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Welk B. Questionnaires for Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2024; 51:233-238. [PMID: 38609195 DOI: 10.1016/j.ucl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The evaluation of people with neurogenic lower urinary tract dysfunction (NLUTD) often involves objective parameters, however quality of life (QOL) assessments are crucial for patient-centered care. This article discusses how to measure QOL and urinary symptoms in NLUTD and highlights various questionnaires such as the Qualiveen, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Questionnaire (I-QOL). These questionnaires focus on bladder-related QOL or symptoms and have been validated in multiple NLUTD populations. These tools are important for advancing research and the clinical care of NLUTD patients, and have the potential to impact decision-making and improve patient outcomes.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, 268 Grosvenor Street, London, Onatrio N6A 4V2, Canada; Department of Epidemiology and Biostatistics, Western University, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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2
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Kaninia S, Stuart CM, Galea I. Dehydration associates with lower urinary tract symptoms in progressive multiple sclerosis. Eur J Neurol 2024; 31:e16175. [PMID: 38117533 DOI: 10.1111/ene.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are common in persons with progressive multiple sclerosis (pwPMS), who may consequently limit their fluid intake. We aimed to investigate the hypothesis that LUTS associate with objective evidence of inadequate hydration status in pwPMS. METHODS In this prospective study, 55 pwPMS were studied over 2 years. A 6-monthly first-morning urine specimen was analysed for urinary osmolality and sodium as hydration markers. LUTS symptom severity in three categories (urgency, voiding and discomfort) was assessed and quantified using a questionnaire. Correlation between LUTS severity and hydration was assessed within subjects and between subjects, controlling for age. RESULTS Some 274 urine samples with accompanying LUTS data from 55 participants were analysed. Biochemical data showed the expected loss of urine-concentrating capacity with increasing age. Inadequate hydration was observed in 47% of participants. LUTS were very common (87% reported urgency and 89% voiding symptoms). Voiding and discomfort, but not urgency severity, were correlated with hydration markers, both within and between participants. CONCLUSIONS LUTS are very common in pwPMS, and associate with inadequate hydration. The causes and consequences of inadequate hydration in MS need further study, since (i) this will focus greater attention on LUTS management in pwPMS and (ii) dehydration has been associated with reversible cognitive dysfunction and physical underperformance.
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Affiliation(s)
- Stefania Kaninia
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlotte M Stuart
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Groah SL, Rounds AK, Pérez-Losada M. Intravesical Lactobacillus rhamnosus GG Alters Urobiome Composition and Diversity Among People With Neurogenic Lower Urinary Tract Dysfunction. Top Spinal Cord Inj Rehabil 2023; 29:44-57. [PMID: 38076286 PMCID: PMC10644857 DOI: 10.46292/sci23-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Neurogenic bladder is associated with bacterial colonization and frequent urinary tract infections. Objectives To explore the effects of one to two doses of intravesical Lactobacillus rhamnosus GG (LGG) on the urobiomes of adults with spinal cord injury/disease (SCI/D) who manage their bladders with intermittent catheterization (IC). Methods This was a pilot substudy within an 18-month phase 1 clinical trial of self-instilled intravesical LGG for urinary symptoms as directed by the Self-Management Protocol using Probiotics (SMP-Pro). Urine samples were collected monthly when participants were asymptomatic. When SMP-Pro "trigger" symptoms (cloudier and/or more foul-smelling urine) occurred, urine samples were collected immediately pre-LGG instillation and 24 to 48 hours after LGG instillation. Urine was collected via a new catheter, immediately placed on ice/freezer, and processed within 12 hours. Genomic DNA was isolated, and the V4 region of the 16S rRNA bacterial gene was amplified and high throughput sequenced. Amplicon sequence variants were inferred and bacterial composition, community structure, and variation across clinical phenotypes were determined. Results 126 urine samples were collected from 26 participants (SCI/D = 23; multiple sclerosis = 2; spina bifida = 1) between 20 and 57 years of age. The urobiomes were characterized by four dominant phyla (>1%): Bacteroidetes, Firmicutes, Proteobacteria, and Actinobacteria, which were comprised of six dominant genera (>3%): Escherichia/Shigella (29.1%), Klebsiella (22.4%), Proteus (15.2%), Aerococcus (6.3%), Streptococcus (6.0%), and Pluralibacter (3.0%). Post-LGG samples were associated with a decline in Escherichia/Shigella predominance (p < .001) and altered bacterial diversity (p < .05). Conclusion Among people with SCI/D who use IC, intravesical LGG alters the bacterial composition and diversity of the urine ecosystem, potentially disrupting the uropathogenic urobiome.
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Affiliation(s)
- Suzanne L. Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Georgetown University Hospital, Washington, DC
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Marcos Pérez-Losada
- Computational Biology Institute, Department of Biostatistics & Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Tractenberg RE, Groah SL, Frost JK, Yumoto F, Rounds AK, Ljungberg IH. Urinary Symptoms Among People With Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Vary by Bladder Management. Top Spinal Cord Inj Rehabil 2023; 29:31-43. [PMID: 38076287 PMCID: PMC10644852 DOI: 10.46292/sci22-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives To determine whether assessment and decision-making around urinary symptoms in people with neurogenic lower urinary tract dysfunction (NLUTD) should depend on bladder management. Methods Three surveys of urinary symptoms associated with NLUTD (USQNBs) were designed specific to bladder management method for those who manage their bladders with indwelling catheter (IDC), intermittent catheter (IC), or voiding (V). Each was deployed one time to a national sample. Subject matter experts qualitatively assessed the wording of validated items to identify potential duplicates. Clustering by unsupervised structural learning was used to analyze duplicates. Each item was classified into mutually exclusive and exhaustive categories: clinically actionable ("fever"), bladder-specific ("suprapubic pain"), urine quality ("cloudy urine"), or constitutional ("leg pain"). Results A core of 10 "NLUTD urinary symptoms" contains three clinically actionable, bladder-specific, and urine quality items plus one constitutional item. There are 9 (IDC), 11 (IC), and 8 (V) items unique to these instruments. One decision-making protocol applies to all instruments. Conclusion Ten urinary symptoms in NLUTD are independent of bladder management, whereas a similar number depend on bladder management. We conclude that assessment of urinary symptoms for persons with NLUTD should be specific to bladder management method, like the USQNBs are.
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
- Department of Neurology, Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Futoshi Yumoto
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
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Rounds AK, Tractenberg RE, Groah SL, Frost JK, Ljungberg IH, Navia H, Pham CT. Urinary Symptoms Are Unrelated to Leukocyte Esterase and Nitrite Among Indwelling Catheter Users. Top Spinal Cord Inj Rehabil 2023; 29:82-93. [PMID: 36819928 PMCID: PMC9936899 DOI: 10.46292/sci22-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Objectives To explore the association between dipstick results and urinary symptoms. Method This was a prospective 12-month observational study of real-time self-administered urine dipstick results and symptoms in a community setting that included 52 spinal cord injury/disease (SCI/D) participants with neurogenic lower urinary tract dysfunction (NLUTD) who use an indwelling catheter. Symptoms were collected using the Urinary Symptom Questionnaire for Neurogenic Bladder-Indwelling Catheter (USQNB-IDC). The USQNB-IDC includes actionable (A), bladder (B1), urine quality (B2), and other (C) symptoms; analyses focused on A, B1, and B2 symptoms. Dipstick results include nitrite (NIT +/-), and leukocyte esterase (LE; negative, trace, small, moderate, or large). Dipstick outcomes were defined as strong positive (LE = moderate/large and NIT+), inflammation positive (LE = moderate/large and NIT-), negative (LE = negative/trace and NIT-), and indeterminate (all others). Results Nitrite positive dipsticks and moderate or large LE positive dipsticks were each observed in over 50% of the sample in every week. Strong positive dipstick results were observed in 35% to 60% of participants in every week. A, B1, or B2 symptoms co-occurred less than 50% of the time with strong positive dipsticks, but they also co-occurred with negative dipsticks. Participants were asymptomatic with a strong positive dipstick an average of 30.2% of the weeks. On average, 73% of the time a person had a negative dipstick, they also had no key symptoms (95% CI, .597-.865). Conclusion No association was observed between A, B1, and B2 symptoms and positive dipstick. A negative dipstick with the absence of key symptoms may better support clinical decision-making.
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Affiliation(s)
- Amanda K Rounds
- MedStar Health Research Institute, Hyattsville, Maryland
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Rochelle E Tractenberg
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
- Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC
| | - Suzanne L Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Georgetown University Hospital Department of Rehabilitation Medicine, Washington, DC
| | - Jamie K Frost
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
| | - Inger H Ljungberg
- MedStar Health Research Institute, Hyattsville, Maryland
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Herminio Navia
- Georgetown University School of Medicine, Washington, DC
| | - Cynthia T Pham
- Georgetown University School of Medicine, Washington, DC
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Tractenberg RE, Groah SL. Development and Assessment of SCI Model Systems Complicated UTI Consensus Guidelines: A Psychometrically Designed Mixed-Methods Protocol. Top Spinal Cord Inj Rehabil 2022; 28:1-11. [PMID: 36457357 PMCID: PMC9678219 DOI: 10.46292/sci22-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Complicated UTI (cUTI) is highly prevalent among people with spinal cord injury and disease (SCI/D), but neither consistent nor evidence-based guidelines exist. Objectives We propose a two-phase, mixed-methods study to develop consensus around diagnostic and decision-making criteria for cUTI among people with SCI/D and the clinicians who treat them. Methods In phase 1 (qualitative), we will engage Spinal Cord Injury Model Systems (SCIMS) clinicians in focus groups to refine existing cUTI-related decision making using three reliable and validated Urinary Symptom Questionnaires for Neurogenic Bladder (USQNBs; intermittent catheterization, indwelling catheterization, and voiding) as points of departure, and then we will conduct a Delphi survey to explore and achieve consensus on cUTI diagnostic criteria among a nationally representative sample of clinicians from physical medicine and rehabilitation, infectious disease, urology, primary care, and emergency medicine. We will develop training materials based on these new guidelines and will deploy the training to both clinicians and consumers nationally. In phase 2 (quantitative), we will assess clinicians' uptake and use of the guidelines, and the impact of the guidelines training on consumers' self-management habits, engagement with the health care system, and antibiotic use over the 12 months after training. Results The output of this study will be diagnostic guidelines for cUTI among people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, with data on uptake (clinicians) and impact (patients). Conclusion This mixed-methods protocol integrates formal psychometric methods with large-scale evidence gathering to derive consensus around diagnostic guidelines for cUTI among people with NLUTD due to SCI/D and provides information on uptake (clinicians) and impact (patients).
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC
- Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC
| | - Suzanne L. Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Georgetown University Hospital, Washington, DC
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Zhang Y, Chen Y, Niu M, Li Y, Zhang J, Zhang L, Wu F, Chen Q, Yu H, Tian J. Establishing a core outcome set for neurogenic bladder trials: study protocol for a scoping review and Delphi surveys. Trials 2022; 23:485. [PMID: 35698096 PMCID: PMC9195205 DOI: 10.1186/s13063-022-06419-1] [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: 01/02/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Neurogenic bladder (NGB) is a chronic and disabling condition with a high prevalence rate, which can cause economic burden on patients and their families and reduce the quality of life of patients. Researchers have carried out a large number of clinical trials on the effectiveness and safety of different interventions for the treatment of NGB. The published clinical trials of NGB generally suffered from inconsistent and irregular reporting of outcome indicators. To facilitate future research studies of NGB, a core outcome set (COS) is required, which helps translate the results into high-quality evidence. Methods and analysis This mixed-method project has four phases instrument: in phase 1, a scoping review of the literature to identify outcomes that have been reported in clinical trials and systematic reviews of clinical trials of interventions for NGB; in phase 2, a qualitative component using interviews to obtain the views of NGB patients, families, and their caregivers; in phase 3, Delphi survey among stakeholders to prioritize the core outcomes; and in phase 4, a face-to-face consensus meeting to discuss and agree on the final NBG COS. Conclusions We will develop a COS that should be reported in future clinical trials of NGB. Trial registration Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: http://www.comet-initiative.org/studies/details/1985. Registered on 02 January 2022. INPLASY INPLASY202210007
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Affiliation(s)
- Yan Zhang
- Department of Spinal Cord Injury Rehabilitation, Gansu Province Hospital Rehabilitation Center, 53 Dingxi Road, Chengguan District, Lanzhou, 730000, Gansu, China
| | - Yamin Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China
| | - Mingming Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China
| | - Yuanyuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China
| | - Jiaoyan Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China
| | - Li Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China.,The Third Ward of Cardiovascular Clinical Medical Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Fangfang Wu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China.,School of Nursing, Shangluo Vocational and Technical College, City, Shangluo, 726000, China
| | - Qingyun Chen
- Department of Clinical Laboratory, The Sixth People's Hospital of Chengdu City, Chengdu, 610000, Sichuan, China
| | - Huijin Yu
- Department of Spinal Cord Injury Rehabilitation, Gansu Province Hospital Rehabilitation Center, 53 Dingxi Road, Chengguan District, Lanzhou, 730000, Gansu, China.
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Lanzhou City, 730000, Gansu Province, China. .,School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, Gansu, China. .,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China.
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Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol 2022; 14:109-133. [PMID: 35402319 PMCID: PMC8992741 DOI: 10.2147/rru.s273663] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/27/2022] [Indexed: 12/15/2022] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection and cause of secondary bloodstream infections. Despite many advances in diagnosis, prevention and treatment, CAUTI remains a severe healthcare burden, and antibiotic resistance rates are alarmingly high. In this review, current CAUTI management paradigms and challenges are discussed, followed by future prospects as they relate to the diagnosis, prevention, and treatment. Clinical and translational evidence will be evaluated, as will key basic science studies that underlie preventive and therapeutic approaches. Novel diagnostic strategies and treatment decision aids under development will decrease the time to diagnosis and improve antibiotic accuracy and stewardship. These include several classes of biomarkers often coupled with artificial intelligence algorithms, cell-free DNA, and others. New preventive strategies including catheter coatings and materials, vaccination, and bacterial interference are being developed and investigated. The antibiotic pipeline remains insufficient, and new strategies for the identification of new classes of antibiotics, and rational design of small molecule inhibitor alternatives, are under development for CAUTI treatment.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Groah S, Tractenberg RE, Frost JK, Rounds A, Ljungberg I. Independence of Urinary Symptoms and Urinary Dipstick Results in Voiders With Neurogenic Bladder. Top Spinal Cord Inj Rehabil 2022; 28:116-128. [PMID: 35521057 PMCID: PMC9009195 DOI: 10.46292/sci21-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Urinary symptoms and urinary tract infection (UTI) are frequent and burdensome problems associated with neurogenic lower urinary tract dysfunction. Objectives To determine whether an association exists between urinary symptoms and urine dipstick results among individuals with spinal cord injury (SCI) or multiple sclerosis (MS). Methods Prospective 12-month cohort study of 76 participants with SCI or MS who manage their bladders by voiding. Eligibility criteria included adults ≥18 years old, at least three UTIs since diagnosis, and residence in the United States. Participants completed the Urinary Symptoms Questionnaire for Neurogenic Bladder-Voider version (USQNB-V) biweekly (26 assessments) and tested their urine by dipstick at the same time. Symptom burden was estimated based on endorsements of USQNB-V symptoms classified as clinically actionable (9), bladder function (8), and urine quality (4). Urine dipstick results assessed were leukocyte esterase (LE) and nitrite (NIT). Results Participants were stratified into four groups based on etiology of neurologic dysfunction and whether they ever experienced any urinary symptoms (USx): SCI+USx (n = 14), SCI+NoUSx (n = 5), MS+USx (n = 32), and MS+NoUSx (n = 25). In descending order, symptom burden was greatest for the MS+USx group, followed by both SCI groups; it was lowest for MS+NoUSx. We assessed multiple definitions of "positive" dipstick and found evidence of independence of USQNB-V symptoms and urinary dipstick results with each definition. In each group, the median (and majority) of strong positive dipsticks did not coincide with any symptoms. Conclusion Among people with SCI or MS who void, self-administered urine dipstick results and urinary symptom reporting contribute independent information for clinical decision making.
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Affiliation(s)
- Suzanne Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
- Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
| | - Amanda Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Inger Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, Maryland
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Tractenberg RE, Frost JK, Yumoto F, Rounds AK, Ljungberg IH, Groah SL. Reliability of the Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB) who void or use indwelling catheters. Spinal Cord 2021; 59:939-947. [PMID: 34345005 PMCID: PMC8486337 DOI: 10.1038/s41393-021-00665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a descriptive psychometrics study. OBJECTIVES Neurogenic lower urinary tract dysfunction (NLUTD), also called Neurogenic Bladder (NB), is a common and disruptive condition in a variety of neurologic diagnoses. Our team developed patient-centered instruments, Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB), specific to people with NLUTD who manage their bladders with intermittent catheterization (IC), indwelling catheters (IDC), or who void (V). This article reports evidence of reliability of the IDC and V instruments. SETTING Online surveys completed by individuals in the United States with NLUTD due to spinal cord injury (SCI), or multiple sclerosis (MS) who manage their bladder with IDC (SCI, n = 306), or by voiding (SCI, n = 103; MS, n = 383). METHODS Reliability estimates were based on endorsement of the items on the USQNB-IDC and USQNB-V. Reliability evidence was representativeness of these symptoms for a national sample (by determining if endorsement > 10%); internal consistency estimates (by Cronbach's alpha and item correlation coefficient, ICC); and interrelatedness of the items (by inferred Bayesian network, BN). We also tested whether a one-factor conceptualization of "urinary symptoms in NLUTD" was supportable for either instrument. RESULTS All items were endorsed by >20% of our samples. Urine quality symptoms tended to be the most commonly endorsed on both instruments. Cronbach's alpha and ICC estimates were high (>0.74), but not suggestive of redundancy. BNs showed interpretable associations among the items, and did not discover uninterpretable or unexpected associations. Neither instrument fit a one-factor model, as expected. CONCLUSIONS The USQNB-IDC and USQNB-V instruments show sufficient, multidimensional reliability for implementation and further study.
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Affiliation(s)
- Rochelle E Tractenberg
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA.
- Departments of Neurology, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA.
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - Jamie K Frost
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA
| | - Futoshi Yumoto
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA
| | - Amanda K Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, USA
- MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Inger H Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, USA
- MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Suzanne L Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
- MedStar National Rehabilitation Hospital, Washington, DC, USA
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11
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Krebs J. Editorial special edition neuro-urology. Spinal Cord 2021; 59:937-938. [PMID: 34381174 DOI: 10.1038/s41393-021-00683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.
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