Presentation Authors: Andrew Portis*, St Paul, MN, Michael Borofsky, Minneapolis, MN, Suzanne Neises, St Paul, MN
Introduction: The episodic nature of urolithiasis is a challenge to understanding quality of life (QoL) in stone patients. We investigate use of population normed Patient Reported Outcomes Information System (PROMISÂ®) instruments to explore QoL in stone patients.
Methods: Patients attending a subspecialty stone clinic were offered PROMISÂ® Global Health (vers. 1.2), pain intensity (Short Form 3a), and pain interference (Short Form 6b) instruments. PROMISÂ® generates population normed T scores (50 = reference population mean, 10 = one standard deviation). Physical and mental health are normed to the US population and higher scores indicate more health. Pain instruments are normed to US population with pain and higher scores indicate more pain. Three types of patients were compared: nonacute, returning for long-term management; and first-time or recurrent acute patients, initial contact following an Emergency Department visit.
Results: Characteristics of 849 patients are displayed in Table 1. Acute stone patients had higher pain scores. Physical health was lower than population norms in acute stone patients but not in nonacute patients. Mental health was lower than population norm only in patients with acute recurrent stones. Physical health < 40 was predicted by pain intensity >60 (odds ratio (OR) 3.28, 95% confidence interval (CI) 1.79-6.01, p= < 0.001), pain interference >60 (OR 2.51, CI .61-3.91, p= < 0.001) and prior stone (OR 1.83, CI 1.18-2.83, p=0.007) on multivariable logistic regression controlling for age and sex. Mental health < 40 was predicted by pain intensity >60 (OR 2.54, CI 1.30-4.97, p=0.006), pain interference >60 (OR 2.72, CI 1.54-4.79, p=0.001) and prior stone (OR 1.83, CI 1.18-2.84, p=0.007). The relationship between QoL and pain metrics is displayed in Figure 1.
Conclusions: PROMISÂ® QoL is lower than population norms in acute but not nonacute stone patients. Current pain is associated with compromised QoL and is amplified in patients with a prior history of stone disease.