. [DOI] [PubMed] [Google Scholar]