University of California, San Francisco
Neurology

Author Of 2 Presentations

Diagnostic Criteria and Differential Diagnosis Poster Presentation

P0253 - Gaps in characterization of bladder dysfunction in clinical care and research (ID 1934)

Speakers
Presentation Number
P0253
Presentation Topic
Diagnostic Criteria and Differential Diagnosis

Abstract

Background

Neurogenic bladder dysfunction (BD) affects up to 90% of patients with multiple sclerosis (MS) at some point during the disease course and is a highly debilitating symptom. Despite its prevalence, there are no consensus guidelines for screening and ascertaining BD. These discrepancies could underrepresent the impact of BD on neurological decline.

Objectives

In a cohort of women with MS, we compared clinical notes and research registry scores pertaining to BD. We secondarily evaluated how often Bowel/Bladder Functional System (B/B FS) scores reflected the severity of bladder (rather than bowel) scores.

Methods

For 100 adult women with MS in the University of California, San Francisco longitudinal observational EPIC cohort (epicstudy.ucsf.edu), we retrospectively extracted data on bladder and bowel symptoms and treatments from prospectively collected clinical notes in the electronic medical record and compared them with research-grade B/B FS scores annually collected in the EPIC registry. We performed descriptive statistics to evaluate agreement between the clinical notes (BD) and research B/B FS scores at matching timepoints (within 6 months). Finally, seeking to understand whether the severity of BD could be inferred by the B/B FS, we calculated the frequency that bladder (vs. bowel) symptoms drove a higher B/B FS.

Results

We included 89 women, aged 37 to 77, with at least one matching clinical and research visit; a total of 316 visits were examined. Overall, 63 of the 89 participants (70.7%) experienced BD symptoms per clinical notes. BD symptoms were described in 284 of the 316 visits (89.9%), and research B/B FS scores were available for 283 of these. The severity of BD symptoms matched the research B/B FS in 203 (71.5%) of visits. For the rest, BD symptoms were more severe than research B/B FS for 46 visits and less severe for 34. BD severity “drove” the overall B/B FS score in 280 (98.6%); in contrast, in only 4 visits (1.4%) bowel symptoms were more severe.

Conclusions

We noted moderate discrepancy between clinical notes and research B/B FS; in 10% visits, BD symptoms were not ascertained; and in 16.3% research evaluations, BD symptoms were underscored. Inconsistencies in screening for both clinical care and research point to the need for consensus around consistency of BD symptom ascertainment and B/B FS scoring. Of relevance to interpreting B/B FS in the context of understanding the impact of BD on clinical course, B/B FS in most cases reflected the severity of bladder symptoms.

Collapse
Symptom Management Poster Presentation

P1107 - Proactively evaluating and treating changes in function in people with multiple sclerosis: the CoachMS pilot study (ID 1488)

Speakers
Presentation Number
P1107
Presentation Topic
Symptom Management

Abstract

Background

In current disease management models for multiple sclerosis (MS), symptoms are treated separately, by multiple specialists, despite the fact that many symptoms interact and exacerbate one another. Impairments in bladder function, ambulation, and mood (BAM) are a common and often debilitating triad of symptoms with compounded detrimental effect.

Objectives

Assess the feasibility of CoachMS: a novel closed-loop, remote, interdisciplinary symptom management platform that integrates specific behavioral approaches to encourage patient self-management.

Methods

We enrolled 21 participants from the University of California, San Francisco MS Center with clinician- or self-reported symptoms in at least 2 of the 3 BAM domains. To quantitatively measure BAM symptoms, participants were given a Fitbit Flex2 to wear for the duration of the study and assessed with weekly, online surveys. At 2 weeks, together with the study team, individual goals were set for each participant. A simple 1:1 randomization allocated participants to either Coach or control groups. The CoachMS group received targeted interventions throughout the remainder of the study if they failed to meet their individual BAM goals, or displayed worsening. The control group was monitored without intervention. Our primary outcome was feasibility; secondary outcomes included proportion of recommended treatments pursued, and changes in BAM symptom severity.

Results

12 participants (55%) completed the study. These participants demonstrated excellent adherence to study protocol and reported satisfaction with the pilot platform. Coach participants demonstrated greater follow-through with clinical recommendations from the 2-week goal setting stage than controls (OR 9.33, 95% CI (0.89, 97.62)). As a cohort, a trend towards improvement in each BAM symptom was noted although the CoachMS and control groups did not differ. One control participant, reporting suicidality in the weekly questionnaires but not to her primary clinicians, was urgently evaluated per protocol, and hospitalized.

Conclusions

The CoachMS platform, a closed-loop system for managing MS symptoms, was feasible; retention can be further optimized with lower questionnaire burden. Reminders and contact from study team improved recommendation follow-though in the Coach group, particularly for outside referrals. The CoachMS protocol could represent a viable, accessible and cost-effective tool to monitor and treat MS symptoms in near real-time; a larger trial is planned.

Collapse

Presenter Of 1 Presentation

Diagnostic Criteria and Differential Diagnosis Poster Presentation

P0253 - Gaps in characterization of bladder dysfunction in clinical care and research (ID 1934)

Speakers
Presentation Number
P0253
Presentation Topic
Diagnostic Criteria and Differential Diagnosis

Abstract

Background

Neurogenic bladder dysfunction (BD) affects up to 90% of patients with multiple sclerosis (MS) at some point during the disease course and is a highly debilitating symptom. Despite its prevalence, there are no consensus guidelines for screening and ascertaining BD. These discrepancies could underrepresent the impact of BD on neurological decline.

Objectives

In a cohort of women with MS, we compared clinical notes and research registry scores pertaining to BD. We secondarily evaluated how often Bowel/Bladder Functional System (B/B FS) scores reflected the severity of bladder (rather than bowel) scores.

Methods

For 100 adult women with MS in the University of California, San Francisco longitudinal observational EPIC cohort (epicstudy.ucsf.edu), we retrospectively extracted data on bladder and bowel symptoms and treatments from prospectively collected clinical notes in the electronic medical record and compared them with research-grade B/B FS scores annually collected in the EPIC registry. We performed descriptive statistics to evaluate agreement between the clinical notes (BD) and research B/B FS scores at matching timepoints (within 6 months). Finally, seeking to understand whether the severity of BD could be inferred by the B/B FS, we calculated the frequency that bladder (vs. bowel) symptoms drove a higher B/B FS.

Results

We included 89 women, aged 37 to 77, with at least one matching clinical and research visit; a total of 316 visits were examined. Overall, 63 of the 89 participants (70.7%) experienced BD symptoms per clinical notes. BD symptoms were described in 284 of the 316 visits (89.9%), and research B/B FS scores were available for 283 of these. The severity of BD symptoms matched the research B/B FS in 203 (71.5%) of visits. For the rest, BD symptoms were more severe than research B/B FS for 46 visits and less severe for 34. BD severity “drove” the overall B/B FS score in 280 (98.6%); in contrast, in only 4 visits (1.4%) bowel symptoms were more severe.

Conclusions

We noted moderate discrepancy between clinical notes and research B/B FS; in 10% visits, BD symptoms were not ascertained; and in 16.3% research evaluations, BD symptoms were underscored. Inconsistencies in screening for both clinical care and research point to the need for consensus around consistency of BD symptom ascertainment and B/B FS scoring. Of relevance to interpreting B/B FS in the context of understanding the impact of BD on clinical course, B/B FS in most cases reflected the severity of bladder symptoms.

Collapse