Adaptação transcultural e validação do questionário urgency, weak stream, incomplete emptying and nocturia (UWIN) para o português brasileiro

Abstract

Lower urinary tract symptoms (LUTS) are common complaints in the adult male population and have a negative affect their quality of life. LUTS are also associated with sexual disorders and represent an economic burden for the healthcare system worldwide. The International Prostatism Symptom Score (IPSS) is a validated tool for assessing these symptoms, but patients with low literacy may have difficulties comprehending and completing it accurately. The Urgency, Weak Stream, Incomplete Emptying and Nocturia (UWIN) questionnaire was developed as a shorter tool in the assessment of LUTS to improve accuracy and minimize error. Aims: This study aimed at performing cross-cultural adaptation to Brazilian Portuguese and validation of the Urgency, Weak Stream, Incomplete Emptying and Nocturia (UWIN) questionnaire for patients with LUTS. Method: The cross-cultural adaptation followed the steps of conceptual, item, semantic, operational and pre-test equivalence to obtain the UWIN-Br version. The population consisted of 308 adult men evaluated at a specialized urological clinic, located in Feira de Santana, Bahia, Brazil. The IPSS (gold standard) and UWIN-Br were administered, and information regarding the uroflowmetry examination was also recorded. Quantitative variables were described by median and interquartile range, while qualitative variables by their absolute values or proportions. To evaluate the criterion validity, we used the Spearman correlation coefficient and Bland-Altman graph. ANOVA was used to analyze the validity of the construct using a hypothesis test. Additionally, the diagnostic accuracy of the UWIN-Br was evaluated in identifying the severe cases defined by the gold standard (IPSS). The statistical software program (GraphPad Prism, version 8.0.2, GraphPad Software, San Diego - California) performed the analyzes. The Research Ethics Committee of the State University of Feira de Santana approved this project. Results: 306 men, median age 59 [52-66] years and years studied 11 [8-13,7]. There was a positive correlation r = 0.804 (p <0.0001) between the total IPSS score and the total UWIN-Br score, as well as the quality of life question (r = 0.761) (p <0.0001). The Bland-Altman plot showed good agreement between the two instruments. Also, we observed that the maximum flow values decreased with the severity of the LUTS. UWIN-Br demonstrated excellent diagnostic accuracy in detecting the most severe cases. The area under the ROC curve was 89% [81 - 97%] 95% CI. 280 (91.5%) subjects completed the questionnaires without help, while 26 (8.5%) did so through an interview. The response time was 1.2 [1.0-1.5] min for UWIN-Br and 2.8 [2.2-3.4] min for IPSS (p <0.0001). Conclusion: UWIN-Br presents satisfactory and similar psychometric properties to the IPSS in the evaluation of LUTS and quality of life, and is suitable for use in both clinical practice and research in our country.