Development and Validation of the Actionable Bladder Symptom Screening Tool for Multiple Sclerosis Patients

Abstract

Bladder symptoms such as urinary urgency, frequency, and incontinence are common in people with multiple sclerosis (MS). These symptoms, which often result from neurogenic detrusor overactivity (NDO), can have a major impact on patients' day-to-day lives. However, in many cases they are over-looked in the clinical management of MS. The objective of this study was to develop and validate a reliable, sensitive, and specific screening tool for patients with bladder problems related to MS. We performed a literature review and then conducted a content validation study followed by a multisite observational study of a new screening tool, the Actionable Bladder Symptom Screening Tool (ABSST). All ABSST domains as well as the total score met the threshold for good internal consistency (Cronbach α ≥ 0.70), with a Cronbach α value of 0.95 for the total score and values ranging from 0.85 to 0.90 for the three domains. The validity of the ABSST was demonstrated by high correlation of the domains and total score with the Overactive Bladder Questionnaire Short Form (OAB-q SF) Symptom Severity and Total Health-Related Quality of Life (HRQOL) scores (Spearman correlation coefficient ≥ 0.782). The predictive validity of the ABSST total score to identify patients who might receive a recommendation to see a urologist was strong. This new instrument, which was developed with input from clinicians as well as MS patients, meets the current content validity and psychometric testing thresholds established by the US Food and Drug Administration, with high sensitivity and specificity.

Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms

“…The ABSST is an eight‐item questionnaire plus a final “Yes/No” item asking patients if they would like to receive help for their bladder problems, see Appendix S1. The total ABSST score ranges from 0 to 8 with a score of 3 or higher validated previously to indicate need for further urological evaluation/referral . Participants with an ABSST score ≥3 and/or who answered “yes” to the independent question “Do you want help for your bladder problems?” were given information about urology follow‐up with an outside urologist or with a urologist on staff at the MS Comprehensive Care Center.…”

“…The Actionable Bladder Symptom and Screening Tool (ABSST) is a validated questionnaire that was developed to allow clinicians to identify patients with MS in need of urologic referral for bladder symptoms . A short form of the ABSST was also validated in this population to predict appropriate urological referral .…”

Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines

“…Litwiller et al 1 showed that even asymptomatic MS patients can suffer from LUTS. This has led a few groups to develop specific screening questionnaires, 15,21 while others based their profiling on combination of patients' properties with different test results. 18,20 Table 2 lists the recommendations made for different screening criteria.…”

“…Critical analysis of different guidelines [15][16][17][18][19][20][21] has resulted in dividing MS-related LUTS evaluation into basic and advanced testing.…”

Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms

“…Although there are numerous validated tools available to assess generalized urinary symptoms in neurogenic bladder patients [10], there are two validated questionnaires which are more specific to urinary symptoms in MS patients. The Actionable Bladder Symptom and Screening Tool is a good initial screening tool and helps primary care physicians identify MS patients with symptomatic UI who may benefit from initial treatment or referral to a urologist [11]. Similarly, the Neurogenic Bladder Symptom Score is a patient reported outcome measure that assesses impact of neurogenic detrusor overactivity [12].…”