Presentation Authors: Chris Du, William Berg*, Alexandra Siegal, Zhenyue Huang, Steven Weissbart, Jason Kim, Stony Brook, NY
Introduction: Patients receiving percutaneous tibial nerve stimulation (PTNS) require routine maintenance sessions for sustained efficacy. Currently, no studies characterize compliance with long-term PTNS maintenance. We sought to evaluate PTNS maintenance therapy dropout rates and identify factors associated with compliance.
Methods: Our PTNS database was queried for patients from 2014-2017. Demographic and visit data were collected. Maintenance therapy was patient driven and frequency of sessions based on symptomology. Dropout from maintenance was assessed at 3, 6, 9, and 12 months after the completion of 12 initial sessions. Multiple variables were tested for correlation with dropout in patients remaining on maintenance therapy for 1 year versus those who discontinued.
Results: We identified 133 PTNS patients, with 96 patients completing initial PTNS therapy and 69 proceeding on maintenance. At 3, 6, 9, and 12 months, continuation rates were 72.4% (50/69), 53.6% (37/69), 43.5% (30/69), and 30.4% (21/69) (Figure 1). The mean days until dropout was 187 (SD=134). Demographic and clinical variables are listed in Table 1. Common reasons for maintenance dropout were perceived inefficacy (n=10), time commitment (n=5), insurance issues (n=4), and interest in other therapies (n=4). A multivariate logistic regression model found that perceived symptom improvement (HR=43, p=0.034) and Medicare status (HR=96, p=0.027) were positively associated while employment (HR=0.12, p=0.045) was negatively associated with continuing maintenance therapy for greater than 1 year.
Conclusions: Overall, 30% of patients continued to receive PTNS maintenance therapy 1 year after initial therapy. Approximately 50% of patients stopped maintenance therapy after 7 months. Possible predictors of continued therapy were perceived symptomatic improvement, insurance and employment status. Inefficacy and time commitment were the most commonly cited reasons for dropout. Future studies are required to understand low compliance in PTNS maintenance therapy.