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THE RELATIONSHIP BETWEEN BLADDER MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH SPINAL CORD INJURY
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
CONCLUSIONS: HRQOL scores for IC/PBS patients were significantly lower (worse) than the general U.S. population and were consistently worse than scores for the other conditions. The lowest scores for IC/PBS patients were observed for social functioning, bodily pain, and role limitations due to physical problems (each of these scores was at least one standard deviation lower than the U.S. general population). These findings underscore the dramatic impact that IC/PBS has on the daily activities and well-being of these patients. Source of Funding: NIDDK
244 PREVALENCE OF URINARY INCONTINENCE IN THE CKID COHORT AND ITS EFFECT ON HEALTH RELATED QUALITY OF LIFE AS MEASURED BY THE PEDSQL Jennifer L Dodson*, Silvia E. Cohn, Christopher Cox, Baltimore, MD; Paul S. Hmiel, Ellen Wood, St. Louis, MO; Tej K. Mattoo, Detroit, MI; Bradley A. Warady, Kansas City, MO; Susan L. Furth, Baltimore, MD INTRODUCTION AND OBJECTIVE: Many children with CKD (chronic kidney disease) have urinary incontinence secondary to urological disorders. Our objective was to determine the prevalence and impact of incontinence on HRQOL among children with CKD. METHODS: The Chronic Kidney Disease in Children (CKiD) study is a prospective, observational cohort of children recruited from 47 sites in the United States and Canada. Eligibility requirements include age 1−16 yr and estimated glomerular filtration rate (GFR) 30−90 ml/min/1.73 m2. Baseline demographics, continence status, GFR, and physical examination were assessed at study entry. HRQOL was measured using the parent and child versions of the Pediatric Quality of Life (PedsQL) Inventory, a 23−item generic health status instrument with a score range of 0-100, and a population based norm for the total child report of 83 (SD 13). Data for participants q5 yr was analyzed and PedsQL scores were compared between 3 groups of children classified according to whether they were dry, enuretic, or had daytime incontinence using multivariable linear regression adjusting for potential confounders. RESULTS: The overall median age of the 329 participants was 12.5 years, 61.4% were male, 70% were Caucasian, and 55.5% had a urological disorder. 71.4% of participants were dry at enrollment, 23.1% had enuresis, and 5.5% had daytime incontinence. Compared to children who were dry, those who had daytime incontinence had total scores on average 13.5 points lower (95% CI: -25.2, -1.8) p=0.02) on the PedsQL Child Report. Physical Functioning (-15.0 (95% CI: -28.2, -1.9) p=0.03), and School Functioning Scores (-15.3 (95% CI: -29.8, -0.8) p=0.04) were also substantially lower in this group. On the PedsQL Parent Proxy instrument, the Physical Functioning Score (-14.2 (95% CI: -26.7, -1.6) p=0.03) was similarly affected by child daytime incontinence. For children with enuresis, scores generally fell between those of children who were dry and those who had daytime incontinence. CONCLUSIONS: Enuresis and daytime incontinence are common in pediatric CKD and are associated with lower HRQOL as measured by the PedsQL Child Report and Parent Proxy Report. Early recognition and treatment of urinary incontinence among children with CKD may improve HRQOL in this population. Source of Funding: NIH NIDDK, NINDS, NICHHD, NHLBI, and the National Kidney Foundation of Maryland
245 THE RELATIONSHIP BETWEEN BLADDER MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH SPINAL CORD INJURY Liu Chin-Wei, Kaka Hama Attar*, Angela Gall, Michael Craggs, Julian R Shah, London, United Kingdom INTRODUCTION AND OBJECTIVE: Spinal Cord Injury (SCI) exerts a heavy burden on health and the health service. Its bladder complications cause severe morbidity which often imposes a significant threat to the health-related quality of life (HRQL) of both patients and
91
relatives. Patients with SCI manage their neuropathic bladders by various methods. This study aimed at assessing the influence that each method of bladder management has on the health-related quality of life (HRQL) in patients with SCI. METHODS: The study was based on 2 questionnaires: the first is validated for SCI but not specific for bladder symptoms while the second is validated for bladder symptoms but not specific for SCI. One hundred and forty-two patients with SCI were recruited to fill in both questionnaires. Information collected included demographic characteristics, urinary symptoms (mainly incontinence and its severity); and an assessment of the mental status of patients. Different methods of bladder management involved normal voiding, bladder reflex triggering, bladder expression, clean intermittent catheterization (CIC) either self-performed or by an attendant, indwelling catheters (urethral or suprapubic), sacral anterior root stimulation and urinary diversion. RESULTS: Only 21% of SCI patients could void normally without any other forms of bladder management. This group had the best HRQL and mental status. Patients whose bladders were managed by clean intermittent catheterization (CIC) by an attendant had the poorest HRQL and mental status; followed by patients with indwelling urethral catheters, and indwelling suprapubic catheters. The frequency of incontinence episodes was the most important factor that negatively influenced HRQL. CONCLUSIONS: To our knowledge, this is the first study correlating the currently existing methods of bladder management with HRQL and mental status of patients with SCI. Understanding this correlation is important in setting a holistic approach to the demands of this specific group of patients. This may include considering modification to their bladder management -if it deems necessary in order to improve the quality aspects of their lives. Source of Funding: None
246 THE EFFICACY OF VISUAL ANALOGUE SCALE QUESTIONNAIRE TO IDENTIFY THE MOST SIGNIFICANT SYMPTOM TO BE TREATED FOR LEADING PATIENT SATISFACTION Atsuko Fujihara*, Osamu Ukimura, Yasuhiro Yamada, Jun Fujiwara, Soh Ushijima, Koji Okihara, Akihiro Kawauchi, Tsuneharu Miki, Kyoto, Japan INTRODUCTION AND OBJECTIVE: Although International Prostate Symptom Score (IPSS) is the most commonly used questionnaire of lower urinaly function, it does not necessarily match to the most significant symptom that patients want to be treated. Recently we developed a novel Visual Analogue Scale (VAS) measure of the patient’s quality of life (QOL) specific to each of the 7 items on the IPSS (IPSS-VAS) (J Urol 176:665, 2006). In this study, we validated this IPSS-VAS to identify the most significant symptom to be treated in men and women. METHODS: A total of 487 men and 324 women were asked to complete IPSS and IPSS-VAS, which were printed on the face and back of an A4 paper, respectively. In men complaining with moderate IPSS score (8-19 points) and severe IPSS score (20-35 points), multiple stepwise linear regression analysis was used in order to define the best predictor of the QOL-score in the bottom of the IPSS questionnaire (QOLIPSS) among the total 14 items of either 7 items of the IPSS-score or the 7 items of the VAS-measure. Especially in women, since we also wanted to assess QOL specific to urinary incontinence, we added another VASmeasure regards “urinary incontinence” (VAS-urinary incontinence), resulting in that IPSS-VAS questionnaire for women consisted of the 8 lines of VAS-measure. RESULTS: In 224 men complaining with moderate IPSS score, the best predictor of the QOL-IPSS was VAS-nocturia (F-value: 17.02, P<0.001), followed by VAS- incomplete emptying (F-value: 8.75, P<0.005). On the other hand, in 72 men complaining with severe IPSS score, the best predictor of the QOL-IPSS was VAS- incomplete emptying (F-value: 12.06, P<0.005), followed by VAS- urgency (F-value: 6.55, P<0.05). The correlation between the severity of IPSS-score and QOL-IPSS was significantly less than that of VAS-measure and QOL-IPSS. In continent women (n=195), best predictor of the QOL-IPSS was VAS-nocturia (F -value=28.8, p<0.00001), followed by VAS-incomplete
Vol. 181, No. 4, Supplement, Sunday, April 26, 2009
CONCLUSIONS: HRQOL scores for IC/PBS patients were significantly lower (worse) than the general U.S. population and were consistently worse than scores for the other conditions. The lowest scores for IC/PBS patients were observed for social functioning, bodily pain, and role limitations due to physical problems (each of these scores was at least one standard deviation lower than the U.S. general population). These findings underscore the dramatic impact that IC/PBS has on the daily activities and well-being of these patients. Source of Funding: NIDDK
244 PREVALENCE OF URINARY INCONTINENCE IN THE CKID COHORT AND ITS EFFECT ON HEALTH RELATED QUALITY OF LIFE AS MEASURED BY THE PEDSQL Jennifer L Dodson*, Silvia E. Cohn, Christopher Cox, Baltimore, MD; Paul S. Hmiel, Ellen Wood, St. Louis, MO; Tej K. Mattoo, Detroit, MI; Bradley A. Warady, Kansas City, MO; Susan L. Furth, Baltimore, MD INTRODUCTION AND OBJECTIVE: Many children with CKD (chronic kidney disease) have urinary incontinence secondary to urological disorders. Our objective was to determine the prevalence and impact of incontinence on HRQOL among children with CKD. METHODS: The Chronic Kidney Disease in Children (CKiD) study is a prospective, observational cohort of children recruited from 47 sites in the United States and Canada. Eligibility requirements include age 1−16 yr and estimated glomerular filtration rate (GFR) 30−90 ml/min/1.73 m2. Baseline demographics, continence status, GFR, and physical examination were assessed at study entry. HRQOL was measured using the parent and child versions of the Pediatric Quality of Life (PedsQL) Inventory, a 23−item generic health status instrument with a score range of 0-100, and a population based norm for the total child report of 83 (SD 13). Data for participants q5 yr was analyzed and PedsQL scores were compared between 3 groups of children classified according to whether they were dry, enuretic, or had daytime incontinence using multivariable linear regression adjusting for potential confounders. RESULTS: The overall median age of the 329 participants was 12.5 years, 61.4% were male, 70% were Caucasian, and 55.5% had a urological disorder. 71.4% of participants were dry at enrollment, 23.1% had enuresis, and 5.5% had daytime incontinence. Compared to children who were dry, those who had daytime incontinence had total scores on average 13.5 points lower (95% CI: -25.2, -1.8) p=0.02) on the PedsQL Child Report. Physical Functioning (-15.0 (95% CI: -28.2, -1.9) p=0.03), and School Functioning Scores (-15.3 (95% CI: -29.8, -0.8) p=0.04) were also substantially lower in this group. On the PedsQL Parent Proxy instrument, the Physical Functioning Score (-14.2 (95% CI: -26.7, -1.6) p=0.03) was similarly affected by child daytime incontinence. For children with enuresis, scores generally fell between those of children who were dry and those who had daytime incontinence. CONCLUSIONS: Enuresis and daytime incontinence are common in pediatric CKD and are associated with lower HRQOL as measured by the PedsQL Child Report and Parent Proxy Report. Early recognition and treatment of urinary incontinence among children with CKD may improve HRQOL in this population. Source of Funding: NIH NIDDK, NINDS, NICHHD, NHLBI, and the National Kidney Foundation of Maryland
245 THE RELATIONSHIP BETWEEN BLADDER MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH SPINAL CORD INJURY Liu Chin-Wei, Kaka Hama Attar*, Angela Gall, Michael Craggs, Julian R Shah, London, United Kingdom INTRODUCTION AND OBJECTIVE: Spinal Cord Injury (SCI) exerts a heavy burden on health and the health service. Its bladder complications cause severe morbidity which often imposes a significant threat to the health-related quality of life (HRQL) of both patients and
91
relatives. Patients with SCI manage their neuropathic bladders by various methods. This study aimed at assessing the influence that each method of bladder management has on the health-related quality of life (HRQL) in patients with SCI. METHODS: The study was based on 2 questionnaires: the first is validated for SCI but not specific for bladder symptoms while the second is validated for bladder symptoms but not specific for SCI. One hundred and forty-two patients with SCI were recruited to fill in both questionnaires. Information collected included demographic characteristics, urinary symptoms (mainly incontinence and its severity); and an assessment of the mental status of patients. Different methods of bladder management involved normal voiding, bladder reflex triggering, bladder expression, clean intermittent catheterization (CIC) either self-performed or by an attendant, indwelling catheters (urethral or suprapubic), sacral anterior root stimulation and urinary diversion. RESULTS: Only 21% of SCI patients could void normally without any other forms of bladder management. This group had the best HRQL and mental status. Patients whose bladders were managed by clean intermittent catheterization (CIC) by an attendant had the poorest HRQL and mental status; followed by patients with indwelling urethral catheters, and indwelling suprapubic catheters. The frequency of incontinence episodes was the most important factor that negatively influenced HRQL. CONCLUSIONS: To our knowledge, this is the first study correlating the currently existing methods of bladder management with HRQL and mental status of patients with SCI. Understanding this correlation is important in setting a holistic approach to the demands of this specific group of patients. This may include considering modification to their bladder management -if it deems necessary in order to improve the quality aspects of their lives. Source of Funding: None
246 THE EFFICACY OF VISUAL ANALOGUE SCALE QUESTIONNAIRE TO IDENTIFY THE MOST SIGNIFICANT SYMPTOM TO BE TREATED FOR LEADING PATIENT SATISFACTION Atsuko Fujihara*, Osamu Ukimura, Yasuhiro Yamada, Jun Fujiwara, Soh Ushijima, Koji Okihara, Akihiro Kawauchi, Tsuneharu Miki, Kyoto, Japan INTRODUCTION AND OBJECTIVE: Although International Prostate Symptom Score (IPSS) is the most commonly used questionnaire of lower urinaly function, it does not necessarily match to the most significant symptom that patients want to be treated. Recently we developed a novel Visual Analogue Scale (VAS) measure of the patient’s quality of life (QOL) specific to each of the 7 items on the IPSS (IPSS-VAS) (J Urol 176:665, 2006). In this study, we validated this IPSS-VAS to identify the most significant symptom to be treated in men and women. METHODS: A total of 487 men and 324 women were asked to complete IPSS and IPSS-VAS, which were printed on the face and back of an A4 paper, respectively. In men complaining with moderate IPSS score (8-19 points) and severe IPSS score (20-35 points), multiple stepwise linear regression analysis was used in order to define the best predictor of the QOL-score in the bottom of the IPSS questionnaire (QOLIPSS) among the total 14 items of either 7 items of the IPSS-score or the 7 items of the VAS-measure. Especially in women, since we also wanted to assess QOL specific to urinary incontinence, we added another VASmeasure regards “urinary incontinence” (VAS-urinary incontinence), resulting in that IPSS-VAS questionnaire for women consisted of the 8 lines of VAS-measure. RESULTS: In 224 men complaining with moderate IPSS score, the best predictor of the QOL-IPSS was VAS-nocturia (F-value: 17.02, P<0.001), followed by VAS- incomplete emptying (F-value: 8.75, P<0.005). On the other hand, in 72 men complaining with severe IPSS score, the best predictor of the QOL-IPSS was VAS- incomplete emptying (F-value: 12.06, P<0.005), followed by VAS- urgency (F-value: 6.55, P<0.05). The correlation between the severity of IPSS-score and QOL-IPSS was significantly less than that of VAS-measure and QOL-IPSS. In continent women (n=195), best predictor of the QOL-IPSS was VAS-nocturia (F -value=28.8, p<0.00001), followed by VAS-incomplete