Department Neurology, RVI, University of Newcastle, Newcastle on Tyne NE1 4LP, England.
BMC Neurol. 2013 Jul 9;13:78. doi: 10.1186/1471-2377-13-78.
The majority of multiple sclerosis (MS) patients develop some form of lower urinary tract dysfunction, usually as a result of neurogenic detrusor overactivity (NDO). Patients identify urinary incontinence as one of the worst aspects of this disease. Despite the high prevalence of NDO, urological evaluation and treatment are significantly under-accessed in this population. The objectives of this study were: 1) to adapt the previously validated Actionable Bladder Symptom Screening Tool (ABSST) to a short form for ease and brevity of application in a clinical setting that is clinically meaningful; and 2) to develop a scoring algorithm that would be interpretable in terms of referring/considering precise diagnosis and treatment.
A US-based, non-randomized, multi-center, stand-alone observational study was conducted to assess the psychometric properties of the ABSST among patients who have MS with and without NDO. Mixed psychometric methods (e.g., classical statistics (Psychometric theory (3rd ed.). New York: McGraw-Hill; 1994) and item response methods (Applying the Rasch Model: Fundamental Measurement in the Human Sciences. New Jersey: Lawrence Earlbaum Associates; 2001)) were used to evaluate the predictive and clinical validity of the shortened form. The latter included clinicians flagging clinically meaningful items and associated response options which would indicate the need for further evaluation or treatment.
A total of 151 patients, all with MS and with and without NDO, were recruited by 28 clinicians in various US geographical locations. Approximately 41% of patients reported a history of or currently having urinary incontinence and/or urinary urgency. The prediction model across the entire range of classification thresholds was evaluated, plotting the true positive identification rate against the false positive rate (1-Specificity) for various cut scores. In this study, the cut-point or total score of greater than or equal to 6 had a sensitivity of approximately 85%, and specificity of approximately 93% (i.e., 85% patients would warrant being referred to a urologist and 93% of the patients whose symptoms would not warrant urologist referral).
Overall the short form ABSST demonstrated sensitivity and specificity as it maintained the integrity of the longer form tool. Concurrent validity for each subscale as well as predictive and concurrent validity of the total shortened instrument was demonstrated. This instrument provides a new method for assessing bladder problems among MS patients, and may facilitate earlier and more precise diagnosis, treatment, and/or referral to a specialist.
大多数多发性硬化症（MS）患者会出现某种形式的下尿路功能障碍，通常是由于神经源性逼尿肌过度活动（NDO）所致。患者认为尿失禁是这种疾病最糟糕的方面之一。尽管 NDO 的患病率很高，但在该人群中，泌尿科评估和治疗的机会明显不足。本研究的目的是：1）将先前经过验证的可操作性膀胱症状筛查工具（ABSST）改编为简短形式，以便在临床环境中更轻松、更简洁地应用，并且具有临床意义；2）制定一种评分算法，可根据参考/考虑进行精确诊断和治疗来解释。
在美国进行了一项非随机、多中心、独立的观察性研究，以评估具有和不具有 NDO 的 MS 患者中 ABSST 的心理测量特性。混合心理测量方法（例如，经典统计学（Psychometric theory (3rd ed.). New York: McGraw-Hill; 1994）和项目反应方法（Applying the Rasch Model: Fundamental Measurement in the Human Sciences. New Jersey: Lawrence Earlbaum Associates; 2001））用于评估缩短形式的预测和临床有效性。后者包括临床医生标记具有临床意义的项目和相关的反应选项，这将表明需要进一步评估或治疗。
共有 151 名患者，均患有 MS，且患有或不患有 NDO，由美国各地的 28 位临床医生招募。大约 41%的患者报告有或目前有尿失禁和/或尿急病史。在整个分类阈值范围内评估了预测模型，绘制了各种截断值的真阳性识别率与假阳性率（1 特异性）的关系。在这项研究中，总分大于或等于 6 的截断点或总分具有约 85%的敏感性和约 93%的特异性（即约 85%的患者需要转介泌尿科医生，而 93%的患者症状不需要泌尿科医生转介）。
总体而言，简短形式的 ABSST 表现出敏感性和特异性，因为它保持了较长形式工具的完整性。每个子量表的同时效度以及缩短仪器的预测和同时效度均得到了证明。该工具为评估 MS 患者的膀胱问题提供了一种新方法，并可能促进更早、更准确的诊断、治疗和/或转介给专家。
