Journal article
Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome
The Journal of urology, Vol.196(5), pp.1450-1455
11/2016
DOI: 10.1016/j.juro.2016.04.070
PMCID: PMC5069105
PMID: 27131464
Abstract
We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability.
Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts.
Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants.
Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.
Details
- Title: Subtitle
- Symptom Variability and Early Symptom Regression in the MAPP Study: A Prospective Study of Urological Chronic Pelvic Pain Syndrome
- Creators
- Alisa J Stephens-Shields - Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: alisaste@mail.med.upenn.eduJ Quentin Clemens - Department of Urology, University of Michigan, Ann Arbor, MichiganThomas Jemielita - Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaJohn Farrar - Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaSiobhan Sutcliffe - Department of Surgery, Washington University, St. Louis, MissouriXiaoling Hou - Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PennsylvaniaJ Richard Landis - Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaMAPP Research Network
- Contributors
- Karl J Kreder (Contributor) - University of Iowa, Urology
- Resource Type
- Journal article
- Publication Details
- The Journal of urology, Vol.196(5), pp.1450-1455
- DOI
- 10.1016/j.juro.2016.04.070
- PMID
- 27131464
- PMCID
- PMC5069105
- NLM abbreviation
- J Urol
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Publisher
- United States
- Grant note
- U01 DK082344 / NIDDK NIH HHS U01 DK082342 / NIDDK NIH HHS U01 DK082315 / NIDDK NIH HHS U01 DK082325 / NIDDK NIH HHS U01 DK082345 / NIDDK NIH HHS U01 DK082333 / NIDDK NIH HHS U01 DK082370 / NIDDK NIH HHS U01 DK082316 / NIDDK NIH HHS
- Language
- English
- Date published
- 11/2016
- Academic Unit
- Obstetrics and Gynecology; Urology
- Record Identifier
- 9984051986802771
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