Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: Validation of three global patient ratings

Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama 35233, USA.
Neurourology and Urodynamics (Impact Factor: 2.46). 01/2006; 25(5):411-7. DOI: 10.1002/nau.20243
Source: PubMed

ABSTRACT To test the validity of three patient global ratings, satisfaction, perception of improvement, and estimated percent improvement, for measuring outcomes of behavioral treatment for urinary incontinence.
This report is a secondary analysis of data from three randomized controlled trials testing behavioral interventions for incontinence. Participants were 359 community-dwelling women, aged 40-92 years, with stress, urge, or mixed urinary incontinence. All participants received an 8-week program of clinic-based or self-administered behavioral training. Subjective outcomes included a patient satisfaction question (PSQ), global perception of improvement (GPI), and estimated percent improvement (EPI). Convergent validity was tested by examining the relationship between each measure and reduction of incontinence (bladder diary), change on the incontinence impact questionnaire (IIQ), and desire for another treatment. Discriminant validity was explored by examining the relationship of the global ratings to five measures not expected to be related to outcome (age, race, BMI, education level, and change in perceived pain).
All three patient global ratings were significantly associated with each other (P < 0.0001), with diary measures of reduction of incontinence episodes (P < 0.0001), and change in the IIQ (P < 0.005), and inversely associated with desire for another treatment (P < 0.0001). All three patient ratings were not significantly associated with age, race, BMI, education level, or change in perceived pain.
Patient global ratings of satisfaction, perception of improvement, and estimated percent improvement have acceptable convergent and discriminant validity for measuring outcomes in studies of behavioral treatment for urinary incontinence.

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    • "Follow-up measurements were made at 3 and 12 months and included self-administered questionnaires about the symptoms of urinary incontinence, a 3-day bladder diary and a question about self-experienced changes in symptoms [8–17,25]. In addition, patients were asked to complete a monthly four-item questionnaire including a question about changes in symptoms, two questions about the severity of the incontinence, and a question on the number of absorbent pads used per day [9] [25] "
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    ABSTRACT: BACKGROUND: Female urinary incontinence is a common condition that has a negative influence on quality of life and generates high costs, but spontaneous help-seeking is limited. In the URINO trial the effects and cost-effectiveness of actively encouraging older women to undergo diagnostics and treatment for urinary incontinence were compared with usual care. OBJECTIVES: To describe the design of the URINO trial and to give data on the effect of treatment uptake after screening. In the discussion, the criteria of Wilson and Jungner are applied to discuss whether screening for urinary incontinence is suitable. METHODS: In a cluster randomized trial all registered female patients aged ≥55 years received a screening questionnaire. The intervention consisted of actively encouraging women to undergo diagnostics, after which tailored treatment was offered. In the control group care as usual was offered, but uptake of diagnostics and treatment was not encouraged. Results The response rate was 76%. 31% reported urinary incontinence; of these, 47% was willing to participate. All patients in the intervention group underwent diagnostics and treatment uptake was 80%; in the control group this was 2%. CONCLUSION: To increase treatment uptake, screening must be followed by active encouragement for further diagnostics and treatment. Based on the principles of Wilson and Jungner, female urinary incontinence is a condition suitable for screening. The effect of treatment however needs further evaluation before screening can be recommended. The results of the URINO trial will fill this gap in knowledge.
    Maturitas 02/2013; 74(4). DOI:10.1016/j.maturitas.2012.12.015 · 2.86 Impact Factor
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    • "focusing attention on aspects the researcher thinks are important, and overlooking issues crucial to the patient and therefore limiting the responses. Answers are only as good as the questions you ask; sound questionnaire design is imperative (Burgio et al., 2006). "
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    • "Limitations of the present study are represented by the lack of assessment of urethral function, which could have given us further useful information , and by the use of a 3-item scale in the assessment of treatment efficacy of antimuscarinic therapy. However, Burgio et al [21] reported that a 3-item scale has an ''acceptable convergent and discriminant validity for measuring outcomes in studies of behavioural treatment for urinary incontinence'' if compared with a 5-item scale or an estimated percentage of improvement (a scale from 0% to 100%). "
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    ABSTRACT: To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment. All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group). Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (p<0.0001). The 34 women with incontinence at orgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p=0.023). Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with DO complaining of incontinence at orgasm.
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