Pariser Joseph J, Welk Blayne, Kennelly Michael, Elliott Sean P
Department of Urology, University of Minnesota, Minneapolis, MN.
Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
Urology. 2019 Jun;128:107-111. doi: 10.1016/j.urology.2019.02.033. Epub 2019 Mar 16.
To examine the utility of the Neurogenic Bladder Symptom Score (NBSS) in adults with cerebral palsy (CP).
Patients participated in a structured intake which included bladder management. Patients (or caregivers, if patients unable) completed NBSS and SF-Qualiveen twice over a 2-week period. Validity was determined using Cronbach's alpha and correlation testing between NBSS, intake, and SF-Qualiveen. Reliability was determined using test-retest method and intraclass correlation coefficients.
Fifty-four patients were included. Thirty-six patients (67%) used a wheelchair; 35 patients (66%) required a caregiver to complete questionnaires. Median NBSS subdomain scores were 12 of 29 for incontinence, 9 of 22 for storage and/or voiding, 2 of 23 for consequences and 1 of 4 for quality of life (QOL). Lower scores reflect fewer symptoms. Reliability was high (intraclass correlation coefficients = 0.90). There was a moderate correlation (R = 0.70) between NBSS QOL and SF-Qualiveen. Bladder management method, as determined by the NBSS, was indwelling catheter in 4, intermittent catheterization in 6, voiding into a toilet in 33, and missing in 11. Importantly, there was no option for voiding into a diaper, which was common in this population.
For adults with CP, the NBSS has high reliability and statistically, it demonstrated appropriate validity, but it has limitations. Its face validity is questionable given that diapers were not an option. The validity of caregiver completion needs further assessment. The NBSS may have a floor effect for detecting urinary consequences or QOL, reflected by consistently low scores in these subdomains. The development of a specific urinary symptom and/or QOL tool for adults with CP is needed.
探讨神经源性膀胱症状评分（NBSS）在成人脑瘫（CP）患者中的应用价值。
患者参与了包括膀胱管理在内的结构化接诊。患者（若患者无法完成，则由照料者）在两周内两次完成NBSS和SF-Qualiveen问卷。通过Cronbach's α系数以及NBSS、接诊情况和SF-Qualiveen之间的相关性测试来确定效度。采用重测法和组内相关系数来确定信度。
共纳入54例患者。36例患者（67%）使用轮椅；35例患者（66%）需要照料者协助完成问卷。NBSS各子域的中位数得分分别为：尿失禁29分中的12分，储尿和/或排尿22分中的9分，后果23分中的2分，生活质量（QOL）4分中的1分。得分越低表明症状越少。信度较高（组内相关系数=0.90）。NBSS生活质量评分与SF-Qualiveen之间存在中度相关性（R=0.70）。根据NBSS确定的膀胱管理方法为：4例留置导尿管，6例间歇性导尿，33例自行排尿至马桶，11例情况不明。重要的是，问卷中没有自行排尿至尿布这一选项，而这在该人群中很常见。
对于成人CP患者，NBSS具有较高的信度，且在统计学上显示出适当的效度，但存在局限性。鉴于问卷中没有尿布这一选项，其表面效度值得怀疑。照料者完成问卷的效度需要进一步评估。NBSS在检测泌尿系统后果或生活质量方面可能存在地板效应，这些子域的得分持续较低反映了这一点。需要为成人CP患者开发一种特定的泌尿系统症状和/或生活质量工具。
