Comparing clinical bladder diaries and recalled patient reports for measuring lower urinary tract symptoms in the symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)

Abstract

Purpose Bladder diaries are a key source of information about lower urinary tract symptoms (LUTS); however, many patients do not complete them as instructed. Questionnaire‐based patient‐reported outcome measures (PROMs) are another option for reporting LUTS but may have recall bias. We assessed the strength of the associations between PROMs and a 3‐day bladder diary. Materials and Methods Symptomatic adults from 6 tertiary care sites completed a 3‐day paper bladder diary and 3‐, 7‐, and 30‐day electronic PROMs. We assessed the linear associations between mapped pairs of diary variables and responses to PROM items using biserial and polyserial correlation coefficients with 95% confidence intervals. Results Of 290 enrolled participants, 175 (60%) completed the bladder diary as instructed and at least one corresponding PROM. Linear associations were strongest between the diary and 3‐day recall of daytime frequency (r = 0.75) and nighttime frequency (r = 0.69), followed by voids with urgency sensations (r = 0.62), and an item reporting any incontinence (r = 0.56). Linear associations between bladder diary and specific incontinence variables (e.g., stress, urgency) were low to negligible (ranging from r = 0.16–0.39). Linear associations were consistent across the 3‐, 7‐, and 30‐day recall periods. Conclusions Missing and unusable bladder diary data were common, highlighting the patient burden associated with this method of data collection. A questionnaire‐based PROM is a reasonable alternative to a diary for reporting voiding frequency and may offer an easier option for reporting some symptoms.

Healthy bladder storage and emptying functions in community‐dwelling women measured by a 2‐day bladder health diary

“…Participant burden is the main drawback of diaries, as diaries are not completed in real-time and bladder data ascertained from recall bias may not be accurate as compared with patient reported outcome measures. 19 These limitations were also noted in a recent systematic review on normative bladder data by Wyman et al where the main source of measurement included bladder diary data. 9 Study limitations include lack of validation of the 2-day diary, nonuniversal response, and the operational definition of nocturia which only measured one night of diary keeping.…”

“…It is possible, however, that the paper diaries may not have been completed in real time, resulting in recall bias. 9,19 Future studies are needed to determine whether the use of electronic diaries and momentary assessments may improve adherence and accuracy. 21…”

“…However, the timing and duration of collecting bladder diary data often balances the frequency of LUTS with patient burden. Participant burden is the main drawback of diaries, as diaries are not completed in real‐time and bladder data ascertained from recall bias may not be accurate as compared with patient reported outcome measures 19 . These limitations were also noted in a recent systematic review on normative bladder data by Wyman et al where the main source of measurement included bladder diary data 9 …”

“…In our study, the correlation between Day 1 and 2 on the diaries was strong, suggesting the 2 day diary was sufficient to capture voiding frequency. It is possible, however, that the paper diaries may not have been completed in real time, resulting in recall bias 9,19 . Future studies are needed to determine whether the use of electronic diaries and momentary assessments may improve adherence and accuracy 21 …”

Dynamic analysis of the individual patterns of intakes, voids, and bladder sensations reported in bladder diaries collected in the LURN study

“…The first group of limitations is related to the collected, or rather to the non-collected data; the second to the methodology and model assumptions. BDs are not perfect, there is always a chance of some intakes or voids being missed or recorded incorrectly [42]. We do not have data on the physical activity and heart rate that affects glomerular filtration rate.…”