Forty studies were included in the review. Sample sizes ranged from 25 to 4,500, but the total number of participants was unclear. All the studies for which designs were reported were cohort studies (prospective, retrospective or unclear).
Simple questions were modestly useful (summary positive LR 2.2, 95% CI: 1.6, 3.2; negative LR 0.39, 95% CI: 0.25, 0.61) for diagnosing stress incontinence, based on 10 studies with significant heterogeneity. Questions were more helpful for diagnosing urge incontinence (summary positive LR 4.2, 95% CI: 2.3, 7.6; negative LR 0.48, 95% CI: 0.36, 0.62), based on 10 studies with some heterogeneity (all p<0.08).
Based on 5 cohort studies, a positive stress test made stress incontinence more likely and a negative test less likely (summary positive LR 3.1, 95% CI:1.7, 5.5; negative LR 0.36, 95% CI: 0.21, 0.6); heterogeneity was not statistically significant. A positive Q-tip test did not contribute to the diagnosis of stress incontinence, although a normal result decreased the likelihood of urge incontinence (2 studies). The pad test and Larsson nomogram were evaluated in one study each and were not considered to be useful.
Overall clinical assessment.
A systematic assessment combining history, clinical examination and bedside tests appeared to be of modest value for diagnosing stress incontinence (summary positive LR from 4 studies 3.7, 95% CI: 2.6, 5.2; negative LR 0.20, 95% CI: 0.08, 0.51); heterogeneity was significant for the negative LR. Two studies of urge incontinence indicated that the overall assessment is less valuable for diagnosing this condition (summary positive LR 2.2, 95% CI: 0.55, 8.7; negative LR 0.63, 95% CI: 0.34, 1.17); heterogeneity was significant for the positive LR.