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Assessment of Perinatal Pelvic Floor Dysfunction Symptoms and Risk Factors: Measurement Properties of the International Consultation on Incontinence—Perinatal Pelvic Health Self‐Assessment Questionnaire ( ICIQ ‐ PPHSAQ )

Alan Uren*, Anne Fee, Paul Abrams, Kerry Avery, Ewa Sucha, Nick Barrowman, Nichola Bale, Tim Draycott, Mohamed Elhodaiby, Jacq Emkes, Hashim Hashim, Charles Knowles, Kate Lough, Chendrimada Madhu, Kathryn McCarthy, John Norrie, Jen Pinkstone, Sally Soodeen, Karen Ward, Nikki Cotterill

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Objective:
To assess the measurement properties of the International Consultation on Incontinence—Perinatal Pelvic Health Self‐Assessment Questionnaire (ICIQ‐PPHSAQ) and to identify symptom subscales for scoring.

Design, Setting and Population:
Two cohorts of perinatal women (antenatal and postnatal) at nine NHS trusts in England completed ICIQ‐PPHSAQ at baseline (16–19 weeks' gestation for the antenatal cohort and 6–9 weeks postnatal for the postnatal cohort) and at up to three further timepoints, with follow‐up extending to 9 months postnatal.

Methods:
Descriptive analyses and exploratory factor analyses (EFAs) identified symptom subscales from which subscale scores were calculated. Internal consistency was evaluated using Cronbach's alpha (α). Test–retest reliability was assessed using an interval of 1 week after baseline, using weighted Kappa (κ) for individual ordinal items and the intraclass correlation coefficient (ICC) for subscale scores. Construct validity and known‐groups validity were assessed by comparison with the Patient Global Impression of Severity (PGI‐S). Responsiveness was assessed by examining the mean differences between baseline and each timepoint.

Results:
A total of 162 antenatal women who were 16–19 weeks gestation, and 173 women 6–9 weeks postnatal were recruited. Almost all the items performed acceptably in the test–retest analyses and completion rates were high in all the scored items (< 5% missing data). EFAs derived nine symptom subscales; seven of which had acceptable overall reliability indicators, except the vaginal symptom and vaginal changes subscales. Known‐groups validity was demonstrated for all nine subscales, and six out of nine showed responsiveness to change (p < 0.05) over the study time‐period.

Conclusion:
The study provides evidence supporting the validity and reliability of ICIQ‐PPHSAQ, with responsiveness demonstrated across several domains. The instrument can be used to assess perinatal pelvic floor dysfunction risk factors and symptoms in English perinatal pelvic health services.
Original languageEnglish
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Early online date8 Apr 2026
DOIs
Publication statusE-pub ahead of print - 8 Apr 2026

Bibliographical note

© 2026 The Author(s).

Keywords

  • questionnaires
  • pelvic health
  • perinatal health
  • pelvic floor dysfunction
  • self‐assessment
  • patient reported outcome measure

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