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The Integral Theory System Questionnaire: an anatomically directed questionnaire to determine pelvic floor dysfunctions in women

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Abstract

Purpose

Anatomical damage to pelvic floor structures may cause multiple symptoms. The Integral Theory System Questionnaire (ITSQ) is a holistic questionnaire that uses symptoms to help locate damage in specific connective tissue structures as a guide to reconstructive surgery. It is based on the integral theory, which states that pelvic floor symptoms and prolapse are both caused by lax suspensory ligaments. The aim of the present study was to psychometrically validate the ITSQ.

Materials and methods

Established psychometric properties including validity, reliability, and responsiveness were considered for evaluation. Criterion validity was assessed in a cohort of 110 women with pelvic floor dysfunctions by analyzing the correlation of questionnaire responses with objective clinical data. Test–retest was performed with questionnaires from 47 patients. Cronbach’s alpha and “split-half” reliability coefficients were calculated for inner consistency analysis.

Results

Psychometric properties of ITSQ were comparable to the ones of previously validated Pelvic Floor Questionnaires. Face validity and content validity were approved by an expert group of the International Collaboration of Pelvic Floor surgeons. Convergent validity assessed using Bayesian method was at least as accurate as the expert assessment of anatomical defects. Objective data measurement in patients demonstrated significant correlations with ITSQ domains fulfilling criterion validity. Internal consistency values ranked from 0.85 to 0.89 in different scenarios.

Conclusions

The ITSQ proofed accurate and is able to serve as a holistic Pelvic Floor Questionnaire directing symptoms to site-specific pelvic floor reconstructive surgery.

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Acknowledgments

We thank Peter Petros for reviewing the manuscript and aiding in the criterion validity and test–retest section. Thomas Bschleipfer, Alfons Gunnemann, Bernhard Liedl and Florian Wagenlehner have been part of the ICOPF (International Collaboration of Pelvic Floor Surgeons) panel evaluating validity issues of the questionnaire. Florian Wagenlehner acknowledges to be consultant for Astellas and Serag-Wiessner, Gianpaolo Perletti to be consultant for Astellas, Thomas Bschleipfer to have been involved in a research study with Allergan.

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Authors and Affiliations

  1. Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany

    Florian Martin Erich Wagenlehner, Oliver Fröhlich, Thomas Bschleipfer & Wolfgang Weidner

  2. Biomedical Research Division, Department of Theoretical and Applied Sciences, Università degli Studi Dell’Insubria, Busto A., Varese, Italy

    Gianpaolo Perletti

  3. Department of Basic Medical Sciences, Ghent University, Ghent, Belgium

    Gianpaolo Perletti

Authors
  1. Florian Martin Erich Wagenlehner
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  2. Oliver Fröhlich
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  3. Thomas Bschleipfer
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  4. Wolfgang Weidner
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  5. Gianpaolo Perletti
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Corresponding author

Correspondence to Florian Martin Erich Wagenlehner.

Appendix: The Integral Theory System Questionnaire (ITSQ)

Appendix: The Integral Theory System Questionnaire (ITSQ)

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Wagenlehner, F.M.E., Fröhlich, O., Bschleipfer, T. et al. The Integral Theory System Questionnaire: an anatomically directed questionnaire to determine pelvic floor dysfunctions in women. World J Urol 32, 769–781 (2014). https://doi.org/10.1007/s00345-013-1150-z

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  • DOI: https://doi.org/10.1007/s00345-013-1150-z

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