Validity and Reliability of the Thai Version of
Dysfunctional Voiding Symptom Score (DVSS)
Questionnaire
Nuntawan Piyaphanee MD*, Sarintip Sirikuntaramas MD*, Achra Sumboonnanonda MD*, Walid A Farhat MD**
* Nephrology Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
** Division of Pediatric Urology, Department of Surgery, University of Toronto; The Hospital for Sick Children,
Toronto, Ontario, Canada
Affiliation :
Background : Bladder and bowel dysfunction (BBD) is a common problem and a predisposing factor for urinary tract infection
in children. Evaluation using the Dysfunctional Voiding Symptom Score (DVSS) questionnaire is widely used. The original
English DVSS has been translated to several languages. Thai version of the DVSS would be helpful for early detection and
management of BBD in children.
Objective : To translate and adapt DVSS to Thai version and evaluate validity and reliability of this questionnaire in children
aged 3-10 years.
Material and Method: DVSS English version was translated into Thai according to the following methodology: translation,
synthesis, back-translation, expert reviews, and pre-testing. Patients aged 3 -10 years with a history of diurnal urinary inconti-
nence, urinary tract infection or abnormal voiding habits, presenting to pediatric nephrology or urology clinic, were recruited
as study group. Age-matched children presenting to general outpatient clinic were recruited as control group. Final DVSS-Thai
version was tested and re-tested at the following 1 - 2 weeks. The internal consistency and test–retest reliability was assessed
with Cronbach’s alpha test and intraclass correlation (ICC), respectively. The optimum cutoff score was analyzed using
receiver operating characteristics (ROC) curve.
Results : The back translation to English of Thai version corresponded to the original English DVSS. Age and sex between
the study (n = 22) and control (n = 30) group were not different. Mean total scores of the DVSS were 11.6±4.7 VS 1.9±1.6
(p<0.001) in the study and control group, respectively. Cronbach’s alpha coefficient was 0.8 and intraclass correlation
coefficient (ICC) was 0.906 (p<0.001). The optimum cutoff score was 5 (sensitivity 100% and specificity 96.7%) with area
under the curve of 0.998 (p<0.001).
Conclusion : Thai version of the DVSS was completed by proper process and demonstrated an excellent validity and
reliability. It should be used to identify BBD in Thai children.
Keywords : lower urinary tract dysfunction, bladder and bowel dysfunction, Thai version, questionnaire, validation
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