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Reliability of the pediatric dysfunctional voiding symptom score in monitoring response to behavioral modification
W Farhat1, G A McLorie, S O'Reilly
1Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Insights
The dysfunctional voiding (DV) symptom score effectively monitors behavioral modification in children. A decrease in DV symptom score indicates treatment effectiveness and compliance with bladder retraining.
Area of Science:
- Pediatric Urology
- Behavioral Medicine
Background:
- Dysfunctional voiding (DV) significantly impacts children's quality of life.
- A validated symptom score is crucial for quantifying DV severity and treatment response.
Purpose of the Study:
- To evaluate the dysfunctional voiding (DV) symptom score's performance in monitoring treatment effectiveness and patient compliance.
- To assess the score's utility in identifying adherence to behavioral modification programs.
Main Methods:
- 104 children (3-10 years) with DV were assessed using the DV symptom score.
- Patients underwent behavioral modification; compliance was assessed via questionnaires.
- Change in DV symptom score was correlated with treatment compliance using Mann-Whitney U test.
Main Results:
- 46% of patients completed follow-up questionnaires.
- Children compliant with behavioral modification showed significantly lower DV symptom scores post-treatment (median 6 vs. 14.5).
- Non-compliant children did not show a significant decrease in DV symptom scores.
Conclusions:
- The DV symptom score reliably quantifies symptom improvement in compliant pediatric patients.
- A stable or increased DV symptom score can identify non-compliance with bladder retraining.
- The DV symptom score is a valuable tool for managing pediatric voiding dysfunction.
Purpose:
We previously evaluated the performance of a newly devised dysfunctional voiding symptom score to quantify abnormal voiding behaviors in children. The symptom score ranges from 0 to 30 with higher scores indicating greater severity. In this study, we test the performance of the symptom score in monitoring effectiveness and compliance with a program of behavioral modification.
Materials And Methods:
One hundred four patients (age 3-10 years) were clinically diagnosed as having dysfunctional voiding (DV). At initial visit, after their baseline DV symptom scores were tabulated, they were introduced to a program of behavioral modification that included both verbal and written instructions. After an average follow up of 5 months, all families were mailed questionnaires to: a) assess whether the child was compliant with bladder retraining, and b) request the completion of a second DV symptom-scoring sheet. The change in symptom score was correlated with treatment compliance. Statistical analysis of the data was done using non-parametric method (Mann-Whitney U test).
Results:
Forty-eight out of 104 children (46%) completed the mailed questionnaires. Twenty-eight (Group A1) were compliant with the behavioral modification program, and the remaining 20 children (Group A2) were not compliant. Although the median score at initial evaluation was similar in both groups (15 versus 14.5 respectively), scores in last follow up were significantly lower in Group A1 than the initial scores (6 versus 14.5 respectively). The scores in last follow-up in Group A2 were not significantly different from their initial symptom scores (median 11 versus 14.5 respectively).
Conclusion:
The DV symptom score reliably and quantitatively reflects improvement in voiding symptoms in patients compliant with behavioral modification. Patients non-compliant with a bladder retraining program may be identified by lack of decrease in their DV symptom score. Key Words: voiding dysfunction, pediatric, behavioral modification, symptom score
