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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points

BMC Urology > Ausgabe 1/2015
Peter Joseph Jongen, Bertil F. Blok, John P. Heesakkers, Marco Heerings, Wim A. Lemmens, Rogier Donders
Wichtige Hinweise

Competing interests

The study was financially supported by Allergan Pharmaceutical Ireland Inc. via an independent and unrestricted research grant. Allergan had the opportunity to review the final version of the manuscript to address any factual inaccuracies or request the redaction of information deemed to be proprietary or confidential and ensure that study support was disclosed.
Peter Joseph Jongen has received honoraria from Allergan, Almirall, Biogen-Idec, Merck-Serono, Novartis, sanofi-aventis and Teva for contributions to symposia as a speaker, or for consultancy activities. In May 2015 he received a honorarium from Allergan for writing an article about the Actionable questionnaire in the Tijdschrift voor Neurologie en Neurochirurgie.

Authors’ contributions

PJJ initiated, conceived, designed and coordinated the Dutch Actionable validation study, contributed to the acquisition, analysis and interpretation of the data, and drafted the manuscript; he also conceived the study presented in this paper. BFB contributed to the design of the Dutch Actionable validation study, the acquisition of the data, and helped to draft the manuscript. JPH contributed to the acquisition of data and revised the manuscript critically for intellectual content. MH organized the Dutch Actionable validation study, contributed to the design of the study, the acquisition, analysis and interpretation of the data. WAL performed the analysis of the data, contributed to the interpretation of the data, helped to draft the manuscript. RD contributed to the analysis of the data and revised the manuscript critically for intellectual content. All authors read and approved the final manuscript.



The Actionable questionnaire is an 8-item tool to screen patients with multiple sclerosis (MS) for neurogenic bladder problems, identifying those patients who might benefit from urological referral and bladder-specific treatment. The original scoring yields a total score of 0 to 24 with cut-off point 6. A simplified scoring, yielding a total score of 0 to 8 with cut-off point 3, has been developed in urogynaecological patients, but has not been investigated in MS.


One-hundred-and-forty-one MS patients completed the Actionable on two occasions. We compared the test performance of the simplified scoring with cut-off point 3 with that of cut-off point 2, using the original scoring with cut-off point 6 as a gold standard. The following measures were calculated: True Positives (TP), True Negatives (TN), False Positives (FP), False Negatives (FN), Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Accuracy. The associations between positive test result and urological treatment, and bladder-specific drug treatment were calculated.


For cut-off point 3 the outcomes (Test 1, Test 2) were: TP 43.26 %, 40.88 %; TN 29.79 %, 32.85 %; FP 0.00 %, 0.00 %; FN 26.95 %, 26.28 %; Sensitivity 0.62, 0.61; Specificity 1.00, 1.00; PPV 1.00, 1.00; NPV 0.53, 0.55; Accuracy 0.73, 0.74; and for cut-off point 2: TP 59.57 %, 59.85 %; TN 26.95 %, 31.39 %; FP 2.84 %, 1.46 %; FN 10.63 %, 7.30 %; Sensitivity 0.85, 0.89; Specificity 0.90, 0.96; PPV 0.95, 0.98; NPV 0.72, 0.81; Accuracy 0.87, 0.91.  Cut-off 3 completely prevented FP outcomes, but wrongly classified 26 % of the patients as negative (FN). Cut-off 2 reduced the FN to 7–10 %, with low FP values (2.84–1.46 %). With cut-off 2, the percentage of patients screened positive was higher in the Progressive group (75.00 %) than in the Relapsing Remitting group (56.25 %) (P = 0.0331), which was not the case with cut-off 3. Only a positive test according to the original scoring was associated with both urological treatment (P = 0.0119) and bladder-specific medication (P = 0.0328).


Our findings suggest that in MS patients the simplified Actionable scoring is more accurate with cut-off point 2 than with cut-off point 3, especially by substantially reducing FN outcomes; and that in MS the original Actionable scoring seems preferable.
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