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Neurogenic Bladder Symptom Score (NBSS)
Neurogenic Bladder Symptom Score (NBSS)
Please visit this website for more information about the instrument: Neurogenic Bladder Symptom Score (NBSS)
Please visit this website for more information about the instrument:
There is no charge to use the NBSS or NBSS-SF for academic research or personal clinical use.
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Supplemental: Parkinson's Disease (PD), Spinal Cord Injury (SCI)
|Short Description of Instrument||
The Neurogenic Bladder Symptom Score (NBSS) (24-item) and the Neurogenic Bladder Symptom Score short form (NBSS-SF) (10-item) are both freely available, self-administered, questionnaires that assesses urinary symptoms and bladder-related consequences in patients with acquired or congenital neurogenic bladder dysfunction as a result of spinal cord injury, multiple sclerosis, and spinal bifida. (Welk et al., 2013; Welk et al., 2020)
Both the NBSS and NBSS-SF have three domains incontinence, storage and voiding, and consequences and have demonstrated validity and reliability. (Welk et al., 2013; Welk et al., 2020)
The objective of the NBSS is to measure symptoms, not to assign relative value to them, or to judge how they impact the patients' quality of life. This is analogous to using the International Prostate Symptom Score (IPSS) or American Urological Association-Symptom Score (AUA-SS) to measure urinary symptoms in benign prostatic hyperplasia. The final question of the NBSS asks about the person's urinary quality of life. (Welk et al., 2013)
The NBSS has validated translations in Brazilian Portuguese (Cintra et al., 2019), Italian (Fragala et al., 2015), and Russian (Philippova et al., 2018). Other validated translations to French, Spanish, Polish, and Turkish are underway (Tate et al., 2020).
|Scoring and Psychometric Properties||
Scoring: The NBSS consists of 24 items across three domains: Incontinence (scored 0-29); Storage and Voiding (scored 0-22); and Consequences (scored 0-23). The first question classifies patients by bladder management, but does not make up part of the numeric score. (Neurogenic Bladder Research Group, 2021) There is a final single general urinary quality of life (QOL) question that is scored from 0 (pleased) to 4 (unhappy). For all domains, a higher score represents a worse symptom burden or QOL. (Welk et al., 2018a) The total score can range from 0 (no symptoms at all) to 74 (maximum symptoms). (Neurogenic Bladder Research Group, 2021) The NBSS-SF consists of 10 items across three domains: Incontinence; Storage and Voiding; and Consequences. The first question of the NBSS classifies patients by bladder management, but this does not make up part of the numeric score. The final question is the same overall QOL question as in the full NBSS. (Welk et al., 2020)
Reliability: Good test-retest for total score (ICC = 0.91) and scale scores (ICC = 0.85-0.86). (Tate et al., 2020; Welk et al., 2014)
Validity: Good internal consistency total score (0.85). Variable for scale scores (0.49-0.93). (Tate et al., 2020; Welk et al., 2018b) Moderate correlation (0.50) with SCI-QOL Bladder Management Difficulties. Strong correlations with other bladder scores (AUASS, International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) and SF-Qualiveen). Significant differences among known groups (e.g., SCI, multiple sclerosis). (Welk et al., 2014; Welk et al., 2018a)
Responsiveness: The smallest real difference for group level comparisons ranged from 0.9 for the quality of life question to 7.7 for the NBSS total score. (Welk et al., 2018a) Significant changes were seen after application of botulinum toxin (Myers et al., 2019) and mirabegron (Welk et al., 2018b).
Strengths: Patients can complete the 24 questions in the NBSS in approximately 6 minutes. (Welk et al., 2014) It is possible to compare scores from individuals with SCI to individuals with other neurological health conditions (e.g., multiple sclerosis, spina bifida). Specifically designed and validated for neurogenic bladder. Can be used by patients who are catheterized.
Weaknesses: The internal consistency is low for the consequence's domain (0.49) and this should be considered if using as a standalone domain (Welk et al., 2017). Has not been validated in PD.
Welk B, Lenherr S, Elliott S, Stoffel J, Gomes CM, de Bessa J, Cintra LKL, Myers JB; Neurogenic Bladder Research Group. The creation and validation of a short form of the Neurogenic Bladder Symptom Score. Neurourol Urodyn. 2020 Apr;39(4):1162-1169.
Welk B, Morrow SA, MadaraszW, Potter P, Sequeira K. The conceptualization and development of a patient-reported neurogenic bladder symptom score. Res Rep Urol. 2013 Oct 10;5:129-37.
Cintra LKL, de Bessa J Júnior, Kawahara VI, Ferreira TPA, Srougi M, Battistella LR, de Souza DR, Bruschini H, Gomes CM. Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for Brazilian Portuguese. Int Braz J Urol. May-Jun 2019;45(3):605-614.
Fragal? E, Russo GI, Di Rosa A, Giardina R, Privitera S, Favilla V, Patti F, Welk B, Cimino S, Castelli T, Morgia G. Association Between the Neurogenic Bladder Symptom Score and Urodynamic Examination in Multiple Sclerosis Patients With Lower Urinary Tract Dysfunction. Int Neurourol J. 2015 Dec;19(4):272-7.
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B; Neurogenic Bladder Research Group (NBRG. org). The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization. Neurourol Urodyn. 2019 Jan;38(1):285-294.
Neurogenic Bladder Research Group. 2021. Neurogenic Bladder Symptom Score (NBSS). Accessed: 23Jun2021. Available at: https://www.nbrg.org/research/nbss/
Pardee C, Bricker D, Rundquist J, MacRae C, Tebben C. Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life. Rehabil Nurs. 2012 May-Jun;37(3):128-35.
Philippova ES, Bazhenov IV, Volkova LI, Moskvina EY, Turova EL, Popova YV. [Russian version of the neurogenic bladder symptom score (NBSS)]. Urologiia. 2018 Dec;(6):5-13. Russian.
Savic G, DeVivo M, Frankel H, Jamous M, Soni B, Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017 Oct;55(10):891-897.
Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, Cameron AP, Santacruz BG, Jakeman LB, Kennelly MJ, Kirshblum S, Krassioukov A, Krogh K, Mulcahey MJ, Noonan VK, Rodriguez GM, Spungen AM, Tulsky D, Post MW. Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med. 2020 Mar;43(2):141-164.
Welk B, Morrow S, Madarasz W, Baverstock R, Macnab J, Sequeira K. The validity and reliability of the neurogenic bladder symptom score. J Urol. 2014 Aug;192(2):452-7.
Welk B, Carlson K, Baverstock R. A pilot study of the responsiveness of the neurogenic bladder symptom score (NBSS). Can Urol Assoc J. 2017 Dec;11(12):376-378.
Welk B, Lenherr S, Elliott S, Stoffel J, Presson AP, Zhang C, Meyers JB. The neurogenic bladder symptom score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord. 2018a Mar;56(3):259-264.
Welk B, Hickling D, McKibbon M, Radomski S, Ethans K. A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction. Neurourol Urodyn. 2018b Nov;37(8):2810-2817.
Document last updated August 2022