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Changes in the Patient-Reported Outcomes Measurement Information System (PROMIS) scores following sacral neuromodulation for lower urinary tract symptoms. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J 2021; 32:2033-2092. [PMID: 34037815 DOI: 10.1007/s00192-021-04810-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these. METHODS Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included. RESULTS 85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF). CONCLUSIONS Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.
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Affiliation(s)
- Thomas G Gray
- Department of Urogynaecology and Pelvic Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, c/o Secretary, Room 27.3.024, Level Three, West Block, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Holly Vickers
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Priyanka Krishnaswamy
- Department of Urogynaecology, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Sanderson DJ, Gevelinger M, Jaworski E, Doyle PJ. Sleep disturbance changes in women after treatment of refractory overactive bladder with sacral neuromodulation. Investig Clin Urol 2020; 61:231-237. [PMID: 32158975 PMCID: PMC7052411 DOI: 10.4111/icu.2020.61.2.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/16/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study is to evaluate changes in sleep disturbance following treatment of overactive bladder with sacral neuromodulation. Materials and Methods This is a sub-analysis of data collected from an institutional review board approved retrospective cohort study evaluating women with Patient-Reported Outcomes Measurement Information System-Sleep Disturbance (PROMIS-SD) before and after sacral neuromodulation for overactive bladder between March 2016 and October 2017. Data collected included demographics, clinical characteristics, and additional PROMIS item banks. Within-group analysis was performed with paired t-tests. Groups based up on PROMIS-SD improvement (change <0) were then compared using Fisher's exact test, t-test, or Mann-Whitney U-test as appropriate. Results Those with improved sleep disturbance (n=7) noted a significant mean improvement of -3.99 (95% confidence interval, -6.32, -1.65; p<0.01). Both pre- and post-procedure PROMIS-Physical Function (38.86±2.35 vs. 34.13±5.58, p=0.07 and 37.14±5.10 vs. 35.44±4.74, p=0.53), Pain Interference (60.04±6.34 vs. 65.50±6.20, p=0.13 and 57.89±5.08 vs. 64.73±7.35, p=0.07), Depression (44.2±4.73 vs. 61.29±9.53, p=0.17 and 54.29±6.25 vs. 57.96±11.42, p=0.47) t-scores were similar between sleep response groups. Conclusions Those with improved sleep disturbance reported significant changes after sacral neuromodulation for overactive bladder. However, no significant differences were identified between those with and without improvement. Further investigation of changes in sleep disturbance and factors affecting change are needed within this population.
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Affiliation(s)
- Derrick J Sanderson
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthew Gevelinger
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Elaine Jaworski
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Paula J Doyle
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.,Department of Urology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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Norton JM, Bradley CS, Brady SS, Brubaker L, Gossett D, Henderson JP, Mazloomdoost D, Musil CM, Rovner E, Bavendam T. Individualizing Urinary Incontinence Treatment: Research Needs Identified at NIDDK Workshop. J Urol 2018; 199:1405-1407. [DOI: 10.1016/j.juro.2017.11.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Jenna M. Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Catherine S. Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sonya S. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Linda Brubaker
- Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - Daniel Gossett
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey P. Henderson
- Center for Women's Infectious Diseases Research, Division of Infectious Diseases, and Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Donna Mazloomdoost
- Gynecologic Health and Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Carol M. Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Tamara Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Sung VW, Borello-France D, Dunivan G, Gantz M, Lukacz ES, Moalli P, Newman DK, Richter HE, Ridgeway B, Smith AL, Weidner AC, Meikle S. Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial. Int Urogynecol J 2016; 27:1479-90. [PMID: 27287818 DOI: 10.1007/s00192-016-3031-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. METHODS ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. RESULTS The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. CONCLUSIONS We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.
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Affiliation(s)
- Vivian W Sung
- The Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA. .,Women and Infants Hospital of Rhode Island Division of Urogynecology and Reconstructive Pelvic Surgery, Warren Alpert Medical School of Brown University, 101 Plain Street 5th floor, Providence, RI, 02903, USA.
| | - Diane Borello-France
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Gena Dunivan
- The Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Marie Gantz
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, NC, USA
| | - Emily S Lukacz
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Reproductive Medicine, UC San Diego Health System, San Diego, CA, USA
| | - Pamela Moalli
- Women's Center for Bladder and Pelvic Health, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diane K Newman
- The Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beri Ridgeway
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ariana L Smith
- The Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Alison C Weidner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Susan Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Item bank development, calibration and validation for patient-reported outcomes in female urinary incontinence. Qual Life Res 2016; 25:1645-54. [PMID: 26732514 DOI: 10.1007/s11136-015-1222-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Current patient-reported outcomes for female urinary incontinence (UI) are limited by their inability to be tailored. Our objective is to describe the development and field testing of seven item banks designed to measure domains identified as important UI in females (UIf). We also describe the calibration and validation properties of the UIf-item banks, which allow for more efficient computerized adaptive testing (CAT) in the future. METHODS The UIf-measures included 168 items covering seven domains: Stress UI (SUI), overactive bladder (OAB), urinary frequency, physical, social and emotional health impact and adaptation. Items underwent rigorous qualitative development and psychometric testing across two sites. Items were calibrated using item response theory and evaluated for internal consistency, construct validity and responsiveness. RESULTS A total of 750 women (249 SUI, 249 OAB and 252 mixed UI) participated. Mean age was 55 ± 14 years, and 23 % were Hispanic and 80 % white. In addition to face and content validity, the measures demonstrated good internal consistency (coefficient alpha 0.92-0.98) and unidimensionality. There was evidence for construct validity with moderate-to-strong correlations with the UDI (r's ≥ 0.6) and IIQ (r's = ≥0.6) scales. The measures were responsive to change for SUI treatment (paired t test p < .001, ES range 1.3-2.9; SRM range 1.3-2.5) and OAB treatment (paired t test p < .05 for all domains except social health impact and adaptation, ES range 0.3-1.5, SRM range 0.4-1.0). The measures were responsive based on concurrent changes with the UDI and IIQ (p < 0.05). CAT versions were developed and pilot-tested. CONCLUSIONS The UIf-item banks demonstrate good psychometric characteristics and are a sufficiently valid set of customizable tools for measuring UI symptoms and life impact.
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Abstract
OBJECTIVE To develop a framework that describes the most important symptom outcomes for anal incontinence treatment from the patient perspective. METHODS A conceptual framework was developed by the Pelvic Floor Disorders Network based on four semistructured focus groups and confirmed in two sets of 10 cognitive interviews including women with anal incontinence. We explored: 1) patient-preferred terminology for describing anal incontinence symptoms; 2) patient definitions of treatment "success"; 3) importance of symptoms and outcomes in the framework; and 4) conceptual gaps (defined as outcomes not previously identified as important). Sessions were conducted according to grounded theory transcribed, coded, and qualitatively and quantitatively analyzed to identify relevant themes. Content and face validity of the framework were further assessed using cognitive interviews. RESULTS Thirty-four women participated in focus groups and 20 in cognitive interviews. Overall, 29 (54%) were aged 60 years or older, 42 (78%) were white, and 10 (19%) had a high school degree or less. Two overarching outcome themes were identified: "primary bowel leakage symptoms" and "ancillary bowel symptoms." Subdomains important in primary bowel leakage symptoms included leakage characteristics (symptom frequency, amount of leakage, symptom bother) and conditions when bowel leakage occurs (predictability, awareness, urgency). Subdomains important under ancillary bowel symptoms included emptying disorders (constipation, obstructed defecation, and wiping issues) and discomfort (pain, burning). New outcomes identified included predictability, awareness, wiping issues, and discomfort. CONCLUSION Women with anal incontinence desire a wide range of symptom outcomes after treatment. These are captured in our conceptual framework, which can aid clinicians and researchers in assessing anal incontinence. LEVEL OF EVIEDENCE: II.
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Griffith JW. Self-report measurement of lower urinary tract symptoms: a commentary on the literature since 2011. Curr Urol Rep 2013; 13:420-6. [PMID: 23054508 DOI: 10.1007/s11934-012-0286-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-report assessment of lower urinary tract symptoms (LUTS) is complicated by the many tools that are available. The International Prostate Symptom Score (IPSS) is widely used and highly recommended in review articles and practice guidelines. This review focuses on work completed since 2011 using the IPSS and other tools. The focus of the review is on the merits and weakness of existing tools, as well as a discussion of how to move the field forward, given that there is already a strong base of questionnaires. Some specific trends in health measurement include the use of item response theory and computer adaptive testing, but it is unclear to what extent they will be adopted within urology. Many current studies in urology are making use of single items to assess important symptoms of interest, such as nocturia and incontinence, so future work might seek to catalogue best-in-class, single-question items.
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Affiliation(s)
- James W Griffith
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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Sung VW, Rogers RG, Barber MD, Clark MA. Conceptual framework for patient-important treatment outcomes for pelvic organ prolapse. Neurourol Urodyn 2013; 33:414-9. [PMID: 23494653 DOI: 10.1002/nau.22397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/15/2013] [Indexed: 11/08/2022]
Abstract
AIMS To develop a comprehensive conceptual framework representing the most important outcomes for women seeking treatment for pelvic organ prolapse (POP). METHODS Twenty-five women with POP were recruited and participated in four semi-structured focus groups to refine and assess the content validity of a conceptual framework representing patient-important outcomes for POP. Specifically, the focus groups addressed the following three aims: (1) to evaluate the content and appropriateness of domains in our framework; (2) to identify gaps in the framework; and (3) to determine the relative importance of our framework domains from the patient perspective. Sessions were transcribed, coded, and qualitatively and quantitatively analyzed using analytic induction and deductive analysis to identify themes and domains relevant to women with POP. RESULTS Our focus groups confirmed the importance of vaginal bulge symptoms (discomfort, bother, and adaptation), and the overarching domains and subdomains of physical (physical function and participation), social (social function, relationships, and sexual function), and mental health (emotional distress, preoccupation, and body image). Patients ranked outcomes in the following order of importance: (1) the resolution of vaginal bulge symptoms, (2) improvement in physical function; (3) improvement in sexual function; (4) improvement in body image perception; and (5) improvement in social function. CONCLUSIONS We developed a conceptual framework for patient important outcomes of women seeking treatment for POP. This framework can improve the transparency and interpretation of POP study findings from the patient perspective. Vaginal bulge and its associated discomfort are most important for the definition of POP treatment success from the patient perspective.
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Affiliation(s)
- Vivian W Sung
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
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Improvements in physical activity and functioning after undergoing midurethral sling procedure for urinary incontinence. Obstet Gynecol 2012; 120:573-80. [PMID: 22914466 DOI: 10.1097/aog.0b013e318263a3db] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The primary objective was to estimate the effect of the midurethral sling on improving leisure physical activity levels and physical functioning in women with stress urinary incontinence (SUI). Our secondary objective was to identify possible risk factors for postoperative insufficient physical activity. METHODS We conducted a prospective, observational study of women undergoing outpatient midurethral sling for SUI. Women completed validated questionnaires for incontinence, leisure physical activity, and physical functioning at baseline and 6 months postoperatively. The primary outcome was leisure physical activity level. We used multiple logistic and linear regression to estimate the effect of improvements in urinary symptoms and life effect on physical activity levels and physical functioning scores. RESULTS Ninety women underwent surgery and 85 returned for follow-up. At baseline, 38% had sedentary, 18% had moderate, and 44% had sufficient leisure physical activity levels. Postoperatively, this modestly improved to 26% sedentary, 20% moderate, and 54% sufficient levels. The median leisure physical activity energy expenditure increased from 396 to 693 metabolic equivalent-minutes per week (P=.04). Physical functioning scores also significantly improved (mean score 44 compared with 55 points, P<.001). On multiple logistic regression, improvements in incontinence life effect were associated with increased odds of leisure physical activity improvement (adjusted odds ratio 1.66; 95% confidence interval 1.08-2.54). On multiple linear regression, improvements in both urinary incontinence severity and effect were associated with improvements in physical functioning scores (P<.01 for both). Factors associated with insufficient postoperative physical activity included low baseline physical activity levels and smaller improvements in urinary effect scores. CONCLUSION Midurethral sling and subsequent improvements in urinary incontinence are associated with improved leisure physical activity levels and physical functioning.
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