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Use of the Vancouver Symptom Score to Assess Treatment Response of Bowel and Bladder Dysfunction in Children
Ruiyang Jiang, BS, Janelle Traylor, PA, Karen Pritzker, PA, Kim Mizener, PA, Nicol Bush, MD.
Children's Medical Center, Dallas, TX, USA.
Introduction: The Vancouver Symptom Score (VSS) has been validated to diagnose Bowel and Bladder Dysfunction (BBD).[Ashfar et al, 2009] However, it has not been validated to measure response to therapy. We analyzed these parameters.
Methods: Patients referred to a pediatric urology BBD specialty clinic completed the VSS at their initial and follow up visits. Treatment consisted of patient education, timed voiding, and bowel therapy on the initial visit, with anticholinergic therapy given at follow up when symptoms persisted. Patients with any daytime lower urinary tract symptoms (LUTS) were included. Item Response Theory (IRT) analysis, and Crohnbach and Spearman’s correlations were performed.
Results: 291 pts (F=192, mean age = 8.03, SD 3.17) had initial and follow up mean VSS scores of 18.8 (SD 7.2) and 13.6 (SD 7.0) out of 52, respectively. The VVS scale demonstrated significant symptom improvement at follow-up (p<0.0001). Pre and post-therapy measurements showed a high degree of internal consistency (alpha = 0.62 and 0.7, respectively), demonstrating a high degree of validity and the ability to discriminate patients before and after therapy with the VVS.
IRT analysis demonstrated that questions 1 (day incontinence, rit=0.47), 2 (degree of day incontinence, rit=0.47), 4 (urgency, rit=0.55) and 5 (holding maneuvers, rit=0.45) had the highest contribution towards the total VSS score, establishing that these questions were the most important contributors to the overall score on the VSS in patients with LUTS.
Conclusions: The VSS has been used to diagnose bowel and bladder dysfunction in pediatric patients, but we used it to assess response to therapy. We report the largest pre/post-treatment study to date, demonstrating VSS scores significantly improved with therapy and that the VSS has strong discriminative psychometric properties. LUTS-related questions (1,2,4, and 5) contributed most to the overall VSS score, and there was high internal test/re-test consistency between individual questions. Such data is critical to our use of BBD questionnaires and the interpretation of results in clinical practice.
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