McMaster-Toronto Arthritis Patient Preference Disability Questionnaire Sensitivity to Change in Low Back Pain: Influence of Shifts in Priorities

To assess the sensitivity to change of the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR) in chronic low back pain (CLBP) and shifts in patients' priorities of disabling activities over time.A prospective longitudinal survey of 100 patients (38 males) with CLBP in a tertiary care teaching hospital. Evaluation at baseline and 6 months by the MACTAR, Quebec Back Pain Disability Questionnaire (QUEBEC), Hospital Anxiety and Depression scale (HAD), Fear-Avoidance Beliefs Questionnaire (FABQ), Coping Strategies Questionnaire (CSQ), and pain and handicap visual analogue scales (VASs). Patients' perceived improvement or worsening of condition was assessed at 6 months. Effect size (ES) and Standardized response mean (SRM) and effect size (ES) were used to evaluate sensitivity to change of the MACTAR.The MACTAR SRM and ES values (SRM = 0.25; ES = 0.37) were among the highest for the instruments evaluated. For patients considering their condition as improved, the SRM was 0.66 and the ES 1. The 3 disability domains, classified by the International Classification of Functioning, Disability and Health (ICF), most often cited as priorities at baseline remained the most cited at follow-up: mobility (40.9% of patients); community, social and civic life (22.7%); and domestic life (22.4%). At 6 months, 48 patients shifted their priorities, for a decrease in MACTAR SRM and ES values for patients considering their condition improved and an increase in these values for those considering their condition deteriorated.Although the MACTAR has similar sensitivity to change as other outcome measures widely used in CLBP, shifts in patient priorities over time are common and influence scores and sensitivity to change

Bladder sensation : evaluation tools and possible influencing factors

La sensibilité vésicale est un pré-Requis au contrôle normal de la vessie. Les objectifs de cette thèse après une analyse de la littérature étaient d'étudier les outils d'évaluation de la sensibilité de la vessie et les possibles facteurs influençant les sensations vésicales. Une première étude démontre l'effet de sensibilisation de l'eau froide pendant une cystomanométrie sur la sensation de besoin d'uriner et les interactions entre les voies afférentes du besoin d'uriner et thermique. Une seconde étude a montré l'effet d'un remplissage rapide lors d'une cystomanométrie sur la sensation de besoin avec un besoin d'uriner retardé. Une troisième étude a mis en évidence chez un certain nombre de patients l'influence de la suggestion verbale sur les sensations vésicales. L'apport des séquences de diffusion en IRM pelvienne pour distinguer le syndrome douloureux vésical chronique /cystite interstitielle d'autres syndromes douloureux pelvi-Périnéaux a été étudié. La validation psychométrique d'un questionnaire sur les circonstances de déclenchement des urgenturies a été commencée. Un protocole de remplissage vésical physiologique a également été développé permettant d'étudier les interactions entre la sensation de besoin d'uriner et les performances attentionnelles. Les deux dernières études ont porté sur l'effet de certains stimuli environnementaux sur les sensations vésicales chez des sujets atteints de syndrome clinique d'hyperactivité vésical et des volontaires sains. Ce travail a permis de souligner certains facteurs pouvant influencer la sensibilité vésicale et de développer des outils prometteurs pour son évaluation.Urinary bladder sensation is a pre-Requisite of a normal bladder control. Understanding the physiological mechanisms leading to bladder sensation generation and transmission to a conscious perception which can lead to a socially acceptable void is fundamental. The aims of this thesis after a comprehensive literature analysis were to study bladder sensation evaluation tools and possible influencing factors. A first study demonstrate the sensitization effect of cold water during cystometry on bladder need to void and the interaction between need to void and thermic afferent pathways. A second study showed the effect of a high filling rate on bladder sensation during a cystometry with a delayed need to void. A third study brought out the influence of verbal suggestion of bladder filling on bladder sensation in a number of patients. The sensibility and specificity of diffusion weighted MRI sequences to detect bladder pain syndrome / interstitial cystitis among pelvic pain was underlined in a fourth study. Then the first steps of the psychometric validation of a new questionnaire about circumstances triggering urinary urgency were developed. A water loading protocol was also developed to study the influence of possible factors on bladder sensation. This protocol allowed studying the interactions between bladder sensation and attentional performances. The two last studies studied the effect of classical environmental urgency triggers on bladder sensation in overactive bladder patients and healthy volunteers. In conclusion this work permitted to underline some possible influencing factors of bladder sensation and to develop new promising tools for bladder sensation evaluation

Etude de la sensibilité vésicale, des moyens d'évaluation et des possibles facteurs l'influençant

Urinary bladder sensation is a pre-Requisite of a normal bladder control. Understanding the physiological mechanisms leading to bladder sensation generation and transmission to a conscious perception which can lead to a socially acceptable void is fundamental. The aims of this thesis after a comprehensive literature analysis were to study bladder sensation evaluation tools and possible influencing factors. A first study demonstrate the sensitization effect of cold water during cystometry on bladder need to void and the interaction between need to void and thermic afferent pathways. A second study showed the effect of a high filling rate on bladder sensation during a cystometry with a delayed need to void. A third study brought out the influence of verbal suggestion of bladder filling on bladder sensation in a number of patients. The sensibility and specificity of diffusion weighted MRI sequences to detect bladder pain syndrome / interstitial cystitis among pelvic pain was underlined in a fourth study. Then the first steps of the psychometric validation of a new questionnaire about circumstances triggering urinary urgency were developed. A water loading protocol was also developed to study the influence of possible factors on bladder sensation. This protocol allowed studying the interactions between bladder sensation and attentional performances. The two last studies studied the effect of classical environmental urgency triggers on bladder sensation in overactive bladder patients and healthy volunteers. In conclusion this work permitted to underline some possible influencing factors of bladder sensation and to develop new promising tools for bladder sensation evaluation.La sensibilité vésicale est un pré-Requis au contrôle normal de la vessie. Les objectifs de cette thèse après une analyse de la littérature étaient d'étudier les outils d'évaluation de la sensibilité de la vessie et les possibles facteurs influençant les sensations vésicales. Une première étude démontre l'effet de sensibilisation de l'eau froide pendant une cystomanométrie sur la sensation de besoin d'uriner et les interactions entre les voies afférentes du besoin d'uriner et thermique. Une seconde étude a montré l'effet d'un remplissage rapide lors d'une cystomanométrie sur la sensation de besoin avec un besoin d'uriner retardé. Une troisième étude a mis en évidence chez un certain nombre de patients l'influence de la suggestion verbale sur les sensations vésicales. L'apport des séquences de diffusion en IRM pelvienne pour distinguer le syndrome douloureux vésical chronique /cystite interstitielle d'autres syndromes douloureux pelvi-Périnéaux a été étudié. La validation psychométrique d'un questionnaire sur les circonstances de déclenchement des urgenturies a été commencée. Un protocole de remplissage vésical physiologique a également été développé permettant d'étudier les interactions entre la sensation de besoin d'uriner et les performances attentionnelles. Les deux dernières études ont porté sur l'effet de certains stimuli environnementaux sur les sensations vésicales chez des sujets atteints de syndrome clinique d'hyperactivité vésical et des volontaires sains. Ce travail a permis de souligner certains facteurs pouvant influencer la sensibilité vésicale et de développer des outils prometteurs pour son évaluation

Evaluation de la sensibilité vésicale au cours d'un calendrier mictionnel et étude de faisabilité de l'évaluation de la sensibilité vésicale au cours d'une exploration cystomanométrique

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Correlation between voiding dysfunction symptoms and uroflowmetry in women suffering from stress urinary incontinence

Objectives: To determine whether the completion of a voiding dysfunction (VD) questionnaire could have a good predictive value for uroflowmetry findings, in a population of stress urinary incontinence (SUI) women. Materials and Methods: From a urodynamic database of 415 SUI women, 93 with isolated SUI who underwent urodynamic investigations were eligible for this study. Patients with obvious etiologies of obstruction were excluded. VD symptoms were analyzed using the Bristol Female Lower Urinary Tract Symptoms Questionnaire. Bladder outlet obstruction (BOO) was defined as a maximal flow rate under 15 ml/s for a urine volume > 200 ml, or a post-void residual volume greater than 50 ml, or an abnormal pattern of the flow curve. The sensitivity, specificity, positive and negative predictive value of questioning VD were calculated. Statistical analysis was done using a Wilcoxon test for continuous data and Fisher exact test for categorical data, and multivariate analysis. Results: Reported VD had a poor specificity (41%) and positive predictive value (32%) of BOO on uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry (P=0.64) in this specific SUI population showing no obvious etiologies of obstruction. Conclusions: No correlation was found between obstructive symptoms and BOO as defined on uroflowmetry, in a specific population of SUI women. Our results suggest that uroflowmetry may be necessary rather than multichannel urodynamics