Summary
Introduction
Electrical nerve stimulation is one of the most commonly used and well-tolerated treatments
for overactive bladder (OAB); however, different studies have used different instruments
to assess patients’ response to treatment.
Objective
To analyze agreement between use of the visual analogue scale (VAS) and the Dysfunctional
Voiding Scoring System (DVSS) for assessing improvement in urinary symptoms following
electrical nerve stimulation treatment in children and adolescents with OAB.
Study design
A cross-sectional analytical study including children and adolescents of 4–17 years
of age diagnosed with OAB who underwent 20 sessions of transcutaneous (TENS) or percutaneous
(PENS) electrical nerve stimulation. The DVSS and the VAS were used to assess daytime
urinary symptoms before and following treatment. While the DVSS was always applied
by a physician, the VAS was applied separately by a physiotherapist and then by a
physician. Treatment was considered successful when the DVSS score was zero and the
VAS score was ≥90%. Correlations between post-treatment VAS and DVSS scores were evaluated
using the kappa coefficient. The VAS scores evaluated by the different professionals
were compared for agreement using intraclass correlation and the Bland–Altman plot.
Results
Data from 49 cases were available for analysis. Of these, 27 (55.1%) were girls. Mean
age was 7.1 ± 2.6 years. There was agreement between the two instruments used, the
DVSS and the VAS, in 36/49 patients (73.5%), with a moderate Kappa of 0.44. There
was moderate agreement between the VAS scores applied by the two different professionals.
Discussion
imitations of the present study include the small sample size and the fact that the
inter-observer evaluation was conducted following a single sequence, i.e. all the
patients were first evaluated by the physiotherapist and then by the physician, which
may have biased answers and the post-treatment VAS scores. Furthermore, although the
child participated actively in completing the questionnaires, in cases of divergent
answers, the questions were redirected to the responsible adult, and the final answer
may not fully represent the patient's true situation.
Conclusion
Tabled
1Summary table Agreement between the rate of improvement in urinary symptoms obtained
with the VAS and that obtained using the DVSS (p = 0.001).
| DVSS = 0 (n = 18) | DVSS >0 (n = 31) | |
|---|---|---|
| VAS = 100% (n = 21)a | 13 (61,9%) | 8 (38.1%) |
| VAS <100% (n = 28)a | 5 (17.9%) | 23 (82.1%) |
DVSS, Dysfunctional Voiding Scoring System; VAS, Visual Analogue Scale. a VAS administered by a physiotherapist.
Keywords
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Article info
Publication history
Published online: August 02, 2022
Accepted:
July 27,
2022
Received in revised form:
June 22,
2022
Received:
January 28,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
