Development and Validation the Uterine Fibroid Symptom and Quality of Life Short-Form: Integrating Classical and Modern Test Theory

Purpose: To develop a shorter version of the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire and evaluate its psychometric properties, aiming to provide a more efficient instrument for symptom and quality-of-life assessment. Patients and Methods: Items were selected using classical test theory (CTT) and item response theory (IRT), and the standardized response mean was used to identify inconsistent items and to evaluate their ability to detect change. The short-form was evaluated for dimensionality, internal consistency reliability, and criterion and known-group validity. Data were obtained from a 20-center prospective cohort of premenopausal Chinese women with symptomatic uterine fibroids who underwent hysterectomy, myomectomy, or HIFU (n = 1939; development n = 969, validation n = 970). Results: To improve adaptability and clinical application, we removed the self-consciousness subscale and retained only one item in the sexual functioning subscale. The resulting 11-item UFS-QoL (UFS-QoL-11) reduced the administrative burden by 70% (from 37 items to 11 items) compared to the original version. It exhibited a strong correlation with UFS-QoL in each domains (all exceeding 0.7). Exploratory factor analysis accounted for 64.22% of total variance, slightly higher than the original scale (63.60%). UFS-QoL-11 demonstrated excellent internal consistency and reliability, and sensitivity in detecting varying levels of current health status. The responsiveness of UFS-QoL-11 was comparable to that of UFS-QoL, with all effect sizes > 0.45. Conclusion: The UFS-QoL-11 demonstrated comparable psychometric performance to the original scale while substantially reducing the number of items. It offers a more efficient instrument for assessing symptom severity and quality of life and shows potential for use in clinical and research settings, although further validation in independent populations is warranted.