Understanding King’s Health Questionnaire (KHQ) in assessment of female urinary incontinence


  • Shripad Hebbar Department of Obstetrics and Gynaecology, KMC Manipal, Manipal University, Manipal, Karnataka
  • Harshita Pandey Department of Obstetrics and Gynaecology, KMC Manipal, Manipal University, Manipal, Karnataka
  • Arun Chawla Department of Urology, KMC Manipal, Manipal University, Manipal, Karnataka


Urinary incontinence (UI), King’s health questionnaire (KHQ), Quality of life (QoL)


Urinary incontinence has emerged as one of the leading medical problems for the geriatric population worldwide. Women are affected physically, mentally and socially and face embarrassment, depression and isolation. Increased life expectancy further adds to the prevalence of the condition and social, economic and health care burden. Although not sinister by itself, urinary incontinence has a profound impact on a woman’s quality of life and warrants appropriate management. The efficacy of interventional procedures is measured by the caregiver mainly by improvement in urodynamic parameters. However, these gadgets do not assess the individual's satisfaction and feeling of wellbeing following the therapeutic intervention. Several generic QoL tools have been developed in an attempt to quantify these changes. But ironically, generic QoL questionnaires lack precision when applied to subjects with specific disease condition. In the context of female urinary problems, various QoL tools have been designed and investigated. King’s Health Questionnaire (KHQ), which was formulated as early as 1997 by the group of researchers from King’s College Hospital London still enjoys popularity till today, because of its strong psychometric properties, ease of administration and it adds objectivity to patient’s subjective symptoms. However, the available information about KHQ is somewhat inadequate for the novice research scholar. The following brief essay aims at easy understanding of implementation, documentation, analysis and interpretation of King’s Health Questionnaire in research settings.



Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49.

Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallett VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:301-19.

Fultz H, Burgio K, Diokno AC, Kinchen KH, Obenchain R, Bump RC. Burden of stress urinary incontinence for community-dwelling women. Am J Obstet Gynecol. 2003;189:1275-82.

Fritel X, Fauconnier A, Levet C, Bénifla JL. Stress urinary incontinence 4 years after the first delivery: a retrospective cohort survey. Acta Obstet Gynecol Scand. 2004;83(10):941-5.

Eliasson K, Larsson T, Mattsson E. Prevalence of stress incontinence in nulliparous elite trampolinists. Scand J Med Sci Sports. 2002;12(2):106-10.

Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Care Pharm. 2014;20(2):130-40.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20.

Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988;26(7):724-35.

Bergner M, Bobbitt R, Carter W, Gibson B. The sickness impact profile: development and final revision of a health status measure. Med Care. 1985;19:787-805.

Hunt SM, McEwen J, McKenna SP. Measuring health status. A new tool for clinicians and epidemiologists. J Roy CON Gen Pract. 1985;35:185-8.

Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.

Garin O, Ferrer M, Pont A, Rué M, Kotzeva A, Wiklund I, et al. Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses. Qual Life Res. 2009;18(1):71-85.

Arranz P, Remor E, Quintana M, Villar A, Díaz JL, Moreno M, et al. Development of a new disease-specific quality-of-life questionnaire to adults living with haemophilia. Haemophilia. 2004;10(4):376-82.

van Doorn RK, Winkler LM, Zwinderman KH, Mearin ML, Koopman HM. CDDUX: a disease-specific health-related quality-of-life questionnaire for children with celiac disease. J Pediatr Gastroenterol Nutr. 2008;47(2):147-52.

Cronin L, Guyatt G, Griffith L, Wong E, Azziz R, Futterweit W, et al. Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS). J Clin Endocrinol Metab. 1998;83(6):1976-87.

Hilditch JR, Lewis J, Peter A, van Maris B, Ross A, Franssen E, et al. A menopause-specific quality of life questionnaire: development and psychometric properties. Maturitas. 1996;24(3):161-75.

Johnson C, Fitzsimmons D, Gilbert J, Arrarras JI, Hammerlid E, Bredart A, et al. Development of the European Organisation for Research and Treatment of Cancer quality of life questionnaire module for older people with cancer: The EORTC QLQ-ELD15. Eur J Cancer. 2010;46(12):2242-52.

Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3:291-306.

Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P. The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. Br J Urol. 1996;77:805-12.

Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP. Quality of life of persons with urinary incontinence: development of a new measure. Urology. 1996;47:67-71.

Wyman JF, Harkins SW, Choi SC, Taylor JR, Fantl JA. Psychosocial impact of urinary incontinence in women. Obstet Gynecol. 1987;70:378-81.

Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104(12):1374-9.

Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C. A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol. 2001;184:552-8.

Hirakawa T, Suzuki S, Kato K, Gotoh M, Yoshikawa Y. Randomized controlled trial of pelvic floor muscle training with or without biofeedback for urinary incontinence. Int Urogynecol J. 2013;24(8):1347-54.

Reese PR, Pleil AM, Okano GJ, Kelleher CJ. Multinational study of reliability and validity of the King’s Health Questionnaire in patients with overactive bladder. Qual Life Res. 2003;12(4):427-42.

Viktrup L, Summers KH, Dennett SL. Clinical practice guidelines for the initial management of urinary incontinence in women: a European-focused review. BJU Int. 2004;94(Suppl 1):14-22.

Kelleher CJ, Pleil AM, Reese PR, Burgess SM, Brodish PH. How much is enough and who says so? BJOG. 2004;111(6):605-12.




How to Cite

Hebbar, S., Pandey, H., & Chawla, A. (2017). Understanding King’s Health Questionnaire (KHQ) in assessment of female urinary incontinence. International Journal of Research in Medical Sciences, 3(3), 531–538. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/1325



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