Overactive bladder (OAB) is a symptom complex, the hallmark of which is “urinary urgency, usually with urinary frequency and nocturia, with or without urgency urinary incontinence” [1]. Several validated scoring systems exist to examine OAB, however, few are able to capture the full range of its symptoms and severity. A validated OAB Symptom Score (OABSS) developed by Blaivas et al. [2], however, captures a wide range of OAB symptoms, quantifies severity, and includes a graded response for urgency. 

Chinese is the second most spoken language in the world. However, barriers to healthcare in English speaking countries exist in the Chinese patient population due to language and cultural differences. Health literacy among Chinese speakers is higher when they are immersed in communication in Chinese rather than English. Therefore, a translated and validated OABSS in Chinese can provide better urologic health outcomes. 

COVID-19 proved to be a major factor in the increasing use of telehealth in all specialties of medicine. In Urology alone, AUA annual census data showed that telehealth visits may have increased up to 12% [3]. To our knowledge, this is the first urologic survey designed for remote use.

The English version of the OABSS was first translated into Chinese and subsequently back translated into English. The Chinese survey mirrored the original English OABSS and include 7 questions – 5 questions pertaining to urinary urgency and 2 questions pertaining to daytime and nighttime urinary frequency. Chinese speaking patients from a urologic private practice in Brooklyn over the age of 18 years were targeted in this study. Patients who underwent invasive office or operating room procedures were excluded from this study.

The Chinese version of the OABSS was developed by native speakers in the healthcare field and then back translated. The Chinese version of the survey was assessed by native Chinese speaking urologists. The back translated OABSS was assessed by a panel of urologists who specialize in LUTS. All of this was done to ensure the survey had not lost meaning through translation. The survey was first administered to 10 patients to gauge feedback on clarity, simplicity, and overall meaning of the questions to the developers of the survey. No revisions to the survey were made based on feedback from the original 10 patients.

If patients had agreed to participate and met the inclusion criteria, a trained volunteer called them to administer the survey using a prepared script in their respective dialects. Patients were subsequently called again within 14 days by the same trained volunteer who administered the first call. Subjects were asked during the second call if they had any change in urinary symptoms, undergone any urologic procedures, or started any medications in the interim. Patients who had any changes in symptoms, no longer met the inclusion criteria, or could not complete the second survey were excluded from the final analysis. 

SPSS version 28 was used for data analysis. 3 statistical tests for validity were performed: Cronbach’s alpha coefficient for internal validity, Spearman’s coefficient for test-retest validity, and t-test between subgroups for discriminant validity.

A total of 56 patients completed both surveys; 16 (26%) had OAB and 40 (74%) did not have OAB. The 5th question on the survey “How often do you get the sudden urge or desire to urinate that makes you want to stop what you are doing and rush to the bathroom” acted as the proxy question for OAB. 

Cronbach’s alpha score for internal validity was 0.76 on both visits 1 and 2. 

There were strong associations between responses from visit 1 to visit 2. Spearman’s coefficients ranged from 0.62 – 0.92, with all questions and total OABSS showing statistically significant associations (p<0.001). 

Discriminant validity was determined by comparing mean OAB scores from visit 1 and 2 in the OAB and non OAB groups. No significant differences in mean OAB scores were appreciated between visit 1 and visit 2 in both OAB (mean OAB score visit 1 = 21.4, mean OAB score visit 2 = 20.5, p=0.95) and non OAB groups (mean OAB score visit 1 = 15.8, mean OAB score visit 2 = 15.6, p=0.89). However, the OAB group had significantly higher mean OAB scores in both visits 1 (mean OAB score for OAB group = 21.4, mean OAB score for non OAB group = 15.8, p<0.001) and 2 (mean OAB score for OAB group = 20.5, mean OAB score for non OAB group = 15.6, p<0.001) compared to the non OAB group.

The Chinese OABSS proved to have acceptable interval validity, strong test-retest validity, and significant discriminant validity. This newly developed tool will be a useful survey for busy physicians to quickly assess patients for OAB and continue to monitor their OAB symptoms over time. In addition, this survey was specifically designed for remote use in Chinese speaking patients, allowing physicians to adapt to a changing medical landscape.

Multiple analyses of validity demonstrate the usefulness of the Chinese OABSS as a useful tool for assessing the full spectrum of OAB with a graded severity scale. As telehealth visits increase in frequency, OAB symptoms can continue to be monitored adequately in the Chinese-speaking population.

Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5-26.
Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C. Validation of the overactive bladder symptom score. J Urol. 2007;178(2):543-547; discussion 547.
American Urological Association. The state of the urology workforce and practice in the United States. AUA 2020; https://www.auanet.org/research/research-resources/aua-census/census-results