THE IMPACT OF A BLADDER TRAINING VIDEO VERSUS STANDARD UROTHERAPY ON QUALITY OF LIFE OF CHILDREN WITH BLADDER AND BOWEL DYSFUNCTION: A RANDOMIZED CONTROLLED TRIAL
Natasha Brownrigg, MN-NP1, Kizanee Jegatheeswaran, BSc2, Mandy Rickard, MN-NP2, Forough Farrokhyar, PhD2, Jorge DeMaria, MD2, Armando J. Lorenzo, MD3, Luis H. Braga, MD2.
1McMaster Children's Hospital, Hamilton, ON, Canada, 2McMaster University, Hamilton, ON, Canada, 3University of Toronto/ The Hospital for Sick Children, Toronto, ON, Canada.
Background: Bladder and bowel dysfunction (BBD) can negatively impact the quality of life (QoL) of children. Literature examining the effect of standard urotherapy (SU) on QoL in this population is scarce. The aim of this study was to determine whether a bladder training video (BTV) is not inferior to SU in improving QOL in children with BBD.
Materials & Methods: Children 5-10 years of age who scored >11 on the Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES) were recruited from our tertiary care center. Children with known vesicoureteral reflux; spinal dysraphism; learning disabilities; recent urotherapy and primary nocturnal enuresis were excluded. QoL was evaluated using the Pediatric Incontinence Quality-of-Life questionnaire (PinQ). Questionnaires were administered at baseline and 3-month follow-up. A PinQ scores of < 20 indicate a mild, 21-50 moderate, and >51 severe impact on QoL. Patients were randomized to receive either SU or BTV during their regular clinic visit. Centralized electronic blocked randomization schemes guaranteed allocation concealment. An intention to treat protocol was followed. Baseline and follow-up QoL scores between groups were compared using paired t-tests.
Results: Of 539 BBD patients screened, 173 (32%) were eligible, and 150 (87%) agreed to be recruited. Of these, 143 (96%) completed the study, 5 (3%) were lost to follow-up, and 2 (1%) withdrew. In total, 140/143 (97%) completed the QoL questionnaire at baseline and follow-up. At baseline, BTV and SU patients scored a mean of 27 ± 13 and 25 ± 12, (p=0.30) respectively, indicating that BBD had a moderate impact on QoL in both groups. Patients in both groups scored highest at baseline and follow-up on the same two questions, which addressed self-confidence and impact of BBD on family. The mean change in PinQ scores from baseline to follow up between the two groups was not statistically significant (BTV: 7 + 12 vs. SU: 5 + 12; p=0.23).
Conclusions: QoL equally improved in both the BTV and SU groups, suggesting that these interventions are similar in addressing this important aspect of care. Changes in QoL should be considered when evaluating interventions for BBD and appears to be an important clinical outcome to determine urotherapy success.
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