JU INSIGHT: A Deception Study to Avoid Recall Bias Confirms Similar Scores for 3 Validated Questionnaires in the Office or Over the Phone in Women With or Without Urinary Incontinence

By: Meghana Reddy, BA; Samuel A. Kusin, BA; Alana Christie, MS; Philippe Zimmern, MD | Posted on: 01 Dec 2022

Reddy M, Kusin SA, Christie A, Zimmern P. A deception study to avoid recall bias confirms similar scores for 3 validated questionnaires in the office or over the phone in women with or without urinary incontinence. J Urol. 2022;208(6):1288-1294.

Study Needs and Importance

There have been many questionnaires developed to evaluate urinary incontinence symptomatology, such as the Urinary Distress Inventory 6-Short Form (UDI-6), Incontinence Impact Questionnaire 7-Short Form (IIQ-7), and Quality of Life (QoL) survey. During the COVID-19 pandemic, it became necessary to administer these questionnaires through virtual modalities, including telephone; however, these questionnaires were developed for office use and have not been formally studied for use over the phone. As a means of minimizing recall bias when administering these questionnaires over the telephone compared to the office visit in continent and incontinent women, we adopted a “deception” study design model to compare scores of 3 validated questionnaires: UDI-6, IIQ-7, and QoL.

Table. Questionnaire Response by Phone Versus Clinic for All Patients (N = 86)

	Mean
	Phone response	Clinic response	Mean difference (95% CI)	P value
UDI-6 questionnaire
Total score (0-18)	6.9 (6, 7.8)	6.4 (5.5, 7.4)	0.4 (−0.1, 1.0)	.10
Q1: Frequency (0-3)	1.7 (1.5, 1.9)	1.5 (1.2, 1.7)	0.2 (0.0, 0.4)	.033
Q2: Urgency (0-3)	1.3 (1.1, 1.6)	1.3 (1, 1.5)	0.0 (−0.2, 0.2)	.81
Q3: Stress (0-3)	0.9 (0.7, 1.2)	1.1 (0.8, 1.3)	−0.1 (−0.3, 0.0)	.13
Q4: Leakage (0-3)	1 (0.8, 1.2)	1 (0.8, 1.2)	0.0 (−0.1, 0.2)	.78
Q5: Emptying (0-3)	1 (0.7, 1.2)	0.9 (0.7, 1.1)	0.1 (−0.1, 0.2)	.44
Q6: Pain (0-3)	0.9 (0.7, 1.2)	0.8 (0.5, 1)	0.2 (−0.0, 0.3)	.13
IIQ-7 questionnaire
Total score (0-21)	3.8 (2.8, 4.8)	4.2 (3.1, 5.4)	−0.5 (−1.3, 0.4)	.26
Q1: Household chores (0-3)	0.4 (0.2, 0.5)	0.4 (0.2, 0.6)	−0.1 (−0.2, 0.1)	.36
Q2: Physical recreation (0-3)	0.7 (0.5, 1)	0.6 (0.4, 0.8)	0.1 (−0.1, 0.3)	.45
Q3: Entertainment activities (0-3)	0.4 (0.3, 0.6)	0.5 (0.3, 0.7)	−0.1 (−0.3, 0.1)	.42
Q4: Travel by car (0-3)	0.6 (0.4, 0.8)	0.5 (0.3, 0.7)	0.1 (−0.1, 0.3)	.31
Q5: Social activities (0-3)	0.4 (0.2, 0.6)	0.5 (0.3, 0.7)	−0.1 (−0.3, 0.1)	.27
Q6: Emotional health (0-3)	0.5 (0.3, 0.7)	0.6 (0.4, 0.8)	−0.2 (−0.4, 0.0)	.12
Q7: Frustration (0-3)	0.9 (0.6, 1.1)	1.1 (0.8, 1.3)	−0.2 (−0.4, −0.0)	.036
Quality of life (0-10)	5 (4.3, 5.7)	4.6 (3.9, 5.2)	0.3 (−0.3, 1.0)	.28
Abbreviations: CI, confidence interval; IIQ-7, International Incontinence Questionnaire-Short Form; Q, question; UDI-6, Urinary Distress Inventory-Short Form. Questionnaires scores are reported using the 0-3 scale of the subdomains. Bolded P values are statistically significant.

What We Found

This study was powered on a minimally important difference in the UDI-6 Question 3 for stress urinary incontinence. We found that overall the total scores of the 3 questionnaires were not statistically different when administered over the phone versus in the office several days later to the same patients (see Table). The deception model was very well accepted by our patients.

Limitations

The limitations of this study include participation of older women, mostly Caucasian, and having access to a female pelvic medicine and reconstructive specialists tertiary care center. A multicenter study with enrollment of diverse ethnicities will be needed to confirm the current findings.

Interpretation for Patient Care

Taken together, our findings support the notion that the administration of these 3 questionnaires over the phone produces comparable scores over an office visit. These findings should be comforting to those interested in using these outcome instruments during telehealth calls and can benefit investigators wishing to obtain longitudinal data on patients lost to follow-up.