Rating improvements in urinary incontinence: do patients and their physicians agree?

Objective: to determine whether patients perceptions of improvement following behavioural interventions for urinary incontinence (UI) correspond with physicians global ratings of change, and to compare both these ratings with more objective UI outcome measures. Methods: consecutive new female patients aged 65 years and older recruited from outpatient UI clinics in Quebec received a behavioural management protocol for UI. At 3-month follow-up, patients and physicians were independently asked for their global impression of change in UI status. Patients completed 3-day voiding diaries and a UI-specific quality-of-life index before and after treatment. Results: 108 patients (mean age 73 +/- 5 years, range 65-86 years) with stress, urge and mixed UI participated. There was concordance between patients and physicians ratings of change in 57% of cases. Among the remaining cases, patients were 1.6 times as likely to report significant improvements compared to physicians. Patients ratings correlated more strongly with improvements in UI episodes in the voiding diary (r = 0.4, P = 0.002 versus r = 0.3, P = 0.004 for physicians) and on the quality-of-life index (r = 0.5, P < 0.0001 versus r = 0.4, P < 0.0001 for physicians). Conclusion: physicians underestimate clinically meaningful changes in UI in older women following behavioural interventions.