The Recurrent Urinary Tract Infection Symptom Scale (RUTISS): Responsiveness to antibiotic treatment and the minimal clinically important difference

Newlands, A. F. ORCID: https://orcid.org/0000-0002-4718-0075, Tidmarsh, L. V. ORCID: https://orcid.org/0009-0004-0613-1607, Kramer, M., Bradbury, M., Snuggs, S. ORCID: https://orcid.org/0000-0001-5191-9517 and Finlay, K. A. ORCID: https://orcid.org/0000-0002-8997-2652 (2026) The Recurrent Urinary Tract Infection Symptom Scale (RUTISS): Responsiveness to antibiotic treatment and the minimal clinically important difference. Urology. ISSN 1527-9995 doi: 10.1016/j.urology.2026.01.020 (In Press)

Abstract/Summary

Objective To evaluate the responsiveness of the Recurrent Urinary Tract Infection Symptom Scale (RUTISS) to antibiotic treatment and determine the minimal clinically important difference (MCID). Methods Female adults with recurrent UTI (N=108, mean age=53.6 years) completed a repeated-measures, longitudinal, 40-day naturalistic follow-up study. For participants initiating and completing antibiotic treatment within this period, RUTISS scores were evaluated at baseline (two days pre-treatment), Day 1 of treatment, Day 3, and at follow-up (seven days post-treatment). Responsiveness was assessed using effect sizes pre- and post-treatment (rank-biserial correlation), Spearman’s rank correlations with anchor measures (Patient Global Impression of Change, PGIC, and UTI Symptom Assessment, UTISA), and receiver operating characteristic (ROC) analysis. The MCID was triangulated via anchor- and distribution-based methods. Results The RUTISS total score demonstrated excellent responsiveness between all timepoints and was strongest between baseline and Day 3 (rank-biserial r=.52), with strong correlations with the PGIC (Spearman’s =.73) and UTISA (Spearman’s =.63). ROC analysis indicated excellent discrimination for detecting even minimal improvement (AUC=.82). The recommended MCID was 6.5 points, exceeding the standard error of measurement. All subscales demonstrated good to excellent responsiveness. Conclusion The RUTISS demonstrates excellent responsiveness to antibiotic treatment providing a validated MCID, enabling precise interpretation of treatment effects. As the first fully validated PROM for recurrent UTI, the RUTISS addresses a critical unmet need to assess patient symptom reporting. By providing a responsive and interpretable patient-centred endpoint, the RUTISS enables adequately powered clinical trials and evidence-based symptom monitoring, directly supporting improved patient care and intervention development.

Item Type	Article
URI	https://centaur.reading.ac.uk/id/eprint/127954
Identification Number/DOI	10.1016/j.urology.2026.01.020
Refereed	Yes
Divisions	Interdisciplinary centres and themes > Pain Research Life Sciences > School of Psychology and Clinical Language Sciences > Department of Psychology Life Sciences > School of Psychology and Clinical Language Sciences > Nutrition and Health
Uncontrolled Keywords	Recurrent urinary tract infection; patient-reported outcome measure; patient outcomes; symptom assessment; responsiveness; minimal clinically important difference; sensitivity to change
Publisher	Elsevier
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