Translation and Validation of the IPSS System into its Tagalog Version for Filipino Patients with Lower Urinary Tract Symptoms

Translation and Validation of the IPSS System into its Tagalog Version for Filipino Patients with Lower Urinary Tract Symptoms
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Title:Translation and Validation of the IPSS System into its Tagalog Version for Filipino Patients with Lower Urinary Tract Symptoms
Author/Abstract:
Translation and Validation of the IPSS System into its Tagalog Version for Filipino Patients with Lower Urinary Tract Symptoms

Mark Joseph Abalajon, MD1; Marie Carmela M. Lapitan, MD, FPUA1,2,3 and Brian S. Buckley, PhD3

1Division of Urology, Department of Surgery, University of the Philippines-Philippine General Hospital
2National Institutes of Health, University of the Philippines Manila
3Department of Surgery, College of Medicine, University of the Philippines Manila

Objective: This study aimed to develop and validate a Filipino version of the IPSS questionnaire.

Materials and Methods: Permission to translate the IPSS to Tagalog was obtained from the American Urologic Association. Independent forward and back translation of the English version to Tagalog and back were done. The reconciled Tagalog IPSS was pilot tested on 15 BPH patients. Adjustments to the questionnaire were made based on the pilot testing. One hundred patients with LUTS seen at the Philippine General Hospital for urologic complaints were included. In addition, 10 patients aged 18-30 years old reporting no LUTS were included as controls. After explaining the possible answers, the patients were left to answer the questionnaire on their own. The patients were then asked to undergo uroflowmetry with maximum flow rate (Qmax), volume voided and post-void residual urine volume determination. The internal consistency of the Tagalog IPSS was assessed by calculating
Cronbach's alpha coefficient. Spearman's rank correlation coefficient was used to assess the relationship between IPSS scores and Qmax measurements. The discriminatory power of the total IPSS score in detecting those with a Qmax of 15 ml/sec or less was assessed by calculating the area under the Receiver Operating Characteristic (ROC) curve.

Results : A total of 100 male patients with LUTS attributable to prostatic enlargement, aged 50 to 83 years old (mean age: 64.48 years; SD � 7.7 years), were included. The IPSS scores using the Tagalog questionnaire ranged from 4 to 35, with a mean score of 15 (SD � 8). The mean Qmax was 11.86 ml/sec (SD � 7.19ml/sec). The mean voided volume was 247ml (SD � 144.6ml). The mean residual volume was 43.2ml (SD � 31.2ml). Correlations were consistently statistically significant between uroflowmetry parameters and between total IPSS scores and obstructive and irritative elements. Cronbach's alpha for the whole instrument was 0.890 (7 questions) and 0.877 and 0.727 for the obstructive and irritative elements, respectively. In ROC curve analysis, the area under the curve was 0.886 (95% CI 0.823, 0.948). In detecting those with a Qmax of 15 ml/sec or less, using a cut off of
total IPSS score 7, sensitivity was 91% and specificity was 34%.

Conclusion : The strong correlation between the Tagalog IPSS and uroflowmetry parameters indicates that the IPSS may be a useful screening tool to identify Filipino patients who may benefit from further work-up for their symptoms and possible treatment thereafter. Further studies, with a wider demgraphic scope, should be done to evaluate whether the Tagalog IPSS can be used to measure treatment response.

Key words : validation, translation, lower urinary tract symptoms (LUTS), benign prostatic hyperlasia (BPH)
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