1. The Arabic Translation and Validation of the ICI Vaginal Symptoms Questionnaire Wael Agur MD MRCOG Consultant Urogynaecologist Honorary Senior Clinical Lecturer University of Glasgow 2 nd Annual International Meeting of the RCOG Egyptian Representative Committee Cairo, March 2012

2. Objectives Importance of Questionnaire Use Why the ICIQ-VS? Translation and Validation Protocol

3. Objectives Importance of Questionnaire Use Why the ICIQ-VS? Translation and Validation Protocol

4. The Surgical Ship Sea / See Level Vaginal atrophy High expectations Pelvic Organ Prolapse

5. And the Iceberg Pelvic Organ Prolapse Under-diagnosisOver-diagnosis Vaginal atrophy High expectations ‘Loose’ vagina Inspired by Pescatori et al 2006, A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Disease. Sexual Matters Chronic constipation Reduced sensations Vaginal digitation ‘Sore’ vagina ‘Tight’ vagina Sea / See Level

6. Symptoms and Scores

9. Clinical need for a VS-Q Currently, no clear data on the exact prevalence of prolapse in the Arab world Social, cultural and environmental factors are believed to contribute to a ‘culture of silence’ and is likely to imply a high, unmet need for services Younis N, Khattab H, Zurayk H, El-Moelhy M, Farag A. A community study of gynaecological and related morbidities in rural Egypt. Studies in Family Planning 1993, 24:175-186.

10. Clinical need for a VS-Q To provide Arabic-speaking women and their health professionals with a validated questionnaire in their own language To enable them to express their bothersome issues on a confidential, self-completed form

11. Research need for a VS-Q √

12. Objectives The importance of questionnaire use Why the ICIQ-VS? The translation and validation protocol

13. VS Questionnaires

16. Copyright ©The ICIQ Group

17. Arabic ICIQ-VS

18. Aim To develop the first validated questionnaire in the Arabic language assessing vaginal symptoms in clinical practice and research contexts in the Middle-East

19. Objectives The importance of questionnaire use Why the ICIQ-VS? The translation and validation protocol

20. Translation Protocol Literal translation and adaptation –to formal Arabic by a bilingual native Arabic speakers (completed) Back translation –to English by a bilingual native English speakers (by mid March 2012) Review(s) of translations –Panel of native English & Arabic speakers (May 2012)

21. Validation Protocol-1 Content validity –Face validation –20 patients in Egypt and Saudi Arabia (Aug 2012) Construct validity –relationships to underlying VS theories –difference between community-based (n=50) women and those attending urogyn clinics (n=120)

22. Stability –Scores remain similar after 4 weeks with no treatment (2012/2013) Responsiveness –Significant change in scores following treatment (2012-2013) Internal consistency –Correlation between questions –Cronbach’s alpha coefficient of (0.7–0.8) Validation Protocol-2

23. Considerations Ethics –North Bristol REC, UK –Individual Institutions Funding –The ICIQ Group –Ayrshire Urogynaecology Fund

24. Conclusion Questionnaire use is important in both clinical practice and research contexts. The Arabic ICIQ-VS has the potential to prove reliable and valid and be widely used to empower Arabic-speaking women to better express symptoms and monitor treatment

26. Thank you wael.agur@gla.ac.uk