ICIQ Structure Short Form

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Module Title

ICIQ-UI Short Form

Full Name of Module

ICIQ-Urinary Incontinence Form

Purpose of module The ICIQ-UI Short Form provides a brief and robust measure to assess the impact of symptoms of incontinence on quality of life and outcome of treatment. This short and simple questionnaire is also of use to general practitioners and clinicians in both primary and secondary care institutions to screen for incontinence, to obtain a brief yet comprehensive summary of the level, impact and perceived cause of symptoms of incontinence and to facilitate patient-clinician discussions. Its brevity also makes the ICIQ-UI Short Form an ideal research tool.
Derivation of module New Instrument
Intended Population Adult males and females
Number of items 4
Question items

Frequency of urinary incontinence
Amount of leakage
Overall impact of urinary incontinence
Self-diagnostic item

Lanuage versions available

Afrikaans
Arabic
Australian-English
Brazilian-Portuguese
Bulgarian
Czech
Danish
Dutch
Estonian
Finnish
French
German
Greek
Hungarian
Icelandic

Italian
Japanese
New Zealand-English
Norwegian
Polish
Romanian
Russian
Slovakian
South African-English
Spanish
Swedish
Turkish
Ukrainian
UK-English
US-English

Associated publications Avery K, Donovan J, Peters T, Shaw C, Gotoh M, & Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol.Urodyn. 2004; 23(4) :322-30.
Level of validation according to ICI grades of recommendation Grade A new
Validity, reliability and responsiveness established with rigour in one data set
Scoring system

0-21 overall score with greater values indicating increased severity
Self-diagnostic item unscored

Suggested modules to use in conjuction

ICIQ-MLUTS ; ICIQ-FLUTS - Gender-specific symptom modules
ICIQ-MLUTSsex ; ICIQ-FLUTSsex - Gender-specific sexual matters modules

completion time A few minutes

Request Questionnaire

Post-Treatment

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