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
Acronym
PFDI-20
Primary Image
Pelvic Floor Distress Inventory-20
Expertise, Instruction and Mentorship
Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
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May 9–10
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Populations
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 TrainingAge Ranges
Adult
18 - 64
yearsElderly Adult
65 +
yearsInstrument 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 FunctionConsiderations
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Non-Specific Patient Population
back to PopulationsMinimally 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)
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Baseline Characteristics of the Two Study Populations |
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|
|
|
|
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 |
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|
|
|
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; n = 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)
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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)
-
Standardized response mean (SRM = 1.09)
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. Find it on PubMed
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. Find it on PubMed
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. Find it on PubMed
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. Find it on PubMed
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. Find it on PubMed