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K OKAMURA ET AL.

Table 4

Relationship between the three core symptoms and primary core symptom Total

No. 3 core symptoms chosen

3 2 1 0 Blank Total

62 53 77 58 15 265

In the CLSS questionnaire, the responder must list a maximum of three symptoms causing a burden and then choose the most bothersome from a list of 10 core symptoms. However, less than half selected the most bothersome symptom from their three core symptoms. The significance of the three core and/or one core question must be assessed in the future. Three possible limitations existed in the present study: (i) the small number of cases; (ii) including participants of two towns; and (iii) participants who were residents and not patients. The first might be acceptable, because Kline showed that the sample size should be more than 100.15 The second might also be acceptable because of the similarity in the participants’ backgrounds. Regarding the third, the analysis might be confirmed using patients in clinics. However, we could show the reliability and validity using a sample of residents whose LUTS might be modest compared with patients visiting clinics. It is suggested that the CLSS questionnaire is useful even in an epidemiological study.

Conflict of interest None declared.

References 1 Homma Y, Tsukamoto T, Yasuda K, Ozona S, Yoshida M, Yamaguchi T. Evaluation of psychometric properties of Japanese version of International Prostate Symptom Score and BPH Impact Index. Nihon Hinyokika Gakkai Zasshi 2003; 94: 560–9. (In Japanese.) 2 Okamura K, Nojiri Y, Osuga Y, Tange C. Psychometric analysis of international prostate symptom score for female lower urinary tract symptoms. Urology 2009; 73: 1199–202. 3 Homma Y, Yoshida M, Seki N et al. Symptom assessment tool for overactive bladder syndrome-overactive bladder symptom score. Urology 2006; 68: 318–23.

Core 1 symptom selected from

Core 1 symptom

3 Core

Other than 3 core

0

Blank

46 38 46 0 0 130

11 6 25 56 2 100

5 9 6 2 1 23

0 0 0 0 12 12

4 Gotoh M, Homma Y, Funahashi Y, Matsukawa Y, Kato M. Psychometric validation of the Japanese version of the International Consultation on Incontinence Questionnaire-Short Form. Int. J. Urol. 2009; 16: 303–6. 5 Osuga Y, Okamura K, Ando F, Shimokata H. Prevalence of lower urinary tract symptoms in middle-aged and elderly Japanese. Geriatr. Gerontol. Int. 2013; 13: 1010–17. 6 Okamura K, Usami T, Nagahama, Maruyama S, Mizuta E. The relationships among filling, voiding subscores from international prostatic symptom score and quality of life in Japanese elderly men and women. Eur. Urol. 2002; 42: 498–505. 7 Abrams P, Avery K, Gardener N, Donovan J. The International Consultation on Incontinence Modular Questionnaire: www.iciq.net. J. Urol. 2006; 175 (3 Pt 1): 1063–6. 8 Donovan JL, Peters TJ, Abrams P, Brookes ST, De La Rosette JJMCH, Schafer W. Scoring the short form ICSmaleSF questionnaire. International Continence Society. J. Urol. 2000; 164: 1948–55. 9 Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P. A scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am. J. Obstet. Gynecol. 2004; 191: 73–82. 10 Homma Y, Yoshida M, Yamanishi T, Gotoh M. Core Lower Urinary Tract Symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms. Int. J. Urol. 2008; 15: 816–20. 11 Fujimura T, Kume H, Nishimatsu H et al. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2011; 109: 1512–17. 12 Fujimura T, Kume H, Tsurumaki Y et al. Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: a comparative study. Int. J. Urol. 2011; 18: 778–84. 13 Ito H, Sano F, Ogawa T, Yao M. Evaluation and validation of the core lower urinary tract symptom score as an outcome assessment tool for the treatment of benign prostatic hyperplasia: effects of the α1-adrenoreceptor antagonist silodosin. Int. J. Urol. 2014; 21: 108–12. 14 Homma Y, Araki I, Igawa Y et al.; Japanese Society of Neurogenic Bladder. Clinical guideline for male lower urinary tract symptoms. Int. J. Urol. 2009; 16: 775–90. 15 Kline P. Psychometric theory and method. In: Kline P (ed.). Handbook of Psychological Testing. Routledge, London, 2000; 7–16.

Editorial Comment Editorial Comment to Core lower urinary tract symptom score questionnaire: A psychometric analysis The core lower urinary tract symptom score (CLSS) questionnaire was recently developed by Dr Homma’s group,1 and had been used as a reliable instrument for lower urinary tract symptoms (LUTS) assessment in several studies.2,3 However, the psychometric properties of the CLSS still need to be further 1154

evaluated. It is well known that a newly developed measure should show validity and reliability. In the present study, the authors analyzed psychometric properties of CLSS by using common and simple methods. Although reliability can be calculated in various ways, the most widely accepted measure is © 2014 The Japanese Urological Association

Psychometric analysis of CLSS

internal consistency reliability using Cronbach’s alpha, and an alpha of 0.7 is the minimum acceptable standard.4 Furthermore, construct validation is also essential for the quality of questionnaires. The existence of construct validity could be confirmed with factor analytical techniques. The results of the present study indicated that the CLSS questionnaire showed good reliability and validity.5 In addition, the authors carried out psychometric analyses by sex, and found some difference in correlation of items between men and women. Based on these findings, the authors recommended the CLSS could be used in rapid screening of LUTS or epidemiological investigations. Although several limitations were listed in the Discussion section, the present study evaluated overall psychometric properties of the CLSS for the first time, which might facilitate clinical application in the near future. Wei Li M.D., Ph.D. Department of Urology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China [email protected]

Conflict of interest None declared.

References 1 Homma Y, Yoshida M, Yamanishi T, Gotoh M. Core Lower Urinary Tract Symptom score (CLSS) questionnaire: a reliable tool in the overall assessment of lower urinary tract symptoms. Int. J. Urol. 2008; 15: 816–20. 2 Ito H, Sano F, Ogawa T, Yao M. Evaluation and validation of the core lower urinary tract symptom score as an outcome assessment tool for the treatment of benign prostatic hyperplasia: effects of the α1-adrenoreceptor antagonist silodosin. Int. J. Urol. 2014; 21: 108–12. 3 Wei L, Li Q, Liang H, Jianbo L. The quality of life in patients during intravesical treatment and correlation with local symptoms. J. Chemother. 2014; 26: 165–8. 4 Hinkin TR. A review of scale development practices in the study of organizations. J. Manage. 1995; 21: 967–88. 5 Okamura K, Kimura K, Mizuno H, Okamoto N, Aota Y. Core lower urinary tract symptom score questionnaire: A psychometric analysis. Int. J. Urol. 2014; 21: 1151–4.

DOI: 10.1111/iju.12540

© 2014 The Japanese Urological Association

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Editorial Comment to Core lower urinary tract symptom score questionnaire: a psychometric analysis.

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