Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings.
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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ABSTRACT: Objective: Urinary incontinence (UI) impacts all aspects of life activities. This study aims to cha-racterize change in mobility within the community utilizing the Life Space Assessment (LSA) ques-tionnaire in women undergoing non-surgical UI treatment. Methods: This prospective cohort study, performed from July 2007 to March 2009, followed women seeking non-surgical UI treat-ment from an outpatient tertiary-care clinic and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satis-faction Question (PSQ) were obtained post-treatment. The women were treated with multi-com-ponent behavioral and/or pharmacologic therapies, and we hypothesized that LSA would improve with treatment. Repeated measures analysis with Tukey's HSD and backwards selection linear re-gression model were performed. Results: 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI were recruited. LSA score decreased from baseline to 2 months (mean ± SD; 63 ± 29 to 56 ± 28, p < 0.001) and was sustained at 6 and 12 months (54 ± 28, 54 ± 28). UDI scores improved from 36 ± 23 to 25 ± 24, p < 0.001, at 2 months, and improve-ment persisted at 6 and 12 months (22 ± 22, 21 ± 24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p = 0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p = 0.002), and 6-point for African American race (p = 0.048). Conclusion: Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.Open Journal of Obstetrics and Gynecology 09/2014; 4(14):809-816.
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ABSTRACT: Objectives: Patient perspective is very important for evaluating surgical outcomes. We investigated patient reported goal achievement, overall satisfaction and objective outcome following the midurethral sling (MUS) procedure for female stress urinary incontinence (SUI).Methods: The study prospectively enrolled 88 SUI patients who underwent the MUS procedure between August 2006 and December 2006. Patient examination included medical history, physical examination and an urodynamic study prior to surgery. Before surgery, patients were shown a list and asked to nominate one goal which they most wanted to achieve with surgery (i.e., the target goal). The goals were classified as: symptom-related, daily life-related, personal relationship- and emotion-related, and others. Before and after the surgery, patients completed a Bristol Female Lower Urinary Tract Symptom-Short Form questionnaire. At 1 year postoperatively, patients were assessed in terms of achievement of the target goal, overall satisfaction and cure rate.Results: At the 1-year follow-up, overall target goals were achieved in 90.1% of patients, 82 (93.2%) patients were satisfied with the treatment, and 82 (93.2%) patients were cured. For most patients, the target goals were symptom-related (47 patients, 53.4%). The patients whose goal achievement was less than overall goal achievement were significantly less satisfied than those who fully achieved their goal, and goal achievement was also related to objective cure.Conclusion: Achievement of patient goals was high and could be a good measure of surgical success following MUS for female SUI.Lower urinary tract symptoms 04/2011; 3(1). · 0.54 Impact Factor
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ABSTRACT: Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.Neurourology and Urodynamics 01/2014; · 2.67 Impact Factor