--- title: "Clinical validation of Bladder Health Survey for UI. | Sutter Health" description: "The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples." url: "https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Clinical validation of Bladder Health Survey for UI. # Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women. Minassian VA, Yan XS, Sun H, Platte RO, & Stewart WF. _Int Urogynecol J. 27(3):453-61. doi: 10.1007/s00192-015-2849-8. Epub 2015 Sep 19._ 2016-03-01 ## Abstract INTRODUCTION AND HYPOTHESIS: Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys. METHODS: A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test-retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik's score. RESULTS: Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p < 0.001). The BHS UI score was significantly correlated with the Sandvik severity score (r = 0.68, p < 0.01). CONCLUSION: The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/26386565) ![Xiaowei (Sherry) Yan, Ph.D.](https://dyn.mktgcdn.com/p/NTWox_hkmxIRiqJEc5PXKeBkfR_WMtpSQbEI4J69Xls/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Xiaowei (Sherry) Yan, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042) ## Research topics - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Urologic Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Urologic+Diseases%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [The iceberg of health care utilization in women with urinary incontinence.](https://www.sutterhealth.org/research/publications/health-care-utilization-in-women-with-ui-is-low-1055312611) Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. Int Urogynecol J. 23(8):1087-93. doi: 10.1007/s00192-012-1743-x. Epub 2012 Apr 12. 2012 Aug 01 - Publication ### [Predictors of care seeking in women with urinary incontinence.](https://www.sutterhealth.org/research/publications/predictors-of-care-in-women-with-urinary-incontinence-1055312738) Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. Neurourol Urodyn. 31(4):470-4. doi: 10.1002/nau.22235. Epub 2012 Feb 29. 2012 Apr 01 - Publication ### [Mixed incontinence masked as stress induced urgency urinary incontinence.](https://www.sutterhealth.org/research/publications/mixed-incontinence-masked-as-stress-induced-urgency-ui-1055312723) Minassian VA, Yan XS, Pitcavage J, Stewart WF. J Urol. 196(4):1190-5. doi: 10.1016/j.juro.2016.04.084. Epub 2016 May 6. 2016 Oct 01 - Publication ### [The interaction of stress and urgency urinary incontinence and its effect on quality of life.](https://www.sutterhealth.org/research/publications/stress-vs-urgency-ui-and-effect-on-qol-1055312598) Minassian VA, Sun H, Yan XS, Clarke DN, Stewart WF. Int Urogynecol J. 26(2):269-76. doi: 10.1007/s00192-014-2505-8. Epub 2014 Oct 3. 2015 Feb 01 - Publication ### [Does transition of urinary incontinence from one subtype to another represent progression of the disease?](https://www.sutterhealth.org/research/publications/urinary-incontinence-subtype-transition-disease-progression-1055312746) Minassian VA, Yan X, Pilzek AL, Platte R, Stewart WF. Int Urogynecol J. 29(8):1179-1185. doi: 10.1007/s00192-018-3596-4. Epub 2018 Mar 13. 2018 Aug 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Clinical validation of Bladder Health Survey for UI."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569#medicalscholarlyarticle","name":"Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women.","headline":"Clinical validation of Bladder Health Survey for UI.","abstract":"INTRODUCTION AND HYPOTHESIS: Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys. METHODS: A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test-retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik's score. RESULTS: Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p \u003c 0.001). The BHS UI score was significantly correlated with the Sandvik severity score (r = 0.68, p \u003c 0.01). CONCLUSION: The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples.","description":"The BHS is highly reliable, with robust content and construct validity for detecting UI for use in population samples.","keywords":["Medical Informatics","Urologic Diseases","Women's Health"],"datePublished":"2016-03-01","url":"https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"26386565"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1007/s00192-015-2849-8"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/26386565/","https://doi.org/10.1007/s00192-015-2849-8"],"isPartOf":{"@type":"Periodical","name":"Int Urogynecol J"},"author":[{"@type":"Person","name":"Minassian VA"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042","name":"Yan XS","url":"https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042"},{"@type":"Person","name":"Sun H"},{"@type":"Person","name":"Platte RO"},{"@type":"Person","name":"Stewart WF"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Urologic Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Urologic+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Women's Health","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Women%27s+Health%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569#breadcrumblist"}}} ```