Psychometric validation of the Italian electronic Personal Assessment Questionnaire (I.ePAQ): the Vaginal Section
IUGA Academy. Soligo M. Jun 30, 2018; 213017
Topic: Pelvic Organ Prolapse
Marco Soligo
Marco Soligo

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Psychometric validation of the Italian electronic Personal Assessment Questionnaire (I.ePAQ): the Vaginal Section

Nelva Stellio, L1;Soligo, M1; Casati, P1; De Ponti, E2; Turri, A1; Messori, P3; Cetin, I1

1: Buzzi Hospital - ASST FBF Sacco; 2: San Gerardo Hospital; 3: Macedonio Melloni Hospital - ASST FBF Sacco

Introduction: Patient Reported Outcome questionnaire are increasingly considered the keystone in Pelvic Floor Disorders assessment1. An innovative English language multidisciplinary electronic Personal Assessment Questionnaire (ePAQ) has been psychometrically validated in 20062. A certified Italian translation of ePAQ (I.ePAQ) has been made available by the Italian Society of Urodynamics.

Objective: The aim of our study was to assess the psychometric properties of the I.ePAQ. concerning its Vaginal dimension.

Methods: Patients complaining of vaginal Prolapse at our Unit were included. After consent they filled-in the I.ePAQ via a dedicated touch-screen display (T0). The patients also completed a 10 questions acceptability questionnaire (QQ10) to rate I.ePAQ for positive and negative features and a concurrent questionnaires: Urogenital Distress Inventory (UDI). To women undergoing to prolapse surgery the present protocol was repeated at follow-up after surgery (T1) adding a Patient Global Impression of Improvement (PGI-I) assessment. To test reliability the Cronbach’s Alpha coefficient for the domains obtained from all the ePAQ questionnaires was analyzed. The acceptability questionnaire (QQ10) is adopted for validity. Finally to assess responsiveness of I.ePAQ after surgical treatment results were analyzed with the Cohen's Effect-Size, the Standardized Response Mean and the Wilcoxon’s test (p<0.05 for significance).

Results: 88 women (mean age 67 yrs; mean BMI 26; 82% in menopause) were included and filled in 116 I.ePAQ questionnaires. Results for reliability are shown in table 1 and the Spearman’s correlation between IePAQ and UDI domains is reported in table 2. In table 3 results for Face Validity via the QQ10 questionnaire are reported. Tests on responsiveness, are reported in table 4 and 5.

Conclusions: Testing the Reliability is evident that the electronic questionnaire has a good internal consistency even if one of the domain (pain and sensation) shows a lower result comparing with others. While judging the questionnaire more than 80% of patients express a positive view and more than 75% disagree with negative features, with the major concern as to the questionnaire being too long. The questionnaire is also responsive to changes: answers in every domain (except for capacity) are significantly different between T0 and T1 (tab 4) and this is further confirmed by Cohen's Effect-Size and the Standardized Response Mean all above the 30%. Responsiveness in the domain of capacity might be biased by the persistence of sensation of a reduced capacity due to scarring tissues after surgery. An improvement in our cultural adaptation of the questionnaire in this domain has to be considered.

The vaginal section of the Italian version of ePAQ meets the psychometric properties of validity, reliability and responsiveness. The questionnaire is now ready for clinical application in Italian language patients helping the assessment of prolapse disorder.


  1. Dis. Colon Rectum 2011jan;54(1):85-94
  2. BJOG 2006feb;113(2):231-8

TAB.1: Reliability assessment in 116 questionnaires

TAB.2: Spearman Correlation between domain scores of ePAQ vaginal dimension and domain scores of UDI

TAB.3: ePAQ Acceptance Questionnaire (QQ10); Positive Questions (left) and 'Negative' Questions (right)

TAB.4: Responsiveness via Wilcoxon test in 28 women

TAB.5: Responsiveness via specific coefficients in 28 women


Work supported by industry: no.

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