Critically Appraised Topic
We wanted to determine if GSI could accurately be diagnosed in women in the outpatient physical therapy clinic with patient subjective history. If so, conservative physical therapy treatment could be started immediately, saving the patient time and money by avoiding additional visits to her physician.
Does subjective history accurately diagnose GSI in the outpatient physical therapy clinic?
Clinical Bottom Line
Subjective history can help rule out GSI in women age 18-menopause with urinary incontinence symptoms who present to a medical practice. Question number three of the Urogenital Distress Inventory UDI6 had a sensitivity of 90.9% (confidence interval (CI) 95% is 87.6%-94.2%) and 85% (CI 95% is 78.6%-97.0%) in the Fitzgerald and Lemack articles respectively. This data shows that question number three of the UDI6 is highly sensitive in ruling out GSI in women. As reported in the Largo-Janssen article, subjective history is both sensitive at 78% (CI 95% is 70%-86% ) and specific at 84% (CI 95% is 76.9%-91.1%). After review of these articles, we feel confident utilizing question number 3 from the UDI6 or the subjective history form used in the Largo-Janssen as part of an initial screening for women with urinary incontinence symptoms. These methods are accessible, inexpensive and accurate for ruling out, and potentially ruling in GSI in women in the physical therapy clinic.
Clark, Gina and Murphy, Lauren, "The diagnostic accuracy of patient subjective history compared to the gold standard of urodynamic testing for diagnosing genuine stress urinary incontinence (GSI)" (2012). PT Critically Appraised Topics. 33.