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Pelvic Floor Distress Inventory Short Form

Pelvic Floor Distress Inventory-20

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Purpose

The purpose of the PFDI is to assess the impact that pelvic floor disorders have on health-related quality of life in women.

Link to Instrument

Instrument Details

Acronym PFDI-20

Area of Assessment

Incontinence

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • 20-item questionnaire that is the short form of the 46 question PFDI.
  • Reflects symptoms experienced over the last 3 months.
  • Separated into three subscales:
    1) Urinary Distress Inventory 6 (UDI-6)
    2) Colorectal-Anal Distress Inventory 8 (CRADI-8)
    3) Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6)
  • Can be given in its entirety or as individual scales.
  • Patient/client answers yes or no to questionnaire items and then ranks the level of bother of each “yes” item on a Likert scale:
    1 = “not at all”
    2 = “somewhat”
    3 = “moderately”
    4 = “quite a bit”
    No answers receive a 0
  • Scoring:
    Scale scores - The mean value of all questions answered is then multiplied by 25 for the actual score (range 0 to 100)
    Summary score - Add the scores from the 3 scales together to obtain the summary score (range 0 to 300)
  • The higher the score the greater the perceived impact that pelvic floor dysfunction has on a patient’s life.

Number of Items

20

Equipment Required

  • Paper survey and pen/pencil

Time to Administer

5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Krista Ferguson, PT, OCS in 2010; Updated with a geriatric population by Jill Smiley, MPH in 10/2012.    

ICF Domain

Body Function

Considerations

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Non-Specific Patient Population

back to Populations

Minimally Clinically Important Difference (MCID)

Women with Pelvic Floor Symptoms:(Barber et al, 2005; n = 100 women evaluated at the Pelvic Floor Disorders Clinic at the Duke University Medical Center; mean age = 56(15) years)

  • MCID for the short form: 45 or more point change on summary score

Cut-Off Scores

Women with Pelvic Organ Prolapse: (Kaplan et al, 2012; n = 248 women, 103 prolapse participants and 145 non-prolapse participants; mean age for prolapse participants = 59.9 (11.4) years; mean age for non-prolapse participants = 53.4 (9.5) years)

  • Cut-Off Score of <135.4 has a sensitivity of 62.7% and specificity of 51.0%

Normative Data

Pelvic Floor Distress: (Barber et al, 2005; n = 45 women with pelvic floor disorders scheduled to undergo surgery to evaluate the correlation between short and long forms in a second independent population; the short forms were re-administered 3 to 6 months postoperatively to assess the responsiveness of the instruments; mean age = 59(12) years)

Baseline Characteristics of the Two Study Populations

 

 

 

 

Group 1 (n = 100)

Group 2 (n = 45)

P value

Age*

56 (15)

59 (12)

.23

Caucasian (%)

83%

95%

.30

BMI*

29 (7)

27 (6)

.10

Parity**

2 (0-5)

2 (1-7)

.50

Insurance Status (%)

 

 

.001

Private HMO

44

71

 

Medicaid/Medicare

56

29

 

Previous Hysterectomy (%)

68

51

.08

Previous Pelvic Reconstructive Surgery (%)

32

20

.19

Pelvic Floor Disorders (%)

 

 

 

Urodynamic Stress Incontinence

30

40

.32

Detrusor Overactivity

16

16

.95

Voiding Dysfunction

24

40

.75

Pelvic Organ Prolapse (Stage 3 or 4)

27

58

.0007

Fecal Incontinence

13

11

.96

Defecatory Dysfunction

28

40

.21

Rectal Prolapse

4

6

.96

Number of Pelvic Floor Disorders Per Patient (%)

 

 

<.0001

0***

24

0

 

1

44

34

 

2

26

40

 

3+

6

26

 

*Mean +/- SD, **Median (range), *** In group 1, 24% of patients did not meet the study definition of any pelvic floor diagnoses listed above but all had some symptom of pelvic floor dysfunction.  In contrast, all patients in group 2 met the criteria for one or more pelvic floor disorders

 

 

 

 

Surgical Procedures Performed on Group 2

 

Procedure

Percent

Hysterectomy

38

Trachelectomy

4

Anterior Colporrhaphy

60

Posterior Colporrhaphy

67

Paravaginal Repair (Abdominal or Laparoscopic)

22

Vaginal Vault Suspension

55

Sacral Colpopexy (Abdominal or Laparoscopic)

13

Sling Procedure (Including TVT)

40

Retropubic Urethropexy (Burch)

20

Urethrolysis

2

Anal Sphincteroplasty

4

Rectopexy

2

TVT = Tension-free Vaginal Tape

 

 

Women with Pelvic Floor Symptoms:(Barber et al, 2001)

  • 83% white
  • Median parity was 2(0-5)
  • Mean weight = 78(21) kg

Test/Retest Reliability

Pelvic Floor Distress: (Barber et al, 2005)

  • PFDI-20:  Excellent test-retest reliability (ICC = 0.93) 
  • UDI-6:  Excellent test-retest reliability (ICC = 0.82) 
  • POPDI-6:  Excellent test-retest reliability (ICC= 0.91) 
  • CRADI-8:  Excellent test-retest reliability (ICC = 0.84)

 

Women with Pelvic Floor Symptoms:(Barber et al, 2001)

  • Excellent test-retest reliability (ICC = 0.87)

 

Women with Pelvic Floor Disorders: (Toprak et al, 2012; = 128 women with pelvic floor disorders including pelvic organ prolapse, urinary incontinence, and anal incontinence; mean age = 51.91 (9.82) years; Turkish sample)

  • Excellent test-retest reliability (ICC = 0.98)

Interrater/Intrarater Reliability

Pelvic Floor Distress: (Barber et al, 2005) 

  • PFDI-20:  Excellent (r =.93) 
  • UDI-6:  Excellent (r =.86) 
  • POPDI-6:  Excellent (r =.92) 
  • CRADI-8:  Excellent (r =.93)

Internal Consistency

Pelvic Floor Distress: (Barber et al, 2005) 

  • Excellent internal consistency (Chronbach alpha = 0.88)

 

Women with Pelvic Floor Symptoms:(Barber et al, 2001)

  • Excellent internal consistency (Chronbach alpha = 0.88)

 

Women with Pelvic Floor Disorders: (Toprak et al, 2012)

  • Adequate internal consistency (Chronbach's alpha = 0.79)

 

Pelvic Floor Disorders: (Barber et al, 2011; n = 1006 participants in 4 prospective studies of pelvic floor disorders, including pelvic organ prolapse, stress urinary incontinence, and fecal incontinence at baseline, 3-months, and 12-months; mean age = 58.4 (14.7) years)

Subscale to Total Measure Correlations

 

Subscale

PFDI -20

UDI

0.88 (Excellent)

POPDI

0.90 (Excellent)

CRADI

0.93 (Excellent)

 

Women with Pelvic Organ Prolapse: (Kaplan et al, 2012)

Internal Consistency of PFDI-20

 

 

Chronbach's Alpha

PFDI 20

0.908 (Excellent)

Subscale

 

UDI

0.965 (Excellent)

POPDI

0.952 (Excellent)

CRADI

0.964 (Excellent)

Construct Validity

Pelvic Floor Distress: (Barber et al, 2005)

  • The scales of the PFDI and PFIQ demonstrate significant association with appropriate measures of symptom severity and pelvic floor diagnoses, thereby demonstrating construct validity

 

Women with Pelvic Floor Disorders: (Toprak et al, 2012)

  • Construct validity demonstrated that the PFDI-20 and each subscale displayed significant correlation with other clinical methods used (p<0.05)

 

Women with Pelvic Organ Prolapse: (Kaplan et al, 2012)

  • Adequate correlation between PFDI-20 and POP-Q (r  = 0.387)
  • Poor correlation between UDI (PFDI-20 subscale) and POP-Q (r  = 0.134)
  • Excellent  correlation between POPDI (PFDI-20 subscale) and POP-Q (r  = 0.608)
  • Poor  correlation between CRADI (PFDI-20 subscale) and POP-Q (r  = 0.043)

Content Validity

  • After the item content for the short forms was determined, a multidisciplinary expert panel that included urogynecologists, female urologists, a colorectal surgeon, a pelvic floor physical therapist, and a psychometrician reassessed content validity (Barber et al, 2005).

Face Validity

  • After the item content for the short forms was determined, a multidisciplinary expert panel that included urogynecologists, female urologists, a colorectal surgeon, a pelvic floor physical therapist, and a psychometrician reassessed face validity (Barber et al, 2005).

Responsiveness

Pelvic Floor Distress: (Barber et al, 2005) 

 

Women with Pelvic Organ Prolapse: (Kaplan et al, 2012)

Responsiveness of PFDI-20 and PDFI-20 Subscales

 

 

 

Effect Size (ES)

SRM

PFDI-20

1.38 (Large change)

1.42

UDI

0.88 (Large change)

0.91

POPDI

1.48 (Large change)

1.39

CRADI

0.61 (Moderate change)

0.54

Bibliography

Barber, M. D., Chen, Z., et al. (2011). "Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ)." Neurourology and Urodynamics 30(4): 541-546.

Barber, M. D., Kuchibhatla, M. N., et al. (2001). "Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders." American Journal of Obstetrics and Gynecology 185(6): 1388-1395.

Barber, M. D., Walters, M. D., et al. (2005). "Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)." American Journal of Obstetrics and Gynecology 193(1): 103-113.

Kaplan, P. B., Sut, N., et al. (2012). "Validation, cultural adaptation and responsiveness of two pelvic-floor-specific quality-of-life questionnaires, PFDI-20 and PFIQ-7, in a Turkish population." European Journal of Obstetrics, Gynecology, and Reproductive Biology 162(2): 229-233.

Toprak Celenay, S., Akbayrak, T., et al. (2012). "Validity and reliability of the Turkish version of the Pelvic Floor Distress Inventory-20." Int Urogynecol J 23(8): 1123-1127.