Validation of the VALue of UteruS (VALUS) instrument in brazilian portuguese language for women with uterine fibroids and endometrial polyps: a cross-sectional study

Valvano, Fernanda Rios; Buhl, Carolina Neves; Pereira, Glaucia Miranda Varella; Chang, Olivia Hui-Chiu; Leonardo-Pinto, Joao Paulo; Brito, Luiz Gustavo Oliveira

doi:10.61622/rbgo/2026rbgo20

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Sumário

Original article • Rev Bras Ginecol Obstet 48 • 2026 • https://doi.org/10.61622/rbgo/2026rbgo20 linkcopy

Validation of the VALue of UteruS (VALUS) instrument in brazilian portuguese language for women with uterine fibroids and endometrial polyps: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To translate and culturally validate the VALue of the UteruS (VALUS) instrument in Brazilian Portuguese language and to identify predictors for VALUS score.

Methods: A cross-sectional study (February to November 2024) at a tertiary, academic hospital was performed with 164 women presenting symptomatic uterine fibroids (UF) (n=139) or endometrial polyps (n=25) that underwent hysterectomy or myomectomy/polypectomy. The VALUS instrument was translated and culturally validated first. Psychometric variables (internal consistency, test-retest, discriminant validity) were calculated. Women completed the VALUS instrument prior to the decision-making process to undergo surgery. The Uterine Fibroid Symptoms-Quality of Life (UFS-QOL) was also completed for women with UF. Uni- and multivariate linear regression was calculated to seek for associated factors with the VALUS total score.

Results: Women that underwent hysterectomy were older, with higher education, higher parity and frequency of abdominal/pelvic surgeries than the non-hysterectomy group. VALUS scores were statistically higher in the non-hysterectomy for some questions and total score. Internal consistency of the VALUS instrument was excellent (alpha=0.890) and test-retest analysis did not differ between the groups (p=0.891). The UFS-QoL quality of life score presented a negative correlation with VALUS instrument. Multivariate linear regression demonstrated that the presence of abdominal/pelvic surgeries was associated with a lower VALUS score.

Conclusion: VALUS demonstrated adequate internal consistency and reliability, but with low discriminant validity for the prediction of hysterectomy versus uterine-preservation in women with UF or endometrial polyps. Presence of abdominal/pelvic surgery is associated with a lower VALUS score.

Keywords
Hysterectomy; Uterus; Uterine myomectomy; Leiomyoma; Endometrial polyps; Visual Analog Scale; Psychometrics

Variables		Hysterectomy (n=96)		Non-hysterectomy (n = 68)		p-value
Variables		n(%)	Mean ± SD	n(%)	Mean ± SD	p-value
Age (Years)			45.76 ± 4.53		36.69 ±7.80	<0.001*
Ethnicity	White	37(38.54)		30(44.12)		0.474
Ethnicity	Non-white	59(61.46)		38(55.88)
Years of education			13.07 ± 4.37		11.55 ± 4.51	0.042*
Number of pregnancies, birth and abortions	Pregnancy		2.21± 1.65		1.68 ± 1.89	0.008*
	Vaginal delivery		0.75 ± 1.15		0.76 ± 1.57	0.429
	Cesarean section		1.09 ± 1.22		0.63 ± 1.01	0.004*
	Abortions		0.36 ± 0.76		0.28 ± 0.67	0.442
Weight (kilos)			79.20 ± 17.76		80.81 ± 16.65	0.266
Height (meters)			1.63 ± 0.07		1.62 ± 0.06	0.295
BMI (KG/M2)			30.17 ± 5.69		29.93 ± 6.29	0.545
Abdominal/pelvic surgery	Yes	73(76.84)		39(58.21)		0.012**
Abdominal/pelvic surgery	No	22(23.16)		28(41.79)
Sexual activity	Yes	72(75)		57(83.82)		0.174
Sexual activity	No	24(25)		11(16.18)
Comorbidities	Yes	59(61.46)		36(52.94)		0.276
Comorbidities	No	37(38.54)		32(47.06)

	Hysterectomy (n=96)	Non-hysterectomy (n = 68)	p-value*
	Mean (± SD)	Mean (± SD)	p-value*
VALUS Q1	2.22 ± 1.26	2.76 ± 1.32	0.007
VALUS Q2	2.18 ± 1.21	2.62 ± 1.32	0.023
VALUS Q3	2.36 ± 1.38	2.78 ± 1.41	0.063
VALUS Q4	2.45 ± 1.39	2.66 ± 1.45	0.380
VALUS Q5	2.38 ± 1.42	2.53 ± 1.46	0.520
VALUS Q6	2.18 ± 1.26	2.43 ± 1.29	0.181
Total Score	13.76 ± 6.49	15.78 ± 6.40	0.036

	Hysterectomy (n = 96)				Non-hysterectomy
	Item-test	Item-rest	Co-variance	Alpha	(n = 68)	Item rest	Co-variance	Alpha
VALUSQ1	0.727	0.676	3.174	0.781	0.693	0.633	3.056	0.773
VALUSQ2	0.819	0.785	3.102	0.774	0.764	0.715	2.976	0.766
VALUSQ3	0.784	0.738	3.052	0.772	0.753	0.699	2.943	0.764
VALUSQ4	0.849	0.815	2.967	0.764	0.777	0.725	2.897	0.760
VALUSQ5	0.861	0.828	2.939	0.762	0.810	0.765	2.850	0.756
VALUSQ6	0.872	0.845	3.013	0.767	0.860	0.831	2.885	0.756
Mean				0.802				0.867

Independent variable	Crude beta (95% CI)	p-value	Adjusted beta* (95% CI)	p-value
Age	-0.101(-0.249 to 0.047)	0.180	-0.040(-0.209 to 0.129)	0.639
Ethnicity	-0.139(-1.236 to 0.958)	0.803
Years of education	0.103(-0.122 to 0.329)	0.368
BMI	-0.131(-0.303 to 0.040)	0.132	-0.091(-0.265 to 0.083)	0.304
Parity	-0.611(-1.174 to -0.048)	0.034	-0.327(-0.968 to 0.313)	0.314
Previous abdominal/pelvic surgery	-3.854(-5.952 to -1.755)	<0.001	-3.202(-5.527 to -0.877)	0.007
Presence of sexual activity	0.214 (-2.242 to 2.672)	0.863
Comorbidities	-1.770(-3.791 to 0.250)	0.086	-0.955(-3.073 to 1.161)	0.374

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[TFN1] ^*
t-Student test;

[TFN2] ^**
chi-square test; bold p-values are statistically significant