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Islamoska S, Forman CR, Panicker JN, Flachenecker P, Phé V, Brichetto G, Blok B, Barken KB. The impact of bladder problems on well-being in multiple sclerosis - A cross-sectional study. Mult Scler Relat Disord 2024; 87:105661. [PMID: 38728957 DOI: 10.1016/j.msard.2024.105661] [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] [Received: 10/10/2023] [Revised: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) frequently suffer from bladder problems that are not identified and managed optimally, reducing quality of life and increasing risk of health consequences. OBJECTIVE This study aimed to investigate associations between bladder problems and well-being of pwMS. METHODS The study included 1872 pwMS from France, Germany, Italy, and the UK self-reporting on demographics, MS status, bladder problems and management, and well-being. Logistic regression analyses were performed to investigate associations with self-reported well-being. RESULTS Population mean age was 51 years and 79 % were women. Among pwMS, 55 % reported bladder problems indicating overactive bladder (OAB), and 40 % reported self-experienced urinary retention. Self-management of bladder problems was reported by 32 %, 33 % were yet to have problem resolution, and 45 % reported a wish to receive bladder management help. Additionally, 35 % of pwMS reported that bladder problem onset preceded awareness of a link to MS. OAB, problem self-management, and urinary complications were significantly associated with lower well-being. CONCLUSION Bladder problems affect pwMS across disease subtypes and many attempt self-management. Consequently, pwMS with bladder problems are more likely to experience lower well-being, suggesting an unmet need. Raising awareness of the link between bladder problems and well-being could benefit pwMS living with bladder problems.
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Affiliation(s)
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, UK; UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Véronique Phé
- Sorbonne University, Tenon Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Bertil Blok
- Department of Urology, Section of Neuro-Urology, Erasmus Medical Center, Rotterdam, the Netherlands
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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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3
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Kajbafvala M, Ashnagar Z, Lucio A, Firoozeh F, Salehi R, Pashazadeh F, Dadgoo M, Jafari H. Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 59:103559. [DOI: 10.1016/j.msard.2022.103559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 01/10/2023]
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Malde S, Kelly S, Saad S, Sahai A. Case‐finding tools for the diagnosis of OAB in women: A narrative review. Neurourol Urodyn 2020; 39:13-24. [DOI: 10.1002/nau.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Sanad Saad
- Department of Urology Guy's Hospital London UK
| | - Arun Sahai
- Department of Urology Guy's Hospital London UK
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5
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Polat Dunya C, Tulek Z, Vızvız GY, Gündüz T, Panicker JN, Kürtüncü M, Eraksoy M. Validation of the Turkish version of the eight-item actionable bladder symptom screening tool in multiple sclerosis. Neurourol Urodyn 2019; 39:243-252. [PMID: 31588627 DOI: 10.1002/nau.24177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/19/2019] [Indexed: 11/09/2022]
Abstract
AIMS This study aimed to translate the eight-item Actionable Bladder Symptom Screening Tool (ABSST) and determine its psychometric properties in Turkish speaking subjects. METHODS The study was conducted at the multiple sclerosis (MS) outpatient clinic of the Istanbul Faculty of Medicine, Istanbul University. First, the ABSST was translated into Turkish by an expert panel. We employed the back translation method for linguistic validation. Cronbach's α and test-retest analysis were performed for reliability analysis. The overactive bladder-v8 (OAB-v8) questionnaire was also administered for concurrent validation, and expanded disability status scale (EDSS) and multiple sclerosis quality of life scale-54 (MSQL-54) were used to evaluate construct validity. RESULTS One hundred and five patients (84 females; mean age, 39.5 ± 11.6 years; mean EDSS score, 3.2 ± 1.8) participated in the study. Mean duration of MS was 9.7 ± 8.3 years, and most (n = 96; 91.5%) had relapsing-remitting MS. The mean ABSST score was 9.7 ± 5.8 (range, 0-21). Highest scores were obtained from urgency and frequency, and the lowest from psychosocial effects of lower urinary tract (LUT) symptoms. The Cronbach's α coefficient was 0.856, and item-total score correlations ranged between 0.485 and 0.845. Correlations of ABSST scores with OAB-v8, EDSS, and MSQL-54 scales were significant (P < .001). According to the questionnaire, 38.1% (n = 40) of the patients needed a referral to a urologist or gynecologist for their LUT symptoms. CONCLUSIONS The Turkish version of the ABSST is a valid and reliable screening tool that can be used to identify LUT symptoms in an MS clinic.
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Affiliation(s)
- Cansu Polat Dunya
- Department of Medical Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeliha Tulek
- Department of Medical Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gizem Yagmur Vızvız
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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6
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The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience. PLoS One 2019; 14:e0222731. [PMID: 31536557 PMCID: PMC6752850 DOI: 10.1371/journal.pone.0222731] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Bowel and bladder problems affect more than 50% of people with Multiple Sclerosis (MS). These problems have a large impact on quality of life and place a significant burden on health systems. Objectives This study aimed to ascertain the frequency of bladder and bowel problems in a select Australian MS cohort and to investigate the relationships between level of disability, bladder and bowel problems, and fatigue. Methods Questionnaires on the nature and severity of MS symptoms were distributed to clients attending an Australian MS centre. Log-binomial regression and multiple linear regression models were used to investigate relationships between disability, fatigue, and bladder and bowel problems. Results and conclusions Of 167 questionnaires distributed, 136 were completed. Bladder problems were reported by 87 (74.4%) respondents, whilst 66 (48.9%) experienced functional constipation and 43 (31.9%) faecal incontinence. This frequency in our select Australian MS population is similar to that reported globally. There was a significant correlation between level of disability and: bladder problems (p = 0.015), faecal incontinence (p = 0.001), fatigue (p<0.001) and constipation (p = 0.016, relative risk: 1.16). Further investigation into the causal relationships between various MS symptoms may be beneficial in the development of novel therapeutic strategies for people with MS.
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Brucker BM, Nitti VW, Kalra S, Herbert J, Sadiq A, Utomo P, Aponte MM. Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms. Neurourol Urodyn 2016; 36:1208-1213. [PMID: 27548624 DOI: 10.1002/nau.23101] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/29/2016] [Indexed: 11/09/2022]
Abstract
AIM The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation. METHODS This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist. RESULTS The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score ≥3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST. CONCLUSIONS The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.
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Affiliation(s)
| | - Victor W Nitti
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Sidhartha Kalra
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Joseph Herbert
- Department of Neurology, NYU Langone Medical Center, New York, New York
| | - Areeba Sadiq
- Department of Urology, NYU Langone Medical Center, New York, New York
| | - Puspa Utomo
- Department of Neurology, NYU Langone Medical Center, New York, New York
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Ziemssen T, Phillips G, Shah R, Mathias A, Foley C, Coon C, Sen R, Lee A, Agarwal S. Development of the multiple sclerosis (MS) early mobility impairment questionnaire (EMIQ). J Neurol 2016; 263:1969-83. [PMID: 27393117 DOI: 10.1007/s00415-016-8210-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
The Early Mobility Impairment Questionnaire (EMIQ) was developed to facilitate early identification of mobility impairments in multiple sclerosis (MS) patients. We describe the initial development of the EMIQ with a focus on the psychometric evaluation of the questionnaire using classical and item response theory methods. The initial 20-item EMIQ was constructed by clinical specialists and qualitatively tested among people with MS and physicians via cognitive interviews. Data from an observational study was used to make additional updates to the instrument based on exploratory factor analysis (EFA) and item response theory (IRT) analysis, and psychometric analyses were performed to evaluate the reliability and validity of the final instrument's scores and screening properties (i.e., sensitivity and specificity). Based on qualitative interview analyses, a revised 15-item EMIQ was included in the observational study. EFA, IRT and item-to-item correlation analyses revealed redundant items which were removed leading to the final nine-item EMIQ. The nine-item EMIQ performed well with respect to: test-retest reliability (ICC = 0.858); internal consistency (α = 0.893); convergent validity; and known-groups methods for construct validity. A cut-point of 41 on the 0-to-100 scale resulted in sufficient sensitivity and specificity statistics for viably identifying patients with mobility impairment. The EMIQ is a content valid and psychometrically sound instrument for capturing MS patients' experience with mobility impairments in a clinical practice setting. Additional research is suggested to further confirm the EMIQ's screening properties over time.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, TU Dresden, Germany
| | | | - Ruchit Shah
- University of Mississippi, University, MS, USA
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9
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Sadiq A, Brucker BM. Management of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. Curr Urol Rep 2016; 16:44. [PMID: 26025495 DOI: 10.1007/s11934-015-0519-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) can be a debilitating neurological condition that attributes significant morbidity to bladder dysfunction. Although many effective treatment options exist, symptomatic patients are often underdiagnosed and undertreated. The purpose of this article is to give an overview of the current literature including new screening tools to identify symptomatic patients and updates on treatment options including medications, botulinum toxin, and neuromodulation.
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Affiliation(s)
- Areeba Sadiq
- Department of Urology, New York University Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY, 10016, USA,
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10
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Ghezzi A, Mutta E, Bianchi F, Bonavita S, Buttari F, Caramma A, Cavarretta R, Centonze D, Coghe GC, Coniglio G, Del Carro U, Ferrò MT, Marrosu MG, Patti F, Rovaris M, Sparaco M, Simone I, Tortorella C, Bergamaschi R. Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances. Neurol Sci 2016; 37:437-42. [PMID: 26613723 DOI: 10.1007/s10072-015-2415-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
Many guidelines are available for the management of lower urinary tract symptoms (LUTSs) in multiple sclerosis (MS) patients, but no agreement exists on the best approach for subjects without LUTSs. The objective of this study was to evaluate whether LUTSs can be detected in MS patients asymptomatic for urinary dysfunction, comparing three different tools [measure of post-void residual volume (PRV), bladder diary (BD), a focused questionnaire (IPSS)], and whether disability, disease duration and signs of pyramidal involvement are linked to their subclinical presence. 178 MS patients (118 women) have been included (mean age 41.2 years, mean disease duration 11.3 years, mean EDSS 2.2), and tested with the above-mentioned tools. PRV was abnormal in 14 subjects (7.8%), associated to abnormal findings at IPSS in 3 cases, at BD in 2 cases, at both in 1. BD was abnormal in 37 subjects (20.8%), with concomitant abnormal PRV in 2, abnormal IPSS in 10 cases, abnormal IPSS and BD in 1. IPSS was ≥ 9 in 43 subjects (24.1%). At least one test was abnormal in 76 patients (42.7%): 1 in 57 patients (32.0%), 2 in 17 (9.5%), and 3 tests in 2 (1.1%). Patients with at least one abnormal urinary variable, compared to patients without urinary abnormalities, had a more frequent pyramidal involvement (69.5 vs. 16.8%, χ(2) = 48.6, p < 0.00001), a more frequent occurrence of EDSS ≥2 (83.1 vs. 23.5%, χ(2) = 56.9, p < 0.00001), and a longer disease duration (15.7 ± 7.3 vs. 9.1 ± 7.1, t = 5.7, p < 0.00001). Asymptomatic LUTS were frequent but none of the tests used permitted to better identify asymptomatic patients.
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Affiliation(s)
- A Ghezzi
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy.
| | - E Mutta
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy
| | - F Bianchi
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - S Bonavita
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - F Buttari
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - A Caramma
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - R Cavarretta
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - D Centonze
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - G C Coghe
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - G Coniglio
- Divisione di Neurologia, Ospedale S. Carlo, Matera, Italy
| | - U Del Carro
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - M T Ferrò
- Divisione di Neurologia, Ospedale di Cremona, Cremona, Italy
| | - M G Marrosu
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - F Patti
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - M Rovaris
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - M Sparaco
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - I Simone
- Clinica Neurologica, Università di Bari, Bari, Italy
| | - C Tortorella
- Clinica Neurologica, Università di Bari, Bari, Italy
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Abstract
Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can't be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose.
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Affiliation(s)
- Roderick Clark
- 1 Department of Surgery, Western University, London, ON N6A 4V2, Ontario, Canada ; 2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Blayne Welk
- 1 Department of Surgery, Western University, London, ON N6A 4V2, Ontario, Canada ; 2 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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12
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Jongen PJ, Sinnige LG, van Geel BM, Verheul F, Verhagen WI, van der Kruijk RA, Haverkamp R, Schrijver HM, Baart JC, Visser LH, Arnoldus EP, Gilhuis HJ, Pop P, Booy M, Heerings M, Kool A, van Noort E. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: utilization and valuation by patients. Patient Prefer Adherence 2016; 10:243-50. [PMID: 27042018 PMCID: PMC4780403 DOI: 10.2147/ppa.s93786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis. METHODS To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program's elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction. RESULTS Fifty-five persons completed the questionnaire (estimated response rate 40%). The Multiple Sclerosis Impact Profile (MSIP), Medication and Adherence Inventory, Activities Diary, and electronic consultation (e-consult) were used by 40%, 55%, 47%, and 44% of respondents and were considered meaningful by 83%, 81%, 54%, and 88%, respectively. During out-patient consultations, nurses reportedly used the MSmonitor data three to six times more frequently than neurologists. As to nursing care, more symptoms were dealt with (according to 54% of respondents), symptoms were better discussed (69%), and the overall quality of care had improved (60%) since the use of the program. As to neurological care, these figures were 24%, 31%, and 27%, respectively. In 46% of the respondents, the insight into their symptoms and disabilities had increased since the use of the program; the MSIP, Activities Diary, and e-consult had contributed most to this improvement. The overall satisfaction with the program was 3.5 out of 5, and 73% of the respondents would recommend the program to other persons with multiple sclerosis. CONCLUSION A survey among persons with multiple sclerosis using the MSmonitor program showed that the MSIP, Medication and Adherence Inventory, Activities Diary, and e-consult were frequently used and that the MSIP, Medication and Adherence Inventory, and e-consult were appreciated the most. Moreover, the quality of nursing care, but not so neurological care, had improved, which may relate to nurses making more frequent use of the MSmonitor data than neurologists.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- MS4 Research Institute, Nijmegen, the Netherlands
- Correspondence: Peter Joseph Jongen, Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands, Tel +31 50 363 2843, Email
| | - Ludovicus G Sinnige
- Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Björn M van Geel
- Department of Neurology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - Freek Verheul
- Department of Neurology, Groene Hart Hospital, Gouda, the Netherlands
| | - Wim I Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Reinoud Haverkamp
- Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands
| | - Hans M Schrijver
- Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands
| | - Jacoba C Baart
- Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, the Netherlands
| | - Leo H Visser
- Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Edo P Arnoldus
- Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, Delft, the Netherlands
| | | | - Paul Pop
- Department of Neurology, Viecuri Medical Centre, Venlo-Venray, the Netherlands
| | - Monique Booy
- Multiple Sclerosis Centre, Amphia Hospital, Breda, the Netherlands
| | | | - Anton Kool
- Curavista bv, Geertruidenberg, the Netherlands
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13
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14
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Jongen PJ, Blok BFM, Heesakkers JP, Heerings M, Lemmens WA, Donders R. Validation of a Dutch version of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: an observational web-based study. Health Qual Life Outcomes 2015; 13:175. [PMID: 26518712 PMCID: PMC4628331 DOI: 10.1186/s12955-015-0368-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background In patients with multiple sclerosis (MS) the impact of urological symptoms on quality of life and daily activities is considerable. Yet, a substantial percentage of patients may not be urologically evaluated and thus fail to be treated concordantly. The 8-item Actionable questionnaire is a validated English screening tool for the detection of neurogenic bladder overactivity in MS. To enable the use of the 8-item Actionable in The Netherlands and Belgium we translated the questionnaire into the Dutch language and investigated the test-retest reliability and the concurrent validity of the Dutch version. Methods The process of translating the English Actionable questionnaire into the Dutch language included forward translations and back-translations. Then, in an online observational study, MS patients completed the Dutch Actionable at Days 1 and 8, and the Multiple Sclerosis Quality of Life 54-Items (MSQoL-54) and Multiple Sclerosis Impact Profile (MSIP) questionnaires at Day 1; the Expanded Disability Status Scale (EDSS) score was assessed by phone at Day 1. For assessment of the test-retest reliability Pearson’s correlation coefficient (r) between the Day 1 and Day 8 Actionable scores was calculated. For assessment of the concurrent validity r values were calculated between the Day 1 Actionable score and the EDSS score, the Physical and Mental MSQoL-54 composites, and the MSIP domain and symptom disability scores. Results Study population: N = 141 (106 female, 35 male) (80 relapsing remitting, 48 progressive, 13 unknown), mean age 47.8 (standard deviation [SD] 10.4) years, mean EDSS score 4.7 (SD 1.8); 137 patients completed the Day 8 assessment. Pearson’s r between Actionable scores Day 1 and Day 8: 0.85 (P < .0001). Pearson’s r between Actionable score Day 1 and scores for EDSS 0.41 (P < 0.0001), MSQoL-54 Physical −0.31 (P = 0.0002), MSQoL-54 Mental −0.29 (P = 0.0005), MSIP Excretion and Reproductive Functions 0.44 (P < 0.0001), Muscle and Movement Functions 0.39 (P < .0001), Basic Movement Activities 0.37 (P < 0.0001), Activities of Daily Living 0.32 (P < 0.0001), Participation in Life Situations 0.29 (P = 0.0006) and Mental Functions 0.20 (P = 0.0189). Conclusions The Dutch version of the Actionable urological screening tool for MS shows a good test-retest reliability and a good concurrent validity with disabilities and HRQoL.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Centre Groningen, University Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. .,MS4 Research Institute, Ubbergseweg 34, 6522 KJ, Nijmegen, The Netherlands.
| | - Bertil F M Blok
- Department of Urology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - John P Heesakkers
- Department of Urology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marco Heerings
- MH-Advies and Organisatiebureau, IJselstraat 81, 9406 TR, Assen, The Netherlands.
| | - Wim A Lemmens
- Department for Health Evidence, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Rogier Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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15
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Jongen PJ, Blok BF, Heesakkers JP, Heerings M, Lemmens WA, Donders R. Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points. BMC Urol 2015; 15:106. [PMID: 26498107 PMCID: PMC4619527 DOI: 10.1186/s12894-015-0100-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background The Actionable questionnaire is an 8-item tool to screen patients with multiple sclerosis (MS) for neurogenic bladder problems, identifying those patients who might benefit from urological referral and bladder-specific treatment. The original scoring yields a total score of 0 to 24 with cut-off point 6. A simplified scoring, yielding a total score of 0 to 8 with cut-off point 3, has been developed in urogynaecological patients, but has not been investigated in MS. Methods One-hundred-and-forty-one MS patients completed the Actionable on two occasions. We compared the test performance of the simplified scoring with cut-off point 3 with that of cut-off point 2, using the original scoring with cut-off point 6 as a gold standard. The following measures were calculated: True Positives (TP), True Negatives (TN), False Positives (FP), False Negatives (FN), Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Accuracy. The associations between positive test result and urological treatment, and bladder-specific drug treatment were calculated. Results For cut-off point 3 the outcomes (Test 1, Test 2) were: TP 43.26 %, 40.88 %; TN 29.79 %, 32.85 %; FP 0.00 %, 0.00 %; FN 26.95 %, 26.28 %; Sensitivity 0.62, 0.61; Specificity 1.00, 1.00; PPV 1.00, 1.00; NPV 0.53, 0.55; Accuracy 0.73, 0.74; and for cut-off point 2: TP 59.57 %, 59.85 %; TN 26.95 %, 31.39 %; FP 2.84 %, 1.46 %; FN 10.63 %, 7.30 %; Sensitivity 0.85, 0.89; Specificity 0.90, 0.96; PPV 0.95, 0.98; NPV 0.72, 0.81; Accuracy 0.87, 0.91. Cut-off 3 completely prevented FP outcomes, but wrongly classified 26 % of the patients as negative (FN). Cut-off 2 reduced the FN to 7–10 %, with low FP values (2.84–1.46 %). With cut-off 2, the percentage of patients screened positive was higher in the Progressive group (75.00 %) than in the Relapsing Remitting group (56.25 %) (P = 0.0331), which was not the case with cut-off 3. Only a positive test according to the original scoring was associated with both urological treatment (P = 0.0119) and bladder-specific medication (P = 0.0328). Conclusions Our findings suggest that in MS patients the simplified Actionable scoring is more accurate with cut-off point 2 than with cut-off point 3, especially by substantially reducing FN outcomes; and that in MS the original Actionable scoring seems preferable.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Groningen, University Medical Centre Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. .,MS4 Research Institute, Ubbergseweg 34, 6522 KJ, Nijmegen, The Netherlands.
| | - Bertil F Blok
- Department of Urology, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - John P Heesakkers
- Department of Urology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marco Heerings
- MH-advies & organisatiebureau, IJselstraat 81, 9406 TR, Assen, The Netherlands. .,National MS Foundation The Netherlands, Mathenesserlaan 378, 3023 HB, Rotterdam, The Netherlands.
| | - Wim A Lemmens
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Rogier Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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16
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Ginsberg DA, Schneider LK, Watanabe TK. Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies. Arch Phys Med Rehabil 2015; 96:S341-57.e1. [PMID: 26318392 DOI: 10.1016/j.apmr.2015.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
Neurogenic detrusor overactivity (NDO) is a lower urinary tract dysfunction commonly seen in rehabilitation settings. The emotional, medical, and financial consequences of NDO can be substantial and management typically requires a multidisciplinary team approach. Physiatrists need to be able to identify patients who require referral to specialists for diagnostic testing or higher-tiered treatment and need to engender open lines of communication between their patients and all treating clinicians. This requires an understanding of the evaluation, diagnosis, and treatment of neurogenic lower urinary tract dysfunctions.
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Affiliation(s)
- David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, CA; Rancho Los Amigos National Rehabilitation Center, Downey, CA.
| | | | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, Temple University School of Medicine, Philadelphia, PA; Drucker Brain Injury Center, Moss Rehab at Elkins Park, Elkins Park, PA
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17
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Beadnall HN, Kuppanda KE, O'Connell A, Hardy TA, Reddel SW, Barnett MH. Tablet-based screening improves continence management in multiple sclerosis. Ann Clin Transl Neurol 2015; 2:679-87. [PMID: 26125042 PMCID: PMC4479527 DOI: 10.1002/acn3.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate whether electronic continence questionnaires aid early identification and optimizes management of sphincter dysfunction in a multiple sclerosis clinic. Methods A custom designed, tablet-based cross-platform software tool was designed to capture validated multiple sclerosis (MS) patient-reported outcomes. An unselected cohort of MS patients from a tertiary referral clinic completed electronic tablet-based versions of the Bladder Control Scale (BLCS) and the Bowel Control Scale in the waiting room. Data were captured wirelessly “on-the-fly” and stored in a deidentified, secure database; and individual questionnaire results were immediately available to the treating neurologist in the electronic medical record. Scores of ≥2 on either questionnaire generated an automated electronic referral to the clinic MS continence nurse (MS CN). Results One hundred and fifty-seven MS patients completed a total of 184 electronic continence test sets and on two occasions only the BLCS was completed. An automatic electronic referral for formal continence review was generated 128 times in 108 patients. Fifty-seven formal continence assessments were undertaken by the MS CN following automated referral. All reviews resulted in at least one clinical intervention being made. Interpretation Tablet-based data capture and automated continence referral using this software tool is an efficient, sensitive, and feasible method of screening MS patients for bladder and bowel dysfunction. Concordance with the results of formal continence assessment in this pilot study validates the use of this technology as a screening tool.
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Affiliation(s)
- Heidi N Beadnall
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Kushi E Kuppanda
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Annmaree O'Connell
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Australia Sydney, New South Wales, Australia
| | - Todd A Hardy
- Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Neuroimmunology Clinic, Concord Hospital and University of Sydney Sydney, New South Wales, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Concord Repatriation General Hospital Sydney, New South Wales, Australia ; Concord Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Multiple Sclerosis Clinic, Brain and Mind Research Institute, University of Sydney Sydney, New South Wales, Australia ; Department of Neurology, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
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18
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Jongen PJ, Sinnige LG, van Geel BM, Verheul F, Verhagen WI, van der Kruijk RA, Haverkamp R, Schrijver HM, Baart JC, Visser LH, Arnoldus EP, Gilhuis HJ, Pop P, Booy M, Lemmens W, Donders R, Kool A, van Noort E. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: concept, content, and pilot results. Patient Prefer Adherence 2015; 9:1741-50. [PMID: 26715841 PMCID: PMC4685885 DOI: 10.2147/ppa.s93783] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a growing need to offer persons with multiple sclerosis (PwMS) possibilities for self-management and to integrate multidisciplinary health data. In 2009-2014 we developed a patient-reported outcome based, interactive, web-based program (MSmonitor) for (self-)monitoring, self-management and integrated, multidisciplinary care in MS. METHODS The notions underlying the MSmonitor concept and the program's elements are described. We analyze MSmonitor's role in the self-management of fatigue by retrospective comparison of fatigue and health-related quality of life (HRQoL) before and after usage of specific elements of MSmonitor, and by a correlative analysis between frequency of usage and fatigue change. RESULTS After a step-wise development the program comprises six validated questionnaires: Multiple Sclerosis Impact Profile, Modified Fatigue Impact Scale-5 items (MFIS-5), Hospital Anxiety and Depression Scale, Multiple Sclerosis Quality of Life-54 items, and the 8-item Leeds Multiple Sclerosis Quality of Life (LMSQoL) questionnaires; two inventories: Medication and Adherence Inventory, Miction Inventory; two diaries: Activities Diary, Miction Diary; and two functionalities: e-consult and personal e-logbook. The program is now used in 17 hospitals by 581 PwMS and their neurologists, MS nurses, physical therapists, rehabilitative doctors, continence nurses, and family doctors. Those PwMS (N=105) who used the LMSQoL and MFIS-5 questionnaires at least twice in a period of up to 6 months, showed improved HRQoL (P<0.026). In the subgroup (N=56) who had also used the Activities Diary twice or more, the frequency of diary usage correlated modestly with the degree of fatigue improvement (r=0.292; P=0.028). CONCLUSION MSmonitor is an interactive web-based program for self-management and integrated care in PwMS. Pilot data suggest that the repeated use of the short MFIS-5 and LMSQoL questionnaires is associated with an increase in HRQoL, and that a repeated use of the Activities Diary might contribute to the self-management of fatigue.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
- MS4 Research Institute, Nijmegen, the Netherlands
- Correspondence: Peter Joseph Jongen, Department of Community and Occupational Medicine, University Medical Center Groningen, University Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands, Email
| | - Ludovicus G Sinnige
- Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Björn M van Geel
- Department of Neurology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - Freek Verheul
- Department of Neurology, Groene Hart Hospital, Gouda, the Netherlands
| | - Wim I Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | - Reinoud Haverkamp
- Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands
| | - Hans M Schrijver
- Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands
| | - J Coby Baart
- Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, the Netherlands
| | - Leo H Visser
- Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Edo P Arnoldus
- Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, Tilburg, the Netherlands
| | - H Jacobus Gilhuis
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Paul Pop
- Department of Neurology, Viecuri Medical Centre, Venlo-Venray, the Netherlands
| | - Monique Booy
- Multiple Sclerosis Centre, Amphia Hospital, Breda, the Netherlands
| | - Wim Lemmens
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anton Kool
- Curavista bv, Geertruidenberg, the Netherlands
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Denys P, Phe V, Even A, Chartier-Kastler E. Therapeutic strategies of urinary disorders in MS. Practice and algorithms. Ann Phys Rehabil Med 2014; 57:297-301. [PMID: 24958444 DOI: 10.1016/j.rehab.2014.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Review the literature on therapeutic strategies and guidelines for the treatment of neurogenic bladder in multiple sclerosis. MATERIAL AND METHOD A search on available articles on consensus, recommendations guidelines and algorithm of treatment of urinary tract dysfunction in multiple sclerosis. RESULTS Five national consensus guidelines were recently published and proposed guidelines for the first and second line treatments. CONCLUSION Multiple sclerosis patients suffering from lower urinary tract disorders must benefit from an early diagnosis and simple first line evaluation and treatment. More complex and invasive evaluation in the neuro-urology unit is appropriate for patients who failed to first line treatment or in case of complications.
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Affiliation(s)
- P Denys
- Unité de neuro-urologie, service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, université Versailles - Saint-Quentin, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - V Phe
- Service d'urologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie - Paris 6, 75013 Paris, France
| | - A Even
- Unité de neuro-urologie, service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, université Versailles - Saint-Quentin, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital de la Pitié-Salpêtrière, université Pierre-et-Marie-Curie - Paris 6, 75013 Paris, France
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