Advertisement

Agreement between the visual analogue scale (VAS) and the dysfunctional voiding scoring system (DVSS) in the post-treatment evaluation of electrical nerve stimulation in children and adolescents with overactive bladder

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Austin P.F.
        • Bauer S.B.
        • Bower W.
        • Chase J.
        • Franco I.
        • Hoebeke P.
        • et al.
        The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children's Continence Society.
        Neurourol Urodyn. 2016; 35: 471-481https://doi.org/10.1002/nau.22751
        • Lordêlo P.
        • Teles A.
        • Veiga M.L.
        • Correia L.C.
        • Barroso U.
        Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial.
        J Urol. 2010; 184: 683-689https://doi.org/10.1016/j.juro.2010.03.053
        • Barroso Jr., U.
        • Tourinho R.
        • Lordêlo P.
        • Hoebeke P.
        • Chase J.
        Electrical stimulation for lower urinary tract dysfunction in children: a systematic review of the literature.
        Neurourol Urodyn. 2011; 30: 1429-1436
        • Lee H.N.
        • Chae J.Y.
        • Lee H.S.
        • Choo M.S.
        • Park M.G.
        • Lee S.Y.
        • et al.
        Translation and linguistic validation of the Korean version of the treatment satisfaction visual analogue scale and the overactive bladder satisfaction with treatment questionnaire.
        Int Neurourol J. 2017; 21: 309-319https://doi.org/10.5213/inj.1734992.496
        • Nevéus T.
        • von Gontard A.
        • Hoebeke P.
        • Hjälmås K.
        • Bauer S.
        • Bower W.
        • et al.
        The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation Committee of the International Children's Continence Society.
        J Urol. 2006; 176: 314-324https://doi.org/10.1016/S0022-5347(06)00305-3
        • Hodges S.J.
        Overactive bladder in children.
        Curr Bladder Dysfunct Rep. 2012; 7: 27-32https://doi.org/10.1007/s11884-011-0120-9
        • Quintiliano F.
        • Veiga M.L.
        • Moraes M.
        • Cunha C.
        • de Oliveira L.F.
        • Lordelo P.
        • et al.
        Transcutaneous parasacral electrical stimulation vs oxybutynin for the treatment of overactive bladder in children: a randomized clinical trial.
        J Urol. 2015; 193: 1749-1753https://doi.org/10.1016/j.juro.2014.12.001
        • Barroso Jr., U.
        • Viterbo W.
        • Bittencourt J.
        • Farias T.
        • Lordêlo P.
        Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children.
        J Urol. 2013; 190: 673-677https://doi.org/10.1016/j.juro.2013.02.034
        • Barroso Jr., U.
        • de Azevedo A.R.
        • Cabral M.
        • Veiga M.L.
        • Braga A.A.
        Percutaneous electrical stimulation for overactive bladder in children: a pilot study.
        J Pediatr Urol. 2019; 15: 38.e1-38.e5https://doi.org/10.1016/j.jpurol.2018.10.001
        • Jiang R.
        • Kelly M.S.
        • Routh J.C.
        Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature journal of pediatric urology.
        J Pediatr Urol. 2018; 4: 494-501
        • Trsinar B.
        • Kraij B.
        Maximal electrical stimulation in children with unstable bladder and nocturnal enuresis and/or daytime incontinence: a controlled study.
        Neurourol Urodyn. 1996; 15: 133-142https://doi.org/10.1002/(SICI)1520-6777(1996)15:2<133::AID-NAU2>3.0.CO;2-G
        • Malm-Buatsi E.
        • Nepple K.G.
        • Boyt M.A.
        • Austin J.C.
        • Cooper C.S.
        Efficacy of transcutaneous electrical nerve stimulation in children with overactive bladder refractory to pharmacotherapy.
        Urology. 2007; 70: 980-983https://doi.org/10.1016/j.urology.2007.06.1109
        • Hoffmann A.
        • Sampaio C.
        • Nascimento A.A.
        • Veiga M.L.
        • Barroso U.
        Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation.
        J Pediatr Urol. 2018; 14: 54.e1-54.e6https://doi.org/10.1016/j.jpurol.2017.07.017
        • Barroso Jr., U.
        • Lordêlo P.
        Electrical nerve stimulation for overactive bladder in children.
        Nat Rev Urol. 2011; 8: 402-407https://doi.org/10.1038/nrurol.2011.68
        • Lordêlo P.
        • Soares P.V.
        • Maciel I.
        • Macedo Jr., A.
        • Barroso Jr., U.
        Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results.
        J Urol. 2009; 182: 2900-2904https://doi.org/10.1016/j.juro.2009.08.058
        • de Paula L.I.D.S.
        • de Oliveira L.F.
        • Cruz B.P.
        • de Oliveira D.M.
        • Miranda L.M.
        • de Moraes Ribeiro M.
        • et al.
        Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: a randomized controlled trial.
        J Pediatr Urol. 2017; 13: 263.e1-263.e6https://doi.org/10.1016/j.jpurol.2016.11.019
        • Barroso Jr., U.
        • Lordêlo P.
        • Lopes A.A.
        • Andrade J.
        • Macedo Jr., A.
        • Ortiz V.
        Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study.
        BJU Int. 2006; 98: 166-171https://doi.org/10.1111/j.1464-410X.2006.06264.x
        • Hagstroem S.
        • Mahler B.
        • Madsen B.
        • Djurhuus J.C.
        • Rittig S.
        Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence.
        J Urol. 2009; 182: 2072-2078https://doi.org/10.1016/j.juro.2009.05.101
        • Borch L.
        • Hagstroem S.
        • Kamperis K.
        • Siggaard C.V.
        • Rittig S.
        Transcutaneous electrical nerve stimulation (TENS) combined with oxybutynin is superior to monotherapy in children with urge incontinence: a randomized, placebo controlled study.
        J Urol. 2017; 198: 430-435https://doi.org/10.1016/j.juro.2017.03.117
        • Veiga M.L.
        • Queiroz A.P.
        • Carvalho M.C.
        • Braga A.A.
        • Sousa A.S.
        • Barroso Jr., U.
        Parasacral transcutaneous electrical stimulation for overactive bladder in children: an assessment per session.
        J Pediatr Urol. 2016; 12: 293.e1-293.e5https://doi.org/10.1016/j.jpurol.2016.03.011
        • van Laerhoven H.
        • van der Zaag-Loonen H.J.
        • Derkx B.H.
        A comparison of Likert scale and visual analogue scales as response options in children's questionnaires.
        Acta Paediatr. 2004; 93: 830-835https://doi.org/10.1080/08035250410026572
        • Voutilainen A.
        • Pitkäaho T.
        • Kvist T.
        • Vehviläinen-Julkunen K.
        How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale.
        J Adv Nurs. 2016; 72: 946-957https://doi.org/10.1111/jan.12875
        • Marsh H.W.
        Negative item bias in ratings scales for preadolescent children: a cognitive-developmental phenomenon.
        Dev Psychol. 1986; 22: 37-49https://doi.org/10.1037/0012-1649.22.1.37
        • Rebok G.
        • Riley A.
        • Forrest C.
        • Starfield B.
        • Green B.
        • Robertson J.
        • et al.
        Elementary school-aged children's reports of their health: a cognitive interviewing study.
        Qual Life Res. 2001; 10: 59-70https://doi.org/10.1023/a:1016693417166
        • Salazar M.K.
        Interviewer bias: how it affects survey research.
        AAOHN J. 1990; 38: 567-572