Refining the Recurrent Urinary Tract Infection Symptom Scale

What is it about?

The Recurrent Urinary Tract Infection Symptom Scale (RUTISS) is a 15-item questionnaire that assesses the patient-reported experience of recurrent UTI symptoms. A bifactor graded response model was fitted to the data, identifying potential items for deletion based on sociodemographic characteristics, contribution to local item dependence, or poor fit or discrimination capability. The final RUTISS comprised a 3-item symptom frequency section, a 1-item global rating of change scale, and an 11-item general 'rUTI symptom and pain severity' subscale with four sub-factor domains. The bifactor model fit indices were excellent, indicating that all items were productive for measurement, and that the mean-square fit statistics indicated that all items were productive for measurement (mean square fit indices [MNSQ] = 0.64 -1.29). The 15-item RUTISS is a patient-generated, psychometrically robust questionnaire that dynamically assesses the patient experience of recurrent UTI symptoms and pain. This brief tool offers the unique opportunity to enhance patient-centered care by supporting shared decision-making and patient monitoring. The RUTISS is developed in accordance with best practice recommendations with international patient and clinical input. Initial pilot testing indicated excellent psychometric properties. Exploratory analysis demonstrated strong content validity, test-retest reliability, internal consistency, construct validity, and structural validity. The current study employed modern confirmatory validation approaches to refine the RUTISS and confirm the questionnaire's factor structure. An international, clinically diverse sample reporting rUTI symptom experiences across the full spectrum of RUTISS scores was achieved. The final 15-item questionnaire demonstrates a clear, well-fitted bifactor structure that minimizes respondent burden while optimally maintaining the breadth of rUTI symptom challenges experienced by this vast patient cohort. An rUTI-specific PROM assessing QoL impact, such as the Recurrent UTI Impact Questionnaire (RUTIIQ), should also be administered. Items included in the final RUTISS loaded highly onto specific sub-factors as well as the general factor, thus the four specific rUTI symptom traits can be separated from the general, overarching symptom factor. Both bifactor model and item fit statistics were excellent, demonstrating the strength of the questionnaire and that both an overall RUTISS severity score may be computed as well as individual domain scores. Internal consistency and reliability of the general factor and sub-factor scales were high, meeting gold-

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Why is it important?

The research is important because it validates the patient perspective on recurrent urinary tract infections (rUTIs) by developing and refining a patient-reported outcome measure (PROM) called the Recurrent Urinary Tract Infection Symptom Scale (RUTISS). This scale is crucial in addressing the urgent need to improve patient monitoring and rUTI management, as it provides a comprehensive evaluation of the patient's experience and symptoms. Key Takeaways: 1. The RUTISS is a 15-item questionnaire that measures the patient-reported experience of rUTI symptoms, demonstrating a clear, well-fitted bifactor structure. 2. The RUTISS measures four specific rUTI symptom traits as well as a general, overarching symptom factor, allowing for the separate evaluation of variance explained by a common, general factor and specific factors. 3. The RUTISS has excellent psychometric properties, including high discrimination capability and strong content validity, and is applicable to a diverse, international patient population. 4. The RUTISS is a patient-generated and patient-tested questionnaire that offers the unique opportunity to enhance patient-centred care by supporting shared decision-making and patient monitoring.