Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale

Figures & data

Table 1. SCI-QOL participant characteristics

Variable	Physical/Medical domain sample (n = 757)	Bladder complications subsample (n = 297)
Age (years)	42.9 ± 15.5	40.6 ± 15.2
Sex
Male	79.1%	77.8%
Female	20.9%	22.2%
Ethnicity
Hispanic	10.6%	12.8%
Non-Hispanic	87.8%	85.9%
Not Reported	1.6%	1.4%
Race
Caucasian	71.1%	68.1%
Black or African-American	17.2%	16.9%
Asian	1.5%	2.4%
American Indian/Alaska Native or Native Hawaiian/Pacific Islander	0.9%	1.3%
More than one race	1.5%	0.7%
Other	6.8%	9.2%
Not Reported	1.1%	1.3%
Time since injury (years)	6.7 ± 9.9	7.6 ± 11.6
<1 year post injury	28.9%	27.6%
1–3 years post injury	27.6%	23.9%
>3 years post injury	43.5%	48.5%
Diagnosis
Paraplegia complete	23.9%	31.1%
Paraplegia incomplete	18.5%	13.2%
Tetraplegia complete	23.1%	28.9%
Tetraplegia incomplete	34.4%	26.8%
Education level
High school or less	38.4%	39.4%
Some college	33.5%	35.4%
Bachelor's degree or higher	28.1%	25.3%
Injury etiology
Motor vehicle accident	32.4%	37.7%
Fall	22.3%	18.9%
Gunshot wound/violence	11.8%	13.5%
Diving	6.6%	5.4%
Other sports	7.4%	8.1%
Medical/Surgical accident	3.7%	2.7%
Motorcycle accident	2.6%	2.7%
Other or not reported	6.2%	10.5%
Method(s) of mobility (not mutually exclusive)
Manual wheelchair	54.4%	55.9%
Power wheelchair	44.1%	49.8%
Ambulation	32.7%	13.1%

Table 2. Bladder Management Difficulties items and IRT parameters

Item ID	Response set*	Item stem	Slope	Threshold 1	Threshold 2	Threshold 3	Threshold 4
rToiletBL_1	A	Bladder management interfered with my sleep	1.16719	0.49669	1.32225	2.18143	2.98756
rToiletBL_5	A	I worried that I would have a bladder accident	2.76165	0.17128	0.82065	1.43408	1.83494
rToiletBL_16	A	I worried about performing my bladder program	1.61663	1.13981	1.85039	2.63301	3.22778
rToiletBL_23	A	I was sad / depressed because of problems with bladder functioning	2.04375	0.80860	1.43685	2.09764	2.59699
rToiletBL_30	A	Bladder accidents limited my independence	3.14633	0.89336	1.33440	1.84038	2.33832
rToiletBL_31	A	I was frustrated by bladder accidents	4.20586	0.55064	1.04089	1.49926	1.87459
rToiletBL_32	A	I was bothered by urine leakage	2.86357	0.34123	0.92878	1.56539	2.14690
rToiletBL_39	B	I spent a lot of time taking care of my bladder program	1.36346	0.10172	0.79277	1.46572	2.04802
rToiletBL_42	B	I restricted my fluid intake in order to manage my bladder	1.04545	0.40994	0.92706	1.98277	2.97543
rToiletBL_72	B	Bladder accidents have disrupted my daily activities	3.85401	0.66154	1.06174	1.82561	2.21694
rToiletBL_73	B	I had to stop what I was doing because of a bladder accident	3.58787	0.58616	1.05381	1.83373	2.20367
rToiletBL_76	B	I had bladder accidents	3.79297	0.35862	0.95416	1.67111	1.94110
rToiletBL_80	C	I felt my bladder management was under control	1.27867	0.50109	1.57824	2.33976	2.54941
rToiletBL_Com11	B	I worried that I would have a bladder accident in public	2.49816	0.47227	1.04258	1.79473	2.27231
rToiletBL_Com26	A	I worried about performing my bladder program in a public restroom	1.65331	1.17300	1.70896	2.39132	3.19058

*Context for all items was: ‘Lately’. Response set A was: 1 = Not at all/2 = A little bit/3 = Somewhat/4 = Quite a bit/5 = Very much. Response set B was: 1 = Never/2 = Rarely/3 = Sometimes/4 = Often/5 = Always. C was: 1 = Always/2 = Often/3 = Sometimes/4 = Rarely/5 = Never.

Bold Font indicates the items selected for the short form.

All SCI-QOL Items Copyright © 2015 David Tulsky and Kessler Foundation. All Rights Reserved. Scales should be accessed and used through the corresponding author or http://www.assessmentcenter.net. Do not modify items without permission from the copyright holder.

Figure 1. Bladder Management Difficulties item bank information and precision.

Table 3. Bowel Management Difficulties items and IRT parameters

Item ID	Response Set*	Item stem	Item response theory calibration statistics
			Slope	Threshold 1	Threshold 2	Threshold 3	Threshold 4
rToiletBO_3	A	I worried about the odor associated with bowel accidents	2.31810	0.33615	0.81416	1.39188	1.75706
rToiletBO_4	A	Bowel accidents limited my independence	3.15488	0.48635	1.02217	1.46920	1.87993
rToiletBO_7	A	A bowel accident has affected my self-esteem	2.85321	0.40136	0.87339	1.24240	1.68935
rToiletBO_12	A	I worried about performing my bowel program.	2.08319	0.40209	0.91889	1.41131	1.96636
rToiletBO_22	A	I was embarrassed by the odor associated with my bowel program	2.68325	0.48671	0.96759	1.54300	1.85690
rToiletBO_24	A	I was bothered by abdominal pain	0.92116	0.95265	1.72548	2.68904	3.62275
rToiletBO_27	A	I worried I would have a bowel accident	3.16184	−0.00796	0.48797	1.04774	1.44477
rToiletBO_29	A	I was upset because of problems with my bowel functioning	2.66956	0.18669	0.67345	1.24687	1.65658
rToiletBO_33	A	I was frustrated by repeated bowel accidents	4.90259	0.59783	0.90898	1.35621	1.67546
rToiletBO_35	A	I was bothered by fluid or loose feces leakage	3.66980	0.69274	1.04905	1.53395	1.82327
rToiletBO_36	A	I was bothered by solid stool leakage	4.15097	0.83184	1.11454	1.59355	1.88010
rToiletBO_38	B	I experienced a major inconvenience due to a bowel accident	4.29925	0.47283	0.89257	1.47547	1.72466
rToiletBO_41	B	I worried that I would have gas at an inappropriate time	1.30189	0.21713	0.85471	1.97587	2.55930
rToiletBO_44	B	My bowel care interfered with my sleep	1.86762	0.62713	1.13647	1.87682	2.36049
rToiletBO_46	B	Bowel accidents have interrupted my daily activities	4.76412	0.41791	0.84927	1.43659	1.77930
rToiletBO_48	B	I wanted more information on option for bowel management	1.39545	0.50884	0.84292	1.62293	2.06327
rToiletBO_52	B	I had bowel accidents	4.01342	0.24540	0.79246	1.46460	1.87867
rToiletBO_56	B	I was embarrassed that I needed a bowel program	1.56788	0.50277	0.92051	1.54907	1.79881
rToiletBO_60	B	I had to stop what I was doing because of a bowel accident	4.14570	0.33154	0.85888	1.52127	2.00432
rToiletBO_61	B	I spent a lot of time taking care of a bowel accident	4.63401	0.38974	0.89181	1.45725	1.92979
rToiletBO_67	B	My bowel program took 3 to 6 hours	0.99238	1.55069	2.06008	2.85185	3.68184
rToiletBO_78	B	My clothing was soiled due to a bowel accident	2.89778	0.43474	1.05601	1.92982	2.33384
rToiletBO_Com1	B	I avoided going out in public because of my bowel program	2.56380	0.73768	1.13590	1.89055	2.38333
rToiletBO_Com26.5	A	My sex life was limited by bowel issues	1.96057	1.11389	1.61193	2.08435	2.47192
rToiletBO_Com25	A	I worried that my social activities would be interrupted by a bowel accident	3.21959	0.25994	0.72228	1.40504	1.78818
rToiletBO_Com22	A	I worried that a bowel accident would disrupt my ability to work	2.53371	0.54510	0.93468	1.51278	1.97153

*Context for all items was: ‘Lately’. All items were scored 1–5. Response set A was: Not at all/A little bit/Somewhat/Quite a bit/Very much. Response set B was: Never/Rarely/Sometimes/Often/Always.

Bold Font indicates the items selected for the short form.

All SCI-QOL Items Copyright © 2015 David Tulsky and Kessler Foundation. All Rights Reserved. Scales should be accessed and used through the corresponding author or http://www.assessmentcenter.net. Do not modify items without permission from the copyright holder.

Figure 2. Bowel Management Difficulties item bank information and precision.

Table 4. Bladder complications (scale) items and IRT parameters

Item ID	Response set*	Item stem	Item response theory calibration statistics
			Slope	Threshold 1	Threshold 2	Threshold 3	Threshold 4
rToiletBL_21	A	A UTI (urinary tract infection) limited my daily activities	1.50995	−0.33428	0.28333	1.25659	2.03664
rToiletBL_28	A	I had an increase in spasms because of a UTI (urinary tract infection)	1.50995	−0.09740	0.43821	1.21022	1.84015
rToiletBL_74	B	I had a urinary tract infection (UTI) that would not go away	1.50995	0.23983	0.97059	1.71530	2.46737
rToiletBL_Com3	B	Bladder issues limited my sex life	1.50995	0.76965	1.23460	1.75779	2.17097
rToiletBL_Com9	B	I avoided going out because of my urinary tract infection (UTI)	1.50995	0.74972	1.46888	2.26813	3.33743

*Context for all items was: ‘Lately’. All items were scored 1–5. Response set A was: Not at all/A little bit/Somewhat/Quite a bit/Very much. Response set B was: Never/Rarely/Sometimes/Often/Always.

The Bladder Complications scale also contains a screener item, rToiletBL_50: ‘I had a urinary tract infection’ (Response set B).

All SCI-QOL Items Copyright © 2015 David Tulsky and Kessler Foundation. All Rights Reserved. Scales should be accessed and used through the corresponding author or http://www.assessmentcenter.net. Do not modify items without permission from the copyright holder.

Table 5. Bladder Management Difficulties and Bowel Management Difficulties: accuracy of variable- and fixed-length CATs and short forms: correlations with full-bank score

Item Bank	Mode	N	No. of items administered			Max	%Min	%Max	Corr. w/ Full-bank score
			Mean	SD	Min
Bladder Management difficulties	Variable-length CAT (min 4)	757	8.44	3.75	4	12	32.72	20.40	0.994
	Variable-length CAT (min 8)	757	10.06	1.98	8	12	46.83	50.40	0.994
	8-item fixed-length CAT	757	8	0	8	8	n/a	n/a	0.979
	8-item short form	757	8	0	8	8	n/a	n/a	0.963
Bowel Management Difficulties	Variable-length CAT (min 4)	757	8.18	3.67	4	12	34.74	43.99	0.969
	Variable-length CAT (min 8)	757	9.86	1.95	8	12	50.99	43.99	0.976
	9-item fixed-length CAT	757	9	0	9	9	n/a	n/a	0.965
	9-item short form	757	9	0	9	9	n/a	n/a	0.960

Corr. = Correlation.

Table 6. Bladder Management Difficulties and Bowel Management Difficulties: breadth of coverage for variable length CAT, fixed length CAT, 8-item short form, and full item bank

Item Bank	Mode	N	T score				Standard error
			Mean ± SD	Range	% Ceiling	% Floor	Mean ± SD	Range
Bladder Management difficulties	Variable-length CAT (min 4)	757	49.89 ± 9.10	37.58–83.78	0.13	17.44	0.37 ± 0.15	0.21–0.63
	Variable-length CAT (min 8)	757	49.88 ± 9.11	37.58–83.78	0.13	17.44	0.36 ± 0.16	0.17–0.63
	8-item fixed-length CAT	757	49.89 ± 8.93	38.86–80.82	0.13	4.49	0.38 ± 0.18	0.17–0.64
	8-item short form	757	49.86 ± 8.72	40.90–81.20	0.13	30.65	4.21 ± 1.87	1.90–6.40
	Full bank	757	49.83 ± 9.14	37.40–84.10	0.13	13.34	3.45 ± 1.68	1.50–6.30
Bowel Management difficulties	Variable-length CAT (min 4)	757	48.36 ± 8.43	37.54–73.84	0.13	2.64	0.350 ± 0.15	0.17–0.56
	Variable-length CAT (min 8)	757	48.36 ± 8.46	37.54–73.85	0.13	2.64	0.328 ± 0.17	0.13–0.56
	9-item fixed-length CAT	757	48.32 ± 8.35	38.90–74.25	0.13	28.53	0.342 ± 0.19	0.12–0.59
	9-item short form	757	48.40 ± 8.31	39.20–76.30	0.40	29.99	0.363 ± 0.18	0.15–0.60
	Full bank	757	48.27 ± 8.68	36.10–77.10	0.13	15.85	0.281 ± 0.18	0.10–0.59

Figure 3. Bladder Management Difficulties: measurement reliability by T-score and assessment method.

Figure 4. Bowel Management Difficulties: Measurement reliability by T-score and assessment method.

Table 7. T-score conversion table for SCI-QOL Bladder Management Difficulties SF8a

Raw score	T-score	Standard error
8	40.9	6.4
9	47.6	4.3
10	49.8	4.1
11	51.8	3.7
12	53.2	3.5
13	54.8	3.0
14	56.0	2.8
15	57.0	2.6
16	58.0	2.6
17	58.9	2.5
18	59.8	2.5
19	60.6	2.4
20	61.4	2.4
21	62.2	2.4
22	62.9	2.4
23	63.7	2.4
24	64.4	2.4
25	65.2	2.4
26	65.9	2.4
27	66.7	2.4
28	67.5	2.4
29	68.3	2.5
30	69.1	2.5
31	69.9	2.6
32	70.8	2.7
33	71.8	2.8
34	72.7	2.9
35	73.8	3.1
36	74.9	3.3
37	76.1	3.4
38	77.5	3.6
39	79.1	3.9
40	81.6	4.4

Table 8. T-score conversion table for SCI-QOL Bowel Management Difficulties SF9a

Raw score	T-score	Standard error
9	39.2	6.0
10	45.4	3.7
11	47.3	3.5
12	49.0	3.1
13	50.2	3.0
14	51.4	2.5
15	52.4	2.4
16	53.3	2.2
17	54.0	2.1
18	54.8	2.1
19	55.5	2.0
20	56.1	2.0
21	56.8	1.9
22	57.4	1.9
23	58.0	1.9
24	58.6	1.9
25	59.2	1.9
26	59.7	1.9
27	60.3	1.9
28	60.9	1.9
29	61.4	1.9
30	62.0	1.9
31	62.6	1.9
32	63.2	1.9
33	63.7	1.9
34	64.3	1.9
35	65.0	1.9
36	65.6	1.9
37	66.3	2.0
38	67.0	2.0
39	67.7	2.1
40	68.5	2.2
41	69.4	2.4
42	70.4	2.5
43	71.6	2.7
44	73.1	3.0
45	76.3	4.0

Table 9. T-score conversion table for SCI-QOL Bladder Complications scale

Raw score	T-score	Standard error
5	39.7	6.6
6	45.8	5.7
7	47.2	5.6
8	49.4	5.4
9	49.5	5.3
10	53.4	5.1
11	55.5	5.0
12	55.9	5.0
13	55.9	4.9
14	58.6	4.9
15	60.3	4.8
16	61.3	4.8
17	63.1	4.8
18	64.4	4.7
19	66.2	4.7
20	66.9	4.8
21	70.8	5.0
22	71.6	5.1
23	73.4	5.2
24	75.0	5.3
25	76.8	6.1