Véronique Bonniaud

Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: Results of a multicenter prospective study†‡§

Electrostimulation is an established therapeutic option for neurogenic urinary disorders. The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with multiple sclerosis (MS) and troublesome symptoms of an overactive bladder (OAB).

Development and validation of the short form of a urinary quality of life questionnaire: SF-Qualiveen.

PURPOSE The 30-item Qualiveen is a specific health related quality of life questionnaire for urinary disorders in patients with neurological conditions, such as multiple sclerosis and spinal cord injury. Previous studies have demonstrated the reliability, validity and responsiveness of Qualiveen. However, to address the needs of large clinical trials and long-term monitoring, in which efficiency may compete with precision of measurement, we developed the 8-item self-administered SF-Qualiveen. MATERIALS AND METHODS A total of 180 English speaking and French speaking outpatients with multiple sclerosis at multiple sclerosis clinics and departments of rehabilitation in Canada and France completed the entire Qualiveen, the Multiple Sclerosis Quality of Life-54 questionnaire or its French version (SEP-59) as well as urinary function assessments at study enrollment and 2 to 10 weeks later. At visit 2 patients also made global ratings of change in urinary health related quality of life. SF-Qualiveen development and testing used this data set. RESULTS Correlations of SF-Qualiveen with its original form were high (r = 0.70 to 0.92). SF-Qualiveen proved reliable (ICC 0.83 to 0.93). Its responsiveness was similar to that of the long form (SRM 0.75 to 1.62). Correlations with other measures were consistent with our a priori predictions (weighted kappa 0.55 for cross-sectional correlations and 0.66 for correlations of change), supporting the cross-sectional and longitudinal construct validity of SF-Qualiveen. CONCLUSIONS SF-Qualiveen has excellent measurement properties, similar to those of the long form. The new instrument is likely to perform well in the clinical and research context.

Quality of life in multiple sclerosis patients with urinary disorders: discriminative validation of the English version of Qualiveen.

The Qualiveen questionnaire is a urinary disorder (UD)-specific health related quality of life (HRQL) instrument. Recent data suggests Qualiveen has excellent validity in French-speaking multiple sclerosis (MS) patients. Aim: To assess discriminative measurement properties of the English version of Qualiveen. Methods>: Fifty-five Canadian MS out-patients completed a set of questionnaires, including Qualiveen, MSQOL-54, a MS-specific HRQL questionnaire, urinary function assessments and the Expanded Disability Status Scale (EDSS) twice at an interval of two to four weeks. Results: Qualiveen proved internally consistent (Cronbach’s alpha coefficients 0.73 to 0.90 for the four Qualiveen domains) and test–retest reliable (intraclass correlation coefficients 0.88 to 0.94). Consistent with a priori predictions, we found a strong association between overall Qualiveen score and the degree of incontinence (0.63), a moderate correlation with the type of urinary symptoms (0.49), a weak association with manner of voiding (0.28) and weak or absent correlations with MSQOL-54 domains, EDSS bladder/bowel and global EDSS. Predictions proved generally accurate (weighted κ = 0.65). Conclusion: The internal consistency, test–retest reliability and cross-sectional construct validity of the English version of Qualiveen are excellent, and similar to the original French version. Further studies should explore Qualiveen’s longitudinal validity and responsiveness.

Development and psychometric validation of the intermittent self-catheterization questionnaire.

BACKGROUND Intermittent catheterization, often performed by the users themselves and known as intermittent self-catheterization (ISC), has become the gold standard treatment for people with chronic urinary retention. To date, there are no validated patient-reported outcome measures for individuals who rely on ISC that focus on ISC-related quality of life and can help health care professionals and catheter users to optimize long-term ISC care. OBJECTIVE The objective of this study was to develop and validate a patient-reported outcome measure, the Intermittent Self-Catheterization Questionnaire (ISC-Q), which evaluates aspects of quality of life specific to the needs of individuals performing ISC. METHODS This study was divided into 2 phases. The first phase focused on the development of the ISC-Q using 20 interviews and a review of selected literature. In addition, 10 interviews with UK and French individuals who performed ISC were conducted to ensure face and content validity of the ISC-Q. In the second phase of the study, the ISC-Q was administered online in the United Kingdom, France, and Germany to 306 individuals with neurologic urinary retention (including spinal cord injury, multiple sclerosis, and spina bifida), who performed ISC for at least 6 months, and were aged 18 to 85 years. Item reduction, reliability, and validity testing were performed to determine the psychometric properties of the ISC-Q. Responsiveness and minimum important differences were also examined. RESULTS The initial phase of the study led to the development of a 4-domain instrument focusing on ease of use, convenience, discreetness, and psychological well-being. Various item reduction techniques were used that resulted in the removal of 3 items from the ISC-Q; there were 24 items in the final version. The conceptual framework of the ISC-Q was confirmed with a four-factor solution of the subscales. The ISC-Q was psychometrically robust, with excellent internal consistency, adequate test-retest reliability, and good validity (convergent and known groups validity). Overall, the responsiveness results show the ISC-Q to be sensitive to change, and the total ISC-Q minimum important difference estimates ranged from 4.94 to 8.73. CONCLUSION The findings illustrate the ISC-Q to be a valid and reliable outcome measure that evaluated aspects of ISC-related quality of life.

Cranberry versus placebo in the prevention of urinary infections in multiple sclerosis: a multicenter, randomized, placebo-controlled, double-blind trial

Objective: Our aim was to assess the usefulness of cranberry extract in multiple sclerosis (MS) patients suffering from urinary disorders. Methods: In total, 171 adult MS outpatients with urinary disorders presenting at eight centers were randomized (stratification according to center and use of clean intermittent self-catheterization) to cranberry versus placebo in a 1-year, prospective, double-blind study that was analyzed using a sequential method on an intent-to-treat basis. An independent monitoring board analyzed the results of the analyses each time 40 patients were assessed on the main endpoint. Cranberry extract (36 mg proanthocyanidins per day) or a matching placebo was taken by participants twice daily for 1 year. The primary endpoint was the time to first symptomatic urinary tract infection (UTI), subject to validation by a validation committee. Results: The second sequential analyses allowed us to accept the null hypothesis (no difference between cranberry and placebo). There was no difference in time to first symptomatic UTI distribution across 1 year, with an estimated hazard ratio of 0.99, 95% CI [0.61, 1.60] (p = 0.97). Secondary endpoints and tolerance did not differ between groups. Conclusion: Taking cranberry extract versus placebo twice a day did not prevent UTI occurrence in MS patients with urinary disorders. Trial Registration NCT00280592.

Italian version of Qualiveen-30: cultural adaptation of a neurogenic urinary disorder-specific instrument.

Qualiveen‐30 is a neurological urinary disorder (UD)‐specific health‐related quality of life (HRQL) instrument, recommended in the European Association of Urology guideline 2008. The objective is to complete the cultural adaptation of Qualiveen‐30 into Italian.

Dyssynergie vésico-sphinctérienne et toxine botulique

Resume Introduction. – Les injections de toxine botulique (TB) dans le sphincter strie uretral representent un traitement en expansion de la dyssynergie vesico-sphincterienne (DVS), mais il reste pourtant mal codifie. Methodologie. – Une revue de la litterature par recherche informatique PubMed, completee par une recherche dans les Annales de readaptation et de medecine physique et dans les compte-rendus de la Societe internationale francophone d’urodynamique et de l’International Continence Society a permis de selectionner 12 references avec PubMed, deux articles dans les Annales et deux rapports de congres. Notre analyse s’est focalisee sur les indications, les protocoles d’utilisation et d’evaluation de TB. Resultats. – Utilisees pour la premiere fois en 1988 chez des patients blesses medullaires afin de lever un obstacle fonctionnel secondaire a une DSV, les injections de TB ont ete des lors une alternative therapeutique efficace dans la prise en charge des troubles urinaires avec DSV. Elles ont ete proposees chez des patients neurologiques incapables de realiser des sondages intermittents, apres echec des traitements medicamenteux et avant d’envisager une intervention chirurgicale. Les criteres d’evaluation sont cliniques (augmentation de l’intervalle intermictionnel, diminution des residus post-mictionnels), urodynamiques (amelioration de la vidange vesicale, augmentation de la capacite vesicale fonctionnelle et diminution des pressions uretrales) et electromyographiques (denervation du sphincter strie uretral). Type, doses et methodologie d’utilisation de TB restent cependant tres heterogenes. La duree d’action differe de 2 a 12 mois selon les protocoles utilises. Les injections transuretrales, realises sous cystoscopie ou transperineales, sous controle EMG, sont equivalentes en terme d’efficacite. Conclusion. – Devant des effets indesirables negligeables et des resultats satisfaisants, a moyen terme, nous encourageons l’utilisation de la TB comme un traitement de la DVS. Nous proposons une methodologie pratique d’utilisation.

Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French

The Female pelvic floor questionnaire (FPFQ) is a self‐administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties.

Choisir un questionnaire de qualité de vie

Points essentiels Definir l’objectif pour lequel le questionnaire sera utilise: Discrimination: Etes-vous interesse par l’utilisation d’un questionnaire pour decrire la qualite de vie de patients ou comparer la qualite de vie entre groupes de patients, par exemple pour determiner parmi vos patients qui est ameliore et qui est deteriore? Evaluation : Etes-vous interesse par l’utilisation d’un questionnaire pour mesurer un changement a travers le temps (amelioration ou aggravation) chez vos patients ?. Determiner les proprietes de mesures necessaires a cet objectif : Si l’objectif est la discrimination, analysez les proprietes : validite de construit, fiabilite. Si l’objectif est l’evaluation, analysez les proprietes: validite de construit, sensibilite aux changements. Choisir la categorie generale du questionnaire questionnaires generiques, questionnaires specifiques.

Scores de symptômes et de qualité de vie au cours des troubles vésicosphinctériens.

OBJECTIVES To identify all available symptom and quality of life questionnaires for men and women with urinary disorders and assess their psychometric properties. METHODS We systematically reviewed the literature in Medline using the key words urinary disorders, urinary incontinence, bladder, score, quality of life, questionnaire, and psychometric validation. RESULTS The first search using the terms urinary incontinence and quality of life resulted in 1018 Abstracts. Articles mentioning but not measuring quality of life were not investigated. Questionnaires were selected because their psychometric properties were tested and they assessed how much a person was bothered by urinary symptoms or quality of life specific to urinary disorders. The questionnaires were usually gender specific. Their psychometric value was far from uniform, and, for most, responsiveness was not reported. CONCLUSION Few quality of life questionnaires are at an advanced stage of validation to be applied in clinical practice. They need to be shorter, responsive and validated in different populations to permit their easy use.