ICIQ

ICIQ Structure Short Form

Module Title	ICIQ-UI Short Form
Full Name of Module	ICIQ-Urinary Incontinence Form
Purpose of module	The ICIQ-UI Short Form provides a brief and robust measure to assess the impact of symptoms of incontinence on quality of life and outcome of treatment. This short and simple questionnaire is also of use to general practitioners and clinicians in both primary and secondary care institutions to screen for incontinence, to obtain a brief yet comprehensive summary of the level, impact and perceived cause of symptoms of incontinence and to facilitate patient-clinician discussions. Its brevity also makes the ICIQ-UI Short Form an ideal research tool.
Derivation of module	New Instrument
Intended Population	Adult males and females
Number of items	4
Question items	Frequency of urinary incontinence Amount of leakage Overall impact of urinary incontinence Self-diagnostic item
Lanuage versions available	Afrikaans Arabic Australian-English Brazilian-Portuguese Bulgarian Czech Danish Dutch Estonian Finnish French German Greek Hungarian Icelandic	Italian Japanese New Zealand-English Norwegian Polish Romanian Russian Slovakian South African-English Spanish Swedish Turkish Ukrainian UK-English US-English
Associated publications	Avery K, Donovan J, Peters T, Shaw C, Gotoh M, & Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol.Urodyn. 2004; 23(4) :322-30.
Level of validation according to ICI grades of recommendation	Grade A new Validity, reliability and responsiveness established with rigour in one data set
Scoring system	0-21 overall score with greater values indicating increased severity Self-diagnostic item unscored
Suggested modules to use in conjuction	ICIQ-MLUTS ; ICIQ-FLUTS - Gender-specific symptom modules ICIQ-MLUTSsex ; ICIQ-FLUTSsex - Gender-specific sexual matters modules
completion time	A few minutes
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