What are the best outcome measures when assessing treatments for LUTD?--achieving the most out of outcome evaluation: ICI-RS 2011

A think tank was convened at the third ICI-RS meeting held in the UK, June 2011, to consider the best outcome measures when assessing treatments for lower urinary tract dysfunction (LUTD). Given the vast array of measures available a focus on questionnaires was decided upon, which continued to highlight a plethora of available tools. The decision was therefore taken to approach this topic from an alternative perspective and instead ask the audience of gathered experts in this field to consider, "What we need to ask as a minimum in order to capture the most fundamental parameters when evaluating new treatments for LUTD?" Discussions highlighted the need for inclusion of a global measure in all outcome evaluations in order to increase comparability between different treatment evaluations and different populations. More specific categories of evaluation identified were: treatment satisfaction, symptom quantification, health related quality of life and adverse events. Further optional components were identified for inclusion where relevant, such as health economic, goal setting and psychosocial evaluation. A "Minimum Outcome Set for Testing (MOST)" was therefore proposed by selecting a health outcome measure from each category while not being prescriptive about specific outcome measurement selection. The 'MOST' toolkit is therefore proposed to promote standardized evaluation in this field and represents a useful starting point for further consideration of this concept.

Quality of life issues in continence care

Urinary and faecal incontinence affect a significant proportion of the population. Both types of incontinence can limit activities of daily living, restrict the individual's ability to function in society and, as a consequence, affect quality of life. Simple treatments and management strategies can be effective, however non-disclosure of symptoms by patients and lack of active diagnosis by clinicians pose significant barriers to the identification of individuals with incontinence, resulting in poor access to treatment. This article will enable readers to identify opportunities within their own practice to focus on quality of life issues in patients with continence problems. Close examination of local practices will help identify goals for improving standards of care for these patients.

A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence

PURPOSE

This study was designed to identify question items required for a comprehensive symptom and quality of life assessment for individuals with anal incontinence.

METHODS

Three substudies addressed the goals: 1) convenience sample of clinical experts was asked to identify symptom items essential to characterize anal incontinence; 2) free-text comments by patients involved in a treatment intervention trial (Norton et al., Gastroenterology 2003;125:1320-9) underwent content analysis to highlight themes regarding life restriction caused by anal incontinence; and 3) qualitative interviews were conducted by using a grounded theory approach with symptomatic patients to identify issues causing impact on quality of life. Terminology for this condition was explored in the interviews to identify the most acceptable phraseology. Finally, the capability of existing anal incontinence questionnaires to capture and assess issues identified as important by patients was assessed.

RESULTS

Seven clinical experts reached consensus that assessment should include the type, frequency and severity of incontinence, whether passive or associated with urgency, ability to delay and discriminate stool type, and "normal" bowel pattern. A total of 284 patients' comments were reviewed and 31 patients were interviewed, highlighting five key issues: unpredictability, toilet location, coping strategies, embarrassment, and social activity restriction. Assessment of available questionnaires for their inclusion of these themes indicates that none currently captures comprehensive information on these issues identified as important by patients.

CONCLUSIONS

Fundamental issues as identified by patients are not currently represented in one overall comprehensive measure. The mixed method approach identified key issues to be assessed to ensure accurate symptomatic assessment and a comprehensive assessment of quality of life impact associated with anal incontinence.