For many years, the evaluation of treatments has been a central issue in patient care.
The various domains assessed have gradually evolved over time, ranging from satisfaction,
improvement and quality of life, to the m ore recent introduction of the Patient Reported
Outcome Measure (PROM). These questionnaires or measurement scales (PROMs) focus
assessment on the patient and his or her direct experience. Statistical validation of
numerous assessment tools has made it possible to quantify objectively many areas of
assessment that were initially linked to the patient's feelings, and therefore to their
subjectivity. Thus, improvement, quality of life, patient expectations and goal
attainment have been the preferred areas for the development of these PROMs.
However, certain areas have been sidelined in the creation of these tools. For example,
the constraint of care or the side-effects or negative effects of treatment have been
little studied using specific assessment tools.
In the field of neurology or neuro-urology, only a few multidimensional questionnaires
take these domains into account. The main one is Qualiveen, which, in addition to quality
of life, looks at discomfort, constraint, fear and patient experience. Other
questionnaires, less specific in terms of population, enable a multidimensional
evaluation of treatments according to 4 domains (efficacy, side effects, ease of use and
overall satisfaction) for the Treatment Satisfaction Questionnaire for Medication (TSQM)
or 6 domains (side effects, efficacy, practical aspects of drug treatment, effects of
drug treatment on daily life, medical follow-up and overall opinion of treatment) for the
Treatment Satisfaction with Medicine Questionnaire (SatMed-Q). These 2 multi-dimensional
questionnaires do not allow for a targeted assessment of the constraint of care, which
represents a much broader domain than the simple side effect or ease of use of a
treatment. What's more, a mixed assessment, both positive (improvement, efficacy) and
negative (side-effects) on the same questionnaire, may well limit the interpretation of
results and patient understanding.
In response to this shortcoming, a specific treatment constraint questionnaire has been
developed for neuro-urological treatments in a neurological patient population.
The LUTS-TCA (Lower Urinary Tract Symptoms Treatment Constraints Assessment) was
developed in French and statistically validated in 2019. This 22-item questionnaire
provides a general assessment of therapeutic constraint (physical, social, psychological,
etc.). The "detailed" study of therapeutic stress is an important part of the overall
therapeutic assessment of these neurological patients, as therapeutic management is often
multiple and complex in terms of treatments, examinations, follow-up and impact on daily
life.
The use of specific, validated tools to take account of care constraints is important,
and is just as justified as the assessment of satisfaction or therapeutic improvement.
The "detailed" study of care constraints is an important part of the overall therapeutic
assessment of these neurological patients, as therapeutic management is often multiple
and complex in terms of treatments, examinations, follow-up and impact on daily life.
The use of specific, validated tools to take account of care constraints is important,
and is just as justified as the assessment of satisfaction or therapeutic improvement.
One of the most widely used questionnaires for measuring treatment improvement is the
Patient Global Impression of Improvment (PGI-I). The PGI-I takes the form of a single
question, with a 7-level Likert scale ranging from +3 (much improved) to -3 (not improved
at all). These positive and, above all, negative levels can be confused with the care
constraint for the negative part of the response mode. To avoid measuring the same thing
twice (negative PGI-I and LUTS TCA), it is vital to be able to measure the 2 parameters
independently.
The aim of the study is to create a short form of the LUTS TCA in French, in a population
of neurological patients.
This short form, which would be easier to use and interpret, would simplify its use in
everyday practice. Indeed, a large majority of neuro-urology patients suffer from
neurodegenerative or progressive pathologies, marked by significant and disabling
physical and psychological fatigue symptoms. Long-form questionnaires, or the addition of
multiple assessment questionnaires during a single visit to the department, make overall
assessment more complex.
In addition, this short-form questionnaire is presented in a slightly different form to
the long-form version, showing several domains of constraint (physical, social,
psychological and care system). This classification should simplify the interpretation
and understanding of care constraint, by and for patients.