Childhood Bladder and Bowel Dysfunction Questionnaire: Development, Feasibility, and Aspects of Validity and Reliability

Objectives: The aim of the study was to develop a questionnaire evaluating the frequency of symptoms over time of concomitant childhood bladder and bowel dysfunctions (CBBDs) in 5- to 12-year-old children and to assess its feasibility and aspects of validity and reliability.

Methods: The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) was developed in phases according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) in cooperation with epidemiologists, pediatricians, physiotherapists (phases 1 and 5), and professional translators (phase 5): selection of items (Delphi-method), content validity (pilot), feasibility (interviews), structural validity and internal consistency (field testing), and guideline-based translation (Dutch-English). Participants were parents of children, ages 5 to 12 years (phases 2-4).

Results: Parents of 1333 children (mean age 7.8 years [standard deviation 2.1]) were included. Most common were urinary incontinence (35.9%), enuresis (29.7%), and constipation/fecal incontinence (30.1%). Concomitant CBBD was seen in 74.2% of 1229 children. Originally, a 27-item CBBDQ was developed. After the pilot (48 parents) a 23-item version remained for evaluation of feasibility aspects by interviewing 56 parents. Based on 1229 completed questionnaires during field testing, the CBBDQ reduced to 18 items. Cronbach a values were 0.74 and 0.71 for bladder and bowel subscales, respectively. Feasibility and aspects of validity and reliability were satisfactory. A definitive and accepted English version of the CBBDQ is available.

Conclusions: When completed by parents, the 18-item evaluative CBBDQ appears feasible, content, and structurally valid with good internal consistency for the bladder and bowel subscales. The Dutch and English versions will be introduced clinically and subjected to further psychometric evaluation.