Joanne P. Robinson

Development and Testing of a Measure of Health-Related Quality of Life for Men with Urinary Incontinence

OBJECTIVES: To describe the development and psychometric testing of male versions of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ).

Consumer Satisfaction in Nursing Homes Current Practices and Resident Priorities

Surveys of resident satisfaction are commonplace in most nursing homes, although surveys used in many facilities may be biased toward concerns of providers and regulators instead of residents. In this study, content for a nursing home satisfaction survey was synthesized from analysis of 11 published and 5 commercially available instruments, as well as qualitative data from interviews with a diverse group of 15 residents in three New Jersey nursing homes. Content analysis of the 16 instruments yielded six broad domains of resident satisfaction: activities, care and services, caregivers, environment, meals, and well-being. Data from residents yielded 87 discrete areas of content across the six domains. In all domains except meals, existing instruments failed to address at least one area of content considered important by residents. Findings from this study provided a framework to generate items for a standardized resident satisfaction survey to be used in New Jersey nursing homes.

Use of Resident Satisfaction Surveys in New Jersey Nursing Homes and Assisted Living Facilities

In this article, the authors present the results of a questionnaire inquiring into the use and usefulness of resident satisfaction surveys sent to all nursing homes (N = 363) and assisted living facilities (N = 152) in New Jersey in fall 2000. The authors found 86% of nursing homes and 88% of assisted living facilities to be using resident satisfaction surveys. Satisfaction information was reported as extremely useful or very useful in 72% of nursing homes and 83% of assisted living facilities. However, satisfaction instruments used by nursing homes and assisted living facilities are highly varied, and instruments appear to have been developed largely on an ad hoc basis, with little attention to testing of validity or psychometric properties. Standardization initiatives are clearly needed. In addition, the uses of satisfaction information were limited and primarily aimed at administrative goals rather than at improving quality of care. These factors may restrict the potential benefits of resident satisfaction information.

Lower Urinary Tract Symptoms in Men With Parkinson Disease

Purpose: The aim of this study was to examine the prevalence, presentation, and predictors of lower urinary tract symptoms (LUTS) in men with idiopathic Parkinson disease (PD). Methods: Guided by the Theory of Unpleasant Symptoms, this retrospective exploratory study used data abstracted from admission clinical records of 271 male patients with idiopathic PD enrolled in a movement disorders clinic at a large metropolitan Veterans Affairs Medical Center in the eastern region of the United States. Data from the admission questionnaire, Unified Parkinson’s Disease Rating Scale, and Mini Mental State Examination were abstracted by trained research assistants. Interrater reliability for the abstraction process was 0.99 in a randomly selected 10% sample of records. Descriptive statistics were used to determine the prevalence of LUTS. Logistic regression was used to determine LUTS risk factors and predictors. Results: At least one LUTS was reported by 40.2% of participants. Incontinence was the most prevalent symptom, affecting almost 25% of participants, followed by nocturia (14.8%) and frequency (13.7%). Of the 10 identified risk factors for LUTS, four significant predictors were discovered: number of non-PD medications (p < .05), PD duration (p < .05), number of comorbidities (p < .05), and history of a hernia diagnosis (p < .05). Conclusions: Assessment for LUTS should be a component of every evaluation of a patient with PD. Our findings offer a preliminary profile of the male PD patient with LUTS, which is an important step toward effective screening, detection, and access to care and treatment. Next steps in research include further work to identify predictors of LUTS in both male and female PD populations, explore patient perspectives, begin trials of interventions for LUTS in the PD population, and analyze the economic impact.

Managing urinary incontinence following radical prostatectomy.

New diagnoses of prostate cancer more than tripled between 1990 and 1996, largely because of improved methods of detection and heightened public awareness. Radical prostatectomy is often undertaken in men with prostate cancer who are expected to live at least 10 more years and have tumors confined to the prostate gland. Because of high 10-year survival rates, the demand for radical prostatectomy has increased steadily during the past decade and continues to climb as men pursue a cure and attempt to maximize survival. Survival benefits aside, however, radical prostatectomy carries a significant risk of urinary incontinence, which can dramatically impair quality of life. Despite medicines steadfast pursuit of continence-preserving approaches to radical prostatectomy, nurses are currently challenged to provide care for a growing cohort of patients with postprostatectomy incontinence. This article reviews the clinical presentation and pathophysiology of postprostatectomy incontinence, including assessment and treatment options.

Validity testing of the stopwatch urine stream interruption test in radical prostatectomy patients.

OBJECTIVE: To assess convergent validity of the stopwatch urine stream interruption test (UST). Specific aims were to describe relationships among stopwatch UST scores and 4 common clinical indices of pelvic floor muscle strength: 24-hour urine leakage, confidence in performing pelvic muscle exercise, 24-hour pad count, and daily pelvic muscle exercise count. DESIGN: Secondary analysis; instrumentation study. METHODS: The final sample consisted of baseline stopwatch UST scores and measurements of comparison variables from 47 participants in a randomized clinical trial of 3 approaches to pelvic floor training for patients with urinary incontinence following radical prostatectomy. The sample size provided 80% power to detect correlations of moderate strength or higher. The stopwatch UST was conducted in an examination room at the study site by trained study personnel (MP, ADC, JP, SM). Measurements of comparison variables were obtained from 3 instruments: 24-hour pad test, Broome Pelvic Muscle Self-Efficacy Scale, and 3-day bladder diary. Relationships among study variables were evaluated with Pearson correlation coefficients. RESULTS: Stopwatch UST scores were moderately correlated with 24-hour urine leakage on the 24-hour pad test (r = 0.35, P < .05), the most robust comparison measure. Correlations between stopwatch UST scores and all other comparison measures were in the appropriate direction, although weak, and did not reach statistical significance. CONCLUSION: Findings suggest that the stopwatch UST may be a valid index of pelvic floor muscle strength in men following radical prostatectomy. With further testing, the stopwatch UST could become a valuable clinical tool for assessing pelvic floor muscle strength in radical prostatectomy patients with urinary incontinence.