Abstract: PD64-01
Sources of Funding: PCORI grant CER14092138.

Introduction

The Neurogenic Bladder Symptom Score (NBSS) has been validated as a tool to assess bladder quality of life and symptoms. The objective of this study was to externally validate the NBSS and assess responsiveness (ability of a questionnaire to detect change).

Methods

Data from the "Patient reported outcomes for bladder management strategies in spinal cord injury" study was used. Adult SCI patients were eligible for enrollment through direct recruitment or an open online portal. At the initial visit, patients provided an extensive medical history, and completed the NBSS. Responsiveness was assessed in a separate prospective cohort of patients undergoing their first injection of onabotulinum toxin. Medians, interquartile range (IQR), and Pearson correlation coefficient (r) are reported.

Results

609 patients had complete NBSS scores. Median age was 48 (IQR 36-57), and 67% were male. The majority had thoracolumbar lesions (51%) and managed their bladder by CIC (63%). The median NBSS total score was 22 (IQR 15-30, possible range 0 (no symptoms) to 74 (severe symptoms)), and median quality of life was 'mixed'. The Cronbach's alpha of the total score was 0.85, and 0.93, 0.76, and 0.49 for the incontinence, storage/voiding, and consequences domains respectively. All item to domain correlations were moderate to strong (r≥0.3) aside from 3/7 of the items from the consequences domain. Appropriate hypothesized correlations between the NBSS domains and external variables (such as the number of prior urinary infections and the NBSS consequences domain (r=0.51, p≤0.01) were observed. There was no significant correlation between overall quality of life and prior hospitalizations for urinary infections, or incontinence pad usage._x000D_ _x000D_ A separate cohort of 15 patients with neurogenic bladder competed the NBSS pre and post onabotulinum toxin injection, and the mean change in the total NBSS score was -12 (IQR -2 to -25). The mean change of the incontinence domain was -9 (IQR -1 to -15) and -3 (IQR -2 to -5) for the storage/voiding domain. The change scores had a large to moderate effect size (total NBSS (0.91), incontinence domain (1.03), storage/voiding domain (0.69)) suggesting appropriate and clinically relevant responsiveness.

Conclusions

The NBSS demonstrated good validity in a large cohort of SCI patients. Similarly, the total NBSS score and relevant domains were responsive to change, and can be used to assess the impact of an intervention.

Funding

PCORI grant CER14092138.