# Linguistic validation and cognitive assessment of the French version of the Acute Cystitis Symptom Score questionnaire

F Bruyère, A Piraux, J-M Bohbot, C Begue, M Vallée, J Alidjanov, A Pilatz, K G Naber, F M E Wagenlehner

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F Bruyère, A Piraux, J-M Bohbot, C Begue, M Vallée, et al.. Linguistic validation and cognitive assessment of the French version of the Acute Cystitis Symptom Score questionnaire. Progrès en Urologie, 2022, 32 (2), pp.73-76. 10.1016/j.purol.2021.12.001. hal-03513000

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# Linguistic validation and cognitive assessment of the French version of the Acute Cystitis Symptom Score questionnaire

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suppl.
Informations

Validation linguistique et évaluation cognitive de la version française du questionnaire Acute Cystitis Symptom Score (ACSS)

F. Bruyère<sup>a,*</sup>, A. Piraux<sup>b</sup>, J.-M. Bohbot<sup>c</sup>, C. Begue<sup>d,e</sup>, M. Vallée<sup>f,g</sup>, J. Alidjanov<sup>h</sup>, A. Pilatz<sup>h</sup>, K.G. Naber<sup>i</sup>, F.M.E. Wagenlehner<sup>h</sup>

Received 3 September 2021; accepted 3 December 2021
Available online 28 December 2021

**KEYWORDS**
Uncomplicated
urinary tract
infection;

**Summary**

*Introduction.* — The Acute Cystitis Symptom Score (ACSS) questionnaire first developed in Russian and Uzbek languages and now available in many other languages can be used for clinical diagnostics and patient-reported outcome (PRO) in female patients with acute uncomplicated

<footnote><sup>a</sup> Urology Department, University Hospital of Tours, Loire Valley, 2, boulevard Tonnellé, 37044 Tours cedex 9, France</footnote>

<footnote><sup>b</sup> Inserm, CNRS, MINT, SFR ICAT, University Angers, 49000 Angers, France</footnote>

<footnote><sup>c</sup> Institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France</footnote>

<footnote><sup>d</sup> Département de médecine générale, université Angers, 49000 Angers, France</footnote>

<footnote><sup>e</sup> Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail) – UMR_S 1085, SFR ICAT, université Rennes, Angers, France</footnote>

<footnote><sup>f</sup> Department of Urology, Poitiers University Hospital, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France</footnote>

<footnote><sup>g</sup> Inserm U1070, po^le biologie santé, pharmacologie des anti-infectieux, UFR médecine-pharmacie, Poitiers University, 86000 Poitiers, France</footnote>

<footnote><sup>h</sup> Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Rudolph-Buchheimstr, 7, 35392 Giessen, Germany</footnote>

<footnote><sup>i</sup> Department of Urology, Technical University of Munich, Munich, Germany</footnote>

<footnote>* Corresponding author.</footnote>

<footnote>E-mail addresses: f.bruyere@chu-tours.fr (F. Bruyère), arthur.piraux@univ-angers.fr (A. Piraux), jmbohbot@msn.com (J.-M. Bohbot), cyril.begue@univ-angers.fr (C. Begue), maxime.vallee@chu-poitiers.fr (M. Vallée), kurt@nabers.de (K.G. Naber).</footnote>
Acute cystitis;
Acute Cystitis
Symptom Score;
Questionnaire;
Linguistic validation;
Cognitive
assessment;
Female patients;
French version

cystitis (AUC). The aim of the current study was the linguistic validation and cognitive assess-
ment of the French version of the ACSS questionnaire according to internationally accepted
guidelines.

*Methods*. — After two forward translations from Russian into the French language and backward translation into Russian and Uzbek, the two original languages, the scientific committee (SC) performed a slightly adapted French version, which finally was cognitively assessed by female subjects with different ages and educational levels and medical professionals, such as nurses, physicians, and pharmacists.

*Results*. — All comments of the female subjects and professionals were discussed within the SC and after slight, but necessary adaptations, the SC agreed on the final study version of the French ACSS.

*Conclusion*. — Now, the linguistically validated and cognitively assessed French version of the ACSS can be used for clinical studies and practice.

© 2022 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

MOTS CLÉS

Infection urinaire non
compliquée ;
Cystite aiguë ;
Questionnaire ;
Validation
linguistique ;
Femme ;
Français

Résumé

*Introduction*. — Le questionnaire *Acute Cystitis Symptom Score* (ACSS) a été développé, pour la première fois, en langues russe et ouzbek, et est maintenant disponible dans de nombreuses autres langues. Il peut être utilisé pour les diagnostics cliniques et les résultats rapportés par les patientes atteintes de cystite aiguë non compliquées (AUC). Le but de la présente étude était la validation linguistique et l'évaluation cognitive de la version française du questionnaire ACSS selon les lignes directrices internationalement reconnues.

*Méthodes*. — Après deux traductions depuis le russe vers le français, puis du français vers le russe et l'ouzbek, les deux langues originales, le comité scientifique (SC) a réalisé une version française adaptée, qui a finalement été évaluée cognitivement par des sujets féminins d'âges et de niveaux d'éducation différents et des professionnels de la santé, tels que les infirmières, les médecins et les pharmaciens.

*Résultats*. — Tous les commentaires des sujets féminins et des professionnels ont été discutés au sein du SC et après des adaptations légères, mais nécessaires, le SC a approuvé la version finale de l'étude de l'ACSS français.

*Conclusion*. — Désormais, la version française, validée sur le plan linguistique et évaluée cognitivement de l'ACSS, peut être utilisée pour les études cliniques et la pratique.

© 2022 Les Auteurs. Publié par Elsevier Masson SAS. Cet article est publié en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).

Introduction

Acute cystitis is the most frequent bacterial infection in women [1]. The diagnosis of acute uncomplicated cystitis (AUC) can be made with high probability based on a focused history of lower urinary tract symptoms (dysuria, frequency and urgency) and the absence of vaginal discharge or irritation [2]. Various urinary symptoms have been used to assess the diagnosis and severity of UC in women [3–6], but only a few studies developed a questionnaire to also evaluate the severity and impact on activity impairment [4,5], which, however, were not designed for diagnostics of AUC, but only for follow up.

The Acute Cystitis Symptom Score (ACSS) question-
naire was first developed in Uzbek and Russian language
and has been translated and validated in several other
languages, such as German, Hungarian, Italian, UK and
American English [7–12] with many other languages in
preparation.

The ACSS is an 18-item questionnaire divided into 4
domains. The first domain (''Typical'' domain) composed
of 6 items examines typical acute cystitis symptoms, the
second (''Differential'' domain) composed of 4 items exam-
ines symptoms suggesting infection of adjacent or relative
organs (e.g., urethra, vagina, kidney). The third domain
(''QoL'' domain), composed of 3 items examines the impact
of the symptoms on quality of life. There are 4 ranking
choices for each of the above 13 items to accurately measure
the severity of symptoms. The last domain (''Additional''
domain) is composed of 5 additional questions (requiring
simple ''Yes/No'') to gather information on the presence
of known diabetes mellitus and the gynecological profile of
the patient such as menstruation and pregnancy, additional
conditions that may require the appropriate adjustment of
the treatment modality.

The ACSS has proven to be a valuable instrument for clin-
ical studies and medical practice for initial diagnosis, as
well as a patient-reported outcome (PRO) measure moni-
toring the therapeutic efficacy in women suffering from AUC [13,14].

The ACSS can be used for clinical diagnostics and patient-reported outcome (PRO) in female patients with acute uncomplicated cystitis (AUC). The aim of the current study was the linguistic validation and cognitive assessment of the French version of the ACSS questionnaire according to internationally accepted guidelines [15].

## Methods

The Russian version of the ACSS was forward translated into French language by two independent professional translators. From the two French translations, the scientific committee (SC), consisting of the authors, performed a consensus translation, which was backward translated again by two independent translators to Russian and to Uzbek, the two original languages of the ACSS, in order to identify and rule out possible discrepancies. After slight adaptation, this French version of the ACSS was used for the cognitive assessment procedure asking a total of 11 physicians (urologists) and two female nurses to comment on each question of the ACSS about its intelligibility. After slight adaptation also to the American English version, the French version of the ACSS was cognitively assessed again by 17 female subjects with a median (range) age of 46 (20–85) years and different educational levels (no college – 1, college – 5, licence/bachelor – 9, master – 2) and by 6 physicians (3 general practitioners, 1 gynecologist, 2 urologists) and 6 pharmacists. The 2nd part will include female subjects (Ethical committee registration number 2021-069 at 14th April 2021).

## Results

All comments of the female subjects and professionals were discussed within the SC and after slight, but necessary adaptations the SC agreed on the final study version of the French ACSS (Online material Tables 1A and 1B).

## Conclusion

Now, the linguistically validated and cognitively assessed French version of the ACSS can be used for clinical studies and practice to test its suitability and practicability for diagnostics and PRO in female patients with AUC.

## Copyright of the ACSS

The ACSS is copyrighted by the Certificate of Deposit of Intellectual Property in Fundamental Library of Academy of Sciences of the Republic of Uzbekistan, Tashkent (Registration number 2463; 26 August 2015) and the Certificate of the International Online Copyright Office, European Depository, Berlin, Germany (Nr. EU-01-000764; 21 October 2015). The rightsholders are Jakhongir Fatikhovich Alidjanov (Uzbekistan), Ozoda Takhirovna Alidjanova (Uzbekistan), Adrian Martin Erich Pilatz (Germany), Kurt Guenther Naber

(Germany), and Florian Martin Erich Wagenlehner (Germany). The e-USQOLAT is copyrighted by the Authorship Certificate of the International Online Copyright Office, European Depository, Berlin, Germany (Nr. EC-01-001179; 18 May 2017) 19. Translations of the ACSS in other languages are available on the website: http://www.acss.world/downloads.html.

## Author contributions

B.F., A.J., N.K.G., W.F.M.E. had participated in the development of the study plan and design. B.F. chaired the 1st part and P.A. (2nd author) the 2nd part of the cognitive assessment. All authors made up the scientific committee. N.K.G. wrote and revised the first draft of the manuscript. B.F., P.A., A.J. and W.F.M. updated, complemented, and edited the manuscript, which was reviewed, discussed, finalized, and approved by all authors. All authors have read and agreed to the published version of the manuscript.

## Acknowledgement

We would like to thank all medical and pharmaceutical professionals who also took part in the cognitive assessment of the French ACSS version: 1. University Hospital of Tours, Department of Urology, France: Dr Benjamin Faivre d'arcier (urologist), Dr Jean Michel Boutin (urologist), Dr Nicolas Brichart (urologist), Dr Benjamin Pradere (urologist), Dr Rayan Atme (urologist), Florence Claudit (Nurse in urology), Anne Girard (Nurse in urology), Dr Pierre Baron (Resident in urology), Dr Axelle Boehm (Resident in urology), Dr Marina Pizzighella (Resident in urology), Dr Florence Encatassamy (urologist), Dr Tristan Grevez (urologist). 2. Université d'Angers, Faculté de Santé, France; 2.1. Département de Pharmacie: Hichem Bouchenaki, PharmD-PhD, Jacqueline Benoit, PharmD-PhD, Isabelle Baglin, PharmD-PhD, Sébastien Faure, PharmD-PhD, 2.2. **Département de Médecine Générale:** Matthieu Peurois, MD, and Sandra Lemarchand, MD. 3. *Pharmacie des Justices*, Angers, France: Anne Cusin-Cogat, PharmD (Community Pharmacist), Caroline David, PharmD (community pharmacist).

## Disclosure of interest

Kurt G. Naber, Florian M. Wagenlehner, Adrian Pilatz, and Jakhongir Alidjanov are authors and copyright holders of the ACSS questionnaire.

## Appendix A. Supplementary data

Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.purol.2021.12.001.

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