Developing and refining outcome measurement suites: an example from the National Continence Management Strategy

This paper provides a brief overview of the Australian National Continence Management Strategy with respect to its activities related to the assessment of incontinence, the use of measures to evaluate the outcomes of incontinence treatment interventions, and the production of Australian prevalence and burden of disease estimates. It highlights the Continence Outcomes Measurement Suite (COMS) project, in particular, which has moved through a number of developmental stages. Stage 1 involved the scholarly review of commonly used self-report and clinical assessment measures for both urinary and faecal incontinence against the current definitions provided by the International Continence Society (Thomas, et al., 2006). The recommended instruments for urinary incontinence included: the Urogenital Distress Inventory-6 (Uebersax, et al., 1995) and the Incontinence Severity Index (Sandvik, et al., 2000); as well as the Wexner Faecal Continence Grading System (Jorge & Wexner, 1993) for faecal incontinence. Stage 2 of the project incorporated the recommended instruments in a large scale field trial, the 2004 South Australian Health Omnibus Survey (n = 3015). The trial results and subsequent psychometric analyses identified some problems with the recommended instruments and led to their revision and adaptation. These revised instruments were then piloted in a number of continence clinics to obtain some preliminary clinical data for stage 3 of this project. Finally, in tandem with this work, measures of patient satisfaction with incontinence treatment were reviewed and then assessed in a clinical study with incontinence patients and a new short patient satisfaction scale was also developed.