Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points.
BACKGROUND
The Actionable questionnaire is an 8-item tool to screen patients with multiple sclerosis (MS) for neurogenic bladder problems, identifying those patients who might benefit from urological referral and bladder-specific treatment. The original scoring yields a total score of 0 to 24 with cut-off point 6. A simplified scoring, yielding a total score of 0 to 8 with cut-off point 3, has been developed in urogynaecological patients, but has not been investigated in MS.


METHODS
One-hundred-and-forty-one MS patients completed the Actionable on two occasions. We compared the test performance of the simplified scoring with cut-off point 3 with that of cut-off point 2, using the original scoring with cut-off point 6 as a gold standard. The following measures were calculated: True Positives (TP), True Negatives (TN), False Positives (FP), False Negatives (FN), Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Accuracy. The associations between positive test result and urological treatment, and bladder-specific drug treatment were calculated.


RESULTS
For cut-off point 3 the outcomes (Test 1, Test 2) were: TP 43.26 %, 40.88 %; TN 29.79 %, 32.85 %; FP 0.00 %, 0.00 %; FN 26.95 %, 26.28 %; Sensitivity 0.62, 0.61; Specificity 1.00, 1.00; PPV 1.00, 1.00; NPV 0.53, 0.55; Accuracy 0.73, 0.74; and for cut-off point 2: TP 59.57 %, 59.85 %; TN 26.95 %, 31.39 %; FP 2.84 %, 1.46 %; FN 10.63 %, 7.30 %; Sensitivity 0.85, 0.89; Specificity 0.90, 0.96; PPV 0.95, 0.98; NPV 0.72, 0.81; Accuracy 0.87, 0.91. Cut-off 3 completely prevented FP outcomes, but wrongly classified 26 % of the patients as negative (FN). Cut-off 2 reduced the FN to 7-10 %, with low FP values (2.84-1.46 %). With cut-off 2, the percentage of patients screened positive was higher in the Progressive group (75.00 %) than in the Relapsing Remitting group (56.25 %) (P = 0.0331), which was not the case with cut-off 3. Only a positive test according to the original scoring was associated with both urological treatment (P = 0.0119) and bladder-specific medication (P = 0.0328).


CONCLUSIONS
Our findings suggest that in MS patients the simplified Actionable scoring is more accurate with cut-off point 2 than with cut-off point 3, especially by substantially reducing FN outcomes; and that in MS the original Actionable scoring seems preferable.
Department of Community and Occupational Medicine, University Groningen, University Medical Centre Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. p.j.h.jongen@rug.nl.|MS4 Research Institute, Ubbergseweg 34, 6522 KJ, Nijmegen, The Netherlands. p.j.h.jongen@rug.nl.
Peter Joseph
PJ
Jongen
Department of Urology, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. b.blok@erasmusmc.nl.
Bertil F
BF
Blok
Department of Urology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. John.Heesakkers@radboudumc.nl.
John P
JP
Heesakkers
MH-advies & organisatiebureau, IJselstraat 81, 9406 TR, Assen, The Netherlands. m.a.p.heerings@gmail.com.|National MS Foundation The Netherlands, Mathenesserlaan 378, 3023 HB, Rotterdam, The Netherlands. m.a.p.heerings@gmail.com.
Marco
M
Heerings
Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Wim.Lemmens@radboudumc.nl.
Wim A
WA
Lemmens
Department for Health Evidence, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Rogier.Donders@radboudumc.nl.
Rogier
R
Donders
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000175:diagnosis*; D009426:Netherlands; D011594:Psychometrics / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis* / Q000209:etiology*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000209:etiology; D064232:Visual Analog Scale; D055815:Young Adult