Domain-specific cognitive impairment in multiple sclerosis: A systematic review and meta-analysis.

OBJECTIVE: Methods of cognitive measurements in multiple sclerosis (MS) are not standardized. We aimed to identify the prevalence of cognitive domain-specific impairment (DSI) in MS by using subtests of the Brief Repeatable Battery of Neuropsychological Tests (BRB-N) with analyzing different cutoff values. METHODS: The systematic review and meta-analysis were registered on PROSPERO (ID: CRD42021287004). The systematic literature search was performed via PubMed, Embase, and CENTRAL on 24 October 2021. Inclusion criteria were adults of different MS subtypes (CIS, RRMS, PPMS, and SPMS) with the condition of distinct DSI measured by BRB-N. Pediatric MS, computerized versions of BRB-N, and patients receiving steroids were excluded. Primary outcome was pooled prevalence rates of impaired patients within each cutoff and MS subtype, with 95% confidence interval, I-squared statistics for heterogeneity, and chi-squared test for subgroup differences. Risk of bias was assessed using the "JBI Quality Assessment Tool for Prevalence Studies." RESULTS: In 48 eligible observational studies (n = 3431 patients), the three most prevalent thresholds were the 2.0 SD and 1.5 SD below the mean of normative values, and the score below the fifth percentile of the normative values. A progressively increasing worsening of the overall DSI was observed from CIS, moving toward RRMS, PPMS, and SPMS. INTERPRETATION: Cognitive impairment is observed in all MS phenotypes, with varying degrees. Due to several potential influencing factors, our comprehensive literature review has not revealed consistent findings, and we, therefore, recommend considering a more sophisticated, "individual referencing" approach, acknowledging the diverse clinical and sociodemographic characteristics among populations and disparities in cognitive testing.

A novel method for the translation and cross-cultural adaptation of health-related quality of life patient-reported outcome measurements.

BACKGROUND: This paper presents a novel methodology for translation and cross-cultural adaptation of health-related quality-of-life patient-reported outcome measures, incorporating the Delphi method. Specifically, we describe the process of translating the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 from English to Norwegian using this method. METHODS: The multistep translation method combined the European Organization for Research and Treatment of Cancer Quality of Life guidelines, an Expert Panel review, and the Delphi method. It comprised two independent forward- and back-translations. While the bilingual pelvic floor Expert Panel ensured rigorous cross-checking and effective cross-cultural adaptation, the addition of the Delphi method (comprising the attributes of anonymity, controlled feedback, and statistical group response) further established consensus on translated items. OUTCOMES: The application of the Delphi method in the Expert Panel phase proved adequate in producing comprehensible intermediate Norwegian versions ready for pilot testing. The Expert Panel reviewed the comments made by patients completing the instruments and offered advice to allow final translated versions to be produced and tested for measurement properties. This iterative approach, internal logic, and anonymity between rounds improved the evaluations that the panel members provided, which in turn enhanced the final translated Patient Reported Outcome Measures (PROMs). CONCLUSIONS: To our knowledge, this work represents the first demonstration of the application of an Expert Panel review incorporating a Delphi method to assess health-related quality-of-life instruments. The controlled feedback approach, iterative nature, internal logic, and anonymity of the Delphi consensus method appeared to ensure a good cross-cultural adaptation of these PROMs.

Norwegian translation, and validation, of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).

INTRODUCTION AND HYPOTHESIS: The goal was to translate into Norwegian, and validate, short versions of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) using a sample of women with symptomatic pelvic organ prolapse and pelvic floor dysfunction. METHODS: Modified European Organization for Research and Treatment of Cancer Guidelines were used for translation and cultural adaptation. Of 212 eligible Norwegian women who consented to participate, 205 completed the questionnaires, of whom 50 were retested after 1 - 3 weeks, and 76 were tested 6 months after surgery. Reliability, validity and responsiveness were evaluated. Additionally, interpretability, the smallest detectable change, the standard error of measurement, floor and ceiling effects, and the percentages of missing items are reported. RESULTS: Reliability ranged from 0.66 to 0.93 and intraclass correlation coefficients from 0.85 to 0.94. Both construct validity and responsiveness were found to be adequate. The responsiveness of the PFDI-20 was further supported by areas under the curve above 0.70. Estimates were lower for the PFIQ-7. The smallest detectable changes at the individual level were 15 - 21 % and 17 - 27 % for the PFDI-20 and PFIQ-7, respectively. The absolute values of the minimal important changes in the total scores were 48 and 47, respectively. No floor or ceiling effects were evident in the distributions of the PFDI-20 and PFIQ-7 total scores. CONCLUSIONS: The translated questionnaires provided adequate reliability, validity and good responsiveness to change. These short versions of the PFDI and PFIQ are robust measuring instruments that will enable symptom severity and health-related quality of life to be evaluated in the Norwegian context.

A randomized trial comparing changes in sexual health and psychological well-being after subtotal and total hysterectomies.

OBJECTIVE: To evaluate changes in sexual health and psychological well-being one year after subtotal and total hysterectomies. DESIGN: Prospective randomized controlled trial. MATERIAL AND METHODS: One hundred and thirty-two premenopausal patients scheduled for hysterectomy without planned oophorectomy for benign disorders and without a history of cervical dysplasia or symptomatic prolapse were randomized to total (n = 66) or subtotal hysterectomy (n = 66). The McCoy Female Sexuality Questionnaire was used to evaluate changes in sexual health and the Psychological General Well-Being index was used to evaluate changes in psychological well-being. Differences in outcome before and one year after the hysterectomy were calculated for each individual, and changes compared between the groups. RESULTS: Women who had subtotal hysterectomy (SH) reported a significantly greater positive change in frequency of orgasm and sexual pleasure as compared with women who had total hysterectomy (TH) (mean values +/- standard deviation (SD), orgasm: SH: 0.4 +/- 1.1; TH: -0.2 +/- 0.9, p = 0.012, sexual enjoyment: SH 0.3 +/- 1.5; TH: -0.3 +/- 1.3, p = 0.039). There was a significantly greater general health gain for the women who underwent subtotal hysterectomy as compared with total hysterectomy (mean values +/- SD SH: 1.2 +/- 2.3; TH: 0.3 +/- 1.6, p = 0.03). The total score did not show a difference. CONCLUSIONS: Women undergoing subtotal hysterectomy experience a greater positive change in the frequency of orgasm and extent of sexual pleasure after surgery than women undergoing total hysterectomy, but the results must be interpreted with caution.

Hysterectomy and incontinence: a study from the Swedish national register for gynecological surgery.

BACKGROUND: Hysterectomy is one factor that has been suggested to be a risk factor for developing stress incontinence. In Sweden, with a population of 8.86 million, a national register was set up in 1997 in order to have data for assessing the quality of gynecological surgery for benign disorders. METHODS: Data in the Swedish national register for gynecological surgery during the period 1997-2002 were investigated. Surgical methods compared during this time period were: total hysterectomy (abdominal/laparoscopic, n=198/116), subtotal hysterectomy (abdominal/laparoscopic, n=163/86), and total hysterectomy (vaginal/laparoscopic assisted vaginal, n=265/7). Patients who underwent endometrial destruction (endometrial ablation, endometrial balloon treatment, n=187) were used as a control group. Only patients with no preoperative complaints were included. Outcome measures were answers to subjective questions asked pre- and postoperatively regarding urinary problems and incontinence. RESULTS: De novo symptoms of stress incontinence, urgency and urgency incontinence, and/or mixed incontinence were noted in all groups. No differences were found among the groups. CONCLUSION: Factors other than hysterectomy should be discussed causing stress incontinence in women.