Should the Preference-based Index Set of Values Be Country- or Disease-specific? An Analysis Using Data From Women With Symptoms of Overactive Bladder

Background: Overactive bladder (OAB) and urinary incontinence (UI) are common conditions among women. However, no studies have evaluated the utility value of this population using different country-specific value sets. We aimed to 1) verify the difference between the preference-based index extracted from the Short Form six dimensions (SF-6Dv1) questionnaire in women with OAB using different country-specific value sets; 2) translate and cross-culturally adapt the King's Health Questionnaire Five Dimension (KHQ-5D) into Brazilian Portuguese; and 3) examine the association between utility index obtained by the SF-6Dv1 and KHQ-5D. Methods: This cross-sectional study included 387 women over 18 years of age with OAB symptoms, divided into groups with and without UI. All participants answered the sociodemographic questionnaire, KHQ, KHQ-5D, and SF-6Dv1. To the statistical analysis a two-way mixed ANOVA was applied to verify the interaction between the presence of UI and utility index obtained from different country-specific value sets. Post-hoc multiple comparisons were applied following the main analysis. Spearman’s test was applied to verify the correlation between the utility values of SF-6Dv1 and KHQ-5D. The significance level was set at 5%. Results: We evaluated 298 women classified according to the presence of UI (119 without UI vs. 179 with UI). The main analysis showed a statistically significant interaction between the presence of UI and the utility index obtained from the different countries (p = 0.005, Cohen’s d= 0.02). The post-hoc analyses showed that there was a statistically significant main effect of the utility index obtained from different countries (p <0.001, d = 0.63) and in the presence of UI (p = 0.012, d = 0.02). The correlations between the utility indices obtained from different countries using the SF-6Dv1 and KHQ-5D were significant, positive, and small. Conclusions: The differences between the indices obtained in different countries and groups with and without UI, assessed using the SF-6Dv1, are shown. The correlation between general and specifics preference-based measures was small; therefore, the SF-6Dv1 should be used with caution in cost-utility studies for this population. We recommend that in women with OAB, the value set for GPBM be obtained in countries where cost utility is applied.

Quality of Life and Autonomy in Patients with Intermittent Bladder Catheterization Trained by Specialized Nurses

Intermittent bladder catheterization (IBC) involves regular urine draining using a catheter, which is removed immediately after urinary elimination. It allows for the patient’s urological health to be managed and their renal function to be preserved, and it promotes autonomy. Compliance with the prescribed number of daily catheterizations, which must be conducted by the patient, and infection prevention measures are crucial. To identify the patients requiring IBC, and to determine their adherence (whether they followed the prescribed guidelines and their difficulty in carrying out the procedure, as well as to assess how the IBC influences their quality of life and state of mind after receiving self-care training from a specialized nurse), we carried out a prospective, multicenter observational study in 24 Spanish hospitals with one month of monitoring and a sample of 99 patients. The sources of information were the patients’ clinical records, the King’s Health Questionnaire, the Mini-Mental State Examination (MMSE), and the hospital anxiety and depression scale (HADS). Descriptive and bivariate statistics were used to analyses the paired data. After recruitment (n = 99), 79 patients completed the questionnaire at a mean age of 35.2 years (SD = 20.5 years). In total, 53.5% (53) of the sample consisted of men and 32.3% (32) had neurological damage as the reason for prescription; 67% (67.7) performed self-catheterization and 86.7% adhered to the IBC. After one month of monitoring, a statistically significant improvement in quality of life was observed in all criteria, with the exception of personal relationships (p < 0.005), as well as an improvement in anxiety and depression levels (p < 0.001). Patients who require IBC show good adherence to the IBC with a significant percentage of self-catheterization. After one month of IBC, a significant improvement in the patients’ quality of life and mood was observed. These results could be attributed to adequate patient training and adequate personalization of the IBC materials by the specialized nurses.

Psychometric properties of the German-language questionnaire for urinary incontinence diagnosis (QUID) in women with urinary incontinence

Purpose The aim of this study was to translate the questionnaire for urinary incontinence diagnosis (QUID) into German and to assess its psychometric properties in German-speaking women with urinary incontinence (UI). The QUID contains two subscales to measure symptom severity of stress urinary incontinence (SUI) and urge urinary incontinence (UUI) and to distinguish between both forms. Methods A total of 161 women with UI completed the QUID and the King’s Health Questionnaire (KHQ), each in the German version. To examine construct validity Spearman’s correlation coefficients between both questionnaires were computed. Furthermore, the internal consistency (Cronbach’s alpha) of the QUID and its criterion validity were examined. Looking at criterion validity, sensitivity, specificity, ROC curves, and Youden-indexes were computed for both subscales. Results The QUID showed good construct validity by strong correlations with related domains of the KHQ. Cronbach’s alpha values were good for both subscales of the QUID (SUI-subscale: 0.76; UUI-subscale: 0.86). Sensitivity and specificity were 83% (95% CI, 0.72–0.9) and 45% (95% CI, 0.25–0.67) for the SUI-subscale and 83% (95% CI, 0.7–0.91) and 56% (95% CI, 0.4–0.72) for the UUI-subscale. Youden-index was 0.28 for the SUI-subscale and 0.39 for the UUI-subscale at the given cut-off values. Conclusion Psychometric properties of the German-language QUID are principally good and support its use in the German-speaking area. However, the modest specificity when distinguishing between SUI and UUI should be taken into account. Trial registration number: DRKS00018777 (date of registration: 16-January-2020).

Bladder and bowel symptoms following imprisonment in West Australian female prisons

Purpose The purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL). Design/methodology/approach Over a 12-month period 29 women, recently released from Western Australia’s female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King’s Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL. Findings Of those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health. Originality/value Women imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.

Prevalence of Stress Urinary Incontinence in Women from a Rural Community in the Brazilian Amazon

Introduction: Stress urinary incontinence affects a significant number of women and causes great loss of Quality of Life (QoL). Its prevalence varies from 15 to 41.5%. Objective: To assess the prevalence of Stress Urinary Incontinence (SUI) in women living in a rural community in Amapá, the main risk factors and quality of life assessment using a standardized questionnaire. Methodology: A screening questionnaire was applied to 235 women residing in Igarapé da Fortaleza, in the city of Macapá, in 2015. Patients with SUI complaints were submitted to the King’s Health Questionnaire (KHQ) questionnaire. For statistical processing, BioEstat software version 5.3 was used. Results: The prevalence of SUI was 28.9% (68 women). A significant age difference was found between women with SUI (44.2) and without SUI (37.9 ± 12.5 years). Childbirth, birth interval, smoking and Body Mass Index (BMI) showed to be statistically significant differences between groups. Variables such as number of deliveries, birth weight, menopause, education and race did not express a real difference. Conclusion: The prevalence of SUI was 28.9%. There was a significant difference in the group with SUI in terms of age, smoking, parity, interval between births and BMI. In assessing QoL in patients with SUI using KHQ, we found the worst results in general health perception, impact of incontinence, personal relationships, sleep/mood and severity of symptoms.

The Development and Effectiveness of a Care Protocol Using the Stevens Star Model of Knowledge Transformation in Female Patients With Stress Incontinence: An Experimental Study

BACKGROUND: Nurse-led pelvic floor muscle exercise and lifestyle education programs are effective first-line interventions for women with stress incontinence (SI). PURPOSE: To develop an evidence-based stress incontinence care protocol (SICP) using the Stevens Star Model of Knowledge Transformation and evaluate its effect on the frequency and quantity of urinary incontinence, quality of life, pelvic muscle self-efficacy levels, and lifestyle variables of women with SI. METHODS: An SICP was developed on the basis of the Star model. The views of an expert were consulted for testing the content validity of the protocol. Using a pretest-posttest experimental design, 68 women with SI who visited an outpatient clinical at a hospital in Turkey were prospectively enrolled in the intervention (n = 34) and control (n = 34) groups. After obtaining baseline demographic and health history information, participants completed the King’s Health Questionnaire, the Broome Pelvic Muscle Exercise Self-Efficacy Scale, a 3-day voiding diary, and a 1-hour pad test. The intervention group received an 8-week program of care according to the Star model-derived SICP, and follow-up assessments were completed by both groups after 8 and 12 weeks. RESULTS: The content validity index for the SICP was 91.9%. The intervention group had a reduced quantity and frequency of urinary leakage, reduced King’s Health Questionnaire scores, and increased Broome Pelvic Muscle Exercise Self-Efficacy Scale scores (P < .05). CONCLUSION: Care provided according to the Star model-derived SICP reduced the quantity and frequency of SI and improved the perceived pelvic muscle exercise self-efficacy and quality of life of the participants.

Effects of the Pilates method isolated and associated with manual therapy in women with urinary incontinence

Background: Urinary incontinence (UI) is clinically defined by the International Continence Society as involuntary urine loss. Currently, UI isconsidered a public health issue worldwide, considering that the prevalence in women is quite high, requiring attention from healthprofessionals. Objective: To evaluate the effects of the Pilates method associated with Manual Therapy in women with UI. Methods: It wasperformed a randomized, controlled, longitudinal clinical trial with a quantitative approach of the data. 14 female participants were evaluated,aged 20 to 55 years and who had presented episodes of urinary loss in the last months. The following evaluations were carried out: anamnesis,evaluation of urogynecological history, application of the King’s Health Questionnaire and PERFECT test. After all the evaluations, half of thevolunteers received treatment for urinary incontinence through a physical therapy approach that includes the Pilates method associated withManual Therapies (GPT), and the other half received treatment using only the Pilates method (GP). Results: Both groups showed increasedPFM strength, being GPT (p = 0.04) and GP (p = 0.00); increased resistance, being GPT (p = 0.02) and GP (p = 0.01); and the contraction offibers, being GPT (p = 0.04) and GP (p = 0.02). In the GPT there was a decrease in the severity measures (p = 0.01); disappearance ofnocturia (p = 0.04); decreased symptoms of SUI (p = 0.02); and bladder pain (p = 0.04). In the GP, there was a significant improvement in theperception of health (p = 0.00); decreased UI impact on the participant's life (p = 0.02); the influence of UI on emotions (p = 0.00); symptomsof overactive bladder (p = 0.01); and the SUI (p = 0.00). Conclusion: Both treatment protocols decrease episodes of leakage of urine whenthere is an increase in intra-abdominal pressure, increase the PFM strength, endurance and number of fast contractions, and the quality oflife of women with UI. However, only the group that received only the Pilates protocol showed an increase in repetitions of slow contraction.