Introduction
The Pelvic Floor Distress Inventory-20 (PFDI-20) is an essential, condition-specific questionnaire for assessing pelvic floor disorders (PFDs) in women. Developed by authors M. D. Barber, M. D. Walters, and R. C. Bump.It is initially published in the American Journal of Obstetrics & Gynecology in 2005, this tool is useful in both clinical practice and research. Its primary purpose is to evaluate the presence and severity of PFD symptoms and, consequently, their impact on a woman’s quality of life. Having accumulated over 1,600 citations on Google Scholar, the PFDI-20’s reliability and significance in the field of gynecology are well-established.
This article provides a comprehensive guide to its key features, applications, and clinical value, ultimately offering actionable insights for clinicians and researchers.
Key Features of Pelvic Floor Distress Inventory-20 (PFDI-20)
Purpose and Use
The core purpose of the PFDI-20 is to screen and measure symptoms of pelvic floor disorders in women. Due to its focused design, it serves as a valuable tool for clinicians and researchers who specialize in gynecology and women’s health.
Target Population
The PFDI-20 targets an adult population aged 18 and older including:
- Young Adults (18-24 years)
- Middle-Aged Adults (25-44 years)
- Older Adults (45-64 years)
- Seniors (65+ years)
Structure
The PFDI-20 is a concise 20-item questionnaire that consists of three distinct subscales, each focusing on a specific symptom cluster within the pelvic region.
- Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6): which has six questions, covers symptoms of pelvic organ prolapse like a feeling of bulging or vaginal pressure.
- Urinary Distress Inventory 6 (UDI-6): which also has six questions, addresses urinary tract symptoms such as urinary leakage or difficulty urinating.
- Colorectal-Anal Distress Inventory 8 (CRADI-8): which has eight questions, assesses lower gastrointestinal symptoms like constipation or fecal incontinence.
Scoring Method
Each item on the PFDI-20 uses a 5-point Likert scale to measure symptoms over the past three months. The scale ranges from 0 (“not present”) to 4 (“quite a bit”).
To obtain the score for each scale, calculate the mean value of all answered items, and multiply this value by 25 to achieve a scale score ranging from 0 to 100. For missing items use the mean from answered items only.
A higher score indicates greater distress.
In order to obtain the PFDI–20 Summary Score, add the scores from the three subscales together, this will result in a total score that ranges from 0 to 300. It is important to note that, as of now, no official cut-off scores have been universally established for the PFDI-20.
Administration Format
The PFDI-20 is an efficient tool, typically taking only 5 to 10 minutes to complete. Its administration is flexible, as clinicians can used it via:
- Paper-based forms
- Digital (Online)
- In-person interviews.
Notably, no training is required as it is a self-administered questionnaire.
Applications of Pelvic Floor Distress Inventory-20 (PFDI-20)
The PFDI-20 is a valuable tool with a variety of applications in clinical and research settings.
- screening: clinicians can use it to identify patients who may be experiencing pelvic floor distress.
- Research: researchers use the PFDI-20 as a reliable measure to evaluate the effectiveness of interventions and treatments for pelvic floor disorders.
Languages and availability
The PFDI-20 is widely available and has been translated in numerous languages, including:
- Arabic
- English
- Spanish
- French
- Russian
- German
While the questionnaire is free for clinical and academic (non-commercial) purposes, permission may be required for commercial use or for integrating it into digital tools.
Reliability and Validity
The PFDI-20 is highly reliable and valid, with Cronbach’s alpha values ranging from 0.70 to 0.95 across subscales. Numerous studies have shown its validity such as:
- The Original validation study link
- The Iranian version validation link
- The Danish version validation link
- The Korean version validation link
Limitations and Considerations
Despite its strengths, the PFDI-20 has a few limitations:
- Self-report measure: Since the tool relies on self-reported data, patient’s subjective perception may influence responses.
- social desirability bias: Respondents may answer in a way that is viewed favorably by others, which could inflate scores.
- Narrow focus: The questionnaire may not capture all psychological or emotional factors associated with pelvic floor disorders.
Other Versions and Related Questionnairs
For researchers, it is beneficial to recognize that the PFDI-20 is a shortened version of the original PFDI-46. Additionally, clinicians often use it alongside related questionnaires, such as:
- Pelvic Floor Impact Questionnaire (PFIQ-7)
- Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)
- International Consultation on Incontinence Questionnaire (ICIQ series).
Additional Resources
- The Original Validation Study link
- You can access the questionnaire as a PDF through this link
- For inquiries, contact Dr. M.D. Barber: barberm2@ccf.org
Frequently Asked Questions (FAQ)
- Who can use the PFDI-20?
Clinicians, researchers, and healthcare providers use the PFDI-20 for women aged 18 and older who are experiencing symptoms of pelvic floor disorders. - How long does it take to complete the PFDI-20?
Patients typically take 5 to 10 minutes to complete the PFDI-20, which makes it feasible for use in clinical and research settings. - How is the PFDI-20 administered?
Healthcare teams can administer the questionnaire via paper-based forms, digital platforms, or through an in-person interview—offering flexibility in usage. - Is there any cost to using the PFDI-20?
The PFDI-20 is free for non-commercial use. For commercial or funded academic projects, permission may be necessary, as the tool is considered proprietary.
A Word from ResRef about Pelvic Floor Distress Inventory-20 (PFDI-20)
The PFDI-20 is a brief, reliable, and validated tool essential for the assessment of pelvic floor dysfunction symptoms and their impact. Moreover it is useful in both clinical and research settings.
References
- Barber, M., Walters, M. D., & Bump, R. C. (2005). Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). American journal of obstetrics and gynecology, 193(1), 103-113.link
- Mashayekh-Amiri, S., Asghari Jafarabadi, M., Rashidi, F., & Mirghafourvand, M. (2023). Translation and measurement properties of the pelvic floor distress inventory-short form (PFDI-20) in Iranian reproductive age women. BMC Women’s Health, 23(1), 333.link
- Due, U., Brostrøm, S., & Lose, G. (2013). Validation of the Pelvic Floor Distress Inventory‐20 and the Pelvic Floor Impact Questionnaire‐7 in Danish women with pelvic organ prolapse.Acta Obstetricia et Gynecologica Scandinavica, 92(9), 1041-1048.link
- Yoo, E. H., Jeon, M. J., Ahn, K. H., & Bai, S. W. (2013). Translation and linguistic validation of Korean version of short form of pelvic floor distress inventory-20, pelvic floor impact questionnaire-7. Obstetrics & Gynecology Science, 56(5), 330.link
