Determining the Validity and Reliability of the Recurrent Urinary Tract Infection Impact Questionnaire in Veterans with Neurogenic Bladder

Chronic neurologic injuries and diseases such as spinal cord injury (SCI) and multiple sclerosis (MS) often cause bladder dysfunction [‘neurogenic bladder’ (NB)]. Over 400,000 people are estimated to be living with NB in the U.S. The VA provides substantial care for people with NB, due to its unique focus on coordinated, lifelong care for Veterans with complex, chronic disabling conditions. Urinary tract infections (UTIs) are common secondary complications in people with NB, and frequently are recurrent and difficult to prevent and treat. Recurrent UTIs can profoundly diminish patient functioning and quality of life. Patient-reported outcomes (PRO) are reports on health collected directly from patients themselves, without interpretation by a clinician or anyone else. PROs often encompass health related quality of life, functional status, symptoms, experiences with care, and health behaviors. PRO measures (PROMs) are standardized instruments enabling PRO assessment for clinical, research, and other uses. Unfortunately, there is no validated and reliable PROM that assess functional and quality of life impacts or care experiences related to recurrent UTIs in people with NB. Using existing validated PROMs assessing general health-related quality of life or bladder complications in people with NB likely provides incomplete and potentially inaccurate data. A new PROM, the Recurrent UTI Impact Questionnaire (RUTIIQ), has recently been developed to assess psychosocial and quality of life impacts from recurrent UTIs, but it has not been validated specifically in people with NB. Our preliminary work has shown that the RUTIIQ could be an excellent PROM in people with NB but may require adaptations for this patient population. Therefore, the objective of this study is to determine whether the RUTIIQ is a valid and reliable PROM in Veterans with NB due to SCI or MS. In this project, the RUTIIQ will first be adapted by adding two additional items addressing mobility and functional impacts that were previously identified as important to Veterans with NB. Then, the modified RUTIIQ will be tested in cognitive, “think aloud” interviews with a small sample of Veterans with NB to determine comprehension and understanding of the survey. The final RUTIIQ will be administered as an electronic survey to a sample of Veterans with NB due to SCI or MS and recurrent UTIs. Results will be analyzed with various statistical tests to assess the survey’s validity and reliability. All participants in the survey study will be asked to complete the survey twice within a short timeframe, for test-retest analysis as part of the reliability assessment. Further modifications will be made to the survey based on these results. Completion of this SPiRE project will advance the science on using PROs to improve UTI- related clinical care and research. If valid and reliable, the adapted RUTIIQ can be used as a PROM in future research projects assessing effectiveness of interventions to optimize UTI- related care for this highly vulnerable Veteran population. Project Number: 1I21RX005456-01 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Margaret Fitzpatrick | Institution: VA EASTERN COLORADO HEALTH CARE SYSTEM, Aurora, CO | Activity Code: I21 | Study Section: Rehabilitation Research and Development SPiRE Program[RRDS] View on NIH RePORTER: https://reporter.nih.gov/project-details/11050223