title: Reliability of the pediatric dysfunctional voiding symptom score in monitoring response to behavioral modification.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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
authors.affiliation: Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Farhat
authors.forename: G A
authors.initials: GA
authors.lastname: McLorie
authors.forename: S
authors.initials: S
authors.lastname: O'Reilly
authors.forename: A
authors.initials: A
authors.lastname: Khoury
authors.forename: D J
authors.initials: DJ
authors.lastname: Bägli
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000175:diagnosis* / Q000628:therapy*