Non-Oral Poster 30

Abstract

OBJECTIVES: To determine the impact of overactive bladder (OAB) symptoms and treatments on quality of life (QoL) measures in patients with multiple sclerosis (MS). MATERIALS AND METHODS: After obtaining IRB approval, results from the Fall 2005 North American Research Committee On Multiple Sclerosis (NARCOMS) survey were reviewed, including the Urogenital Distress Inventory (UDI-6) with an additional question regarding nocturia, the SF-12 (mental and physical scores), and the Patient Determined Disease Steps (PDDS), a subjective measure of MS symptom severity (scored 0 to 8). A total OAB symptom score was created by summing individual responses to the frequency, urgency, small leakage and nocturia questions, resulting in a possible score of 0 to 12. Data were analyzed using descriptive statistics, the chi-square and Student's t-tests, analysis of variance, and multivariate logistic regression. RESULTS: Of 16,858 surveys mailed, 9702 (58%) complete responses were returned (75.4% females and 24.6% males). Participants with a surgically altered bladder were excluded (N = 21). At least one moderate to severe urinary symptom (score >1) was reported by 6263 (65%) respondents. The median OAB symptom score for all respondents was 5.1. A significant correlation between increasing OAB symptom score and increasing disability as gauged by PDDS score was noted (r = 0.291, P < 0.001). Quality of life assessments based on SF-12 scores were adversely impacted by increasing OAB symptom and PDDS scores (P < 0.001). Among respondents with at least one OAB symptom score >1, significant reductions in SF-12 physical (PCS-12) and mental (MCS-12) scores in all domains were noted (all P < 0.001). When disability was controlled for, reduced physical and mental QoL were correlated with increasing OAB symptom scores (PCS-12 r = 0.17; MCS-12 r = 0.16; both P < 0.001). Among respondents with an OAB symptom score >4, only 2361 (51.3%) had been treated with an anti-cholinergic medication. No significant difference in QoL measures based on the MCS-12 were noted between patients treated [44.65 (SD = 11.78)] or not treated [44.21 (SD = 11.67)] with anti-cholinergic medications (P = 0.142). However, lower median PCS-12 scores were noted among anti-cholinergic medication treated patients [32.84 (SD = 9.85)] versus untreated patients [36.34 (SD = 11.47); P < 0.001]. Respondents who utilized any form of urinary catheterization reported greater disability and reduced QoL (both P < 0.001). When compared, catheterizing respondents reported lower mean (SD) MCS-12 score of 44.1 (12.2), PCS-12 score of 30.5 (9.2) and PDDS score of 5.4 (2.0) versus mean MCS-12 score of 45.7 (11.5), PCS-12 score of 38.1 (11.8), and PDDS score of 3.2 (2.3) (t = 4.9, 23.9, 35.6 respectively, all P < 0.001) in non-catheterizing respondents. CONCLUSION: Overactive bladder symptoms have a significant negative impact on the QoL of MS patients. Although greater reductions in QoL are noted in patients treated with anti-cholinergic medications or catheterization for OAB symptoms, these differences may be secondary to increased physical disability associated with more severe disease.