The following is the summary of “Agreement between the visual analog scale (VAS) and the dysfunctional voiding scoring system (DVSS) in the post-treatment evaluation of electrical nerve stimulation in children and adolescents with overactive bladder” published in the December 2022 issue of Pediatric urology by Nacif, et al.


One of the most popular and well-tolerated treatments for overactive bladder (OAB) is electrical nerve stimulation, but there needs to be more consistency in the tools used to measure patients’ improvement after receiving treatment. The purpose of this study was to compare the reliability of the visual analog scale (VAS) to that of the Dysfunctional Voiding Scoring System (DVSS) in evaluating the efficacy of electrical nerve stimulation in treating OAB in children and adolescents. Children and adolescents aged 4-17 with a diagnosis of OAB who participated in 20 sessions of transcutaneous (TENS) or percutaneous (PENS) electrical nerve stimulation were included in this cross-sectional analysis. Daytime urinary symptoms were evaluated using the DVSS and VAS before and after therapy. While a physician always applied the DVSS, the VAS was applied independently by a physiotherapist and later by a physician. When the DVSS score decreased to zero, and the VAS score increased to 90% or higher, it was determined that treatment had been effective. 

The kappa coefficient was used to analyze the relationship between the VAS and DVSS scores at post-treatment intervals. Intraclass correlation and the Bland-Altman plot were used to examine the level of agreement between the VAS scores evaluated by the various professions. 49 cases’ worth of data could be analyzed. Of the total, 27 (55.1%) were females. The average age was 7.13±2.60 years. 36 out of 49 patients (73.5%), indicating moderate Kappa (0.44) between the DVSS and VAS. The VAS scores assigned by the 2 doctors were mostly in accord with one another.

Possible sources of bias in the present study’s results and discussion surround the study’s small sample size and the fact that the inter-observer evaluation was undertaken in a single sequence, i.e., all patients were first evaluated by the physiotherapist and then by the physician. While the child did take part in filling out the questionnaires, they were referred back to an adult in charge if there were any discrepancies in the responses. Therefore, the final result may not accurately reflect the patient’s actual condition. Similar results were seen when comparing the VAS to the DVSS, and when comparing VAS scores from 2 separate professions. A DVSS score of 0 excludes the use of the VAS, even though both tools appear to be useful and may be complementary.

Source: sciencedirect.com/science/article/abs/pii/S1477513122003370