Nishino et al.；Treatment satisfaction in OAB patients《 Original Article 》

Relationship between quality of life and treatment satisfaction in patientswith overactive bladder in a community hospital
Junichi Nishino1,2, Mizuho Yoshikawa1, Motoki Arakawa1, Shoji Matsuzaki3, Shinji Hidaka1*
Overactive bladder (OAB) is treated primarily with drug treatment. While the effects of drug
treatment on quality of life (QOL) in patients with OAB served by community hospitals havebeen evaluated, treatment satisfaction among this population has not been sufficiently studied.
To address this deficit, we conducted a survey of treatment satisfaction among patients with
OAB to determine whether treatment satisfaction correlates with QOL.
Questionnaires were used to determine QOL and treatment satisfaction of patients withconfirmed OAB who were treated in a community hospital on an outpatient basis. Patient QOL
was evaluated using the Overactive Bladder-questionnaire Short Form, and treatment
satisfaction was assessed with a multidimensional questionnaire. Correlations among treatment
satisfaction domains were investigated with principal component analysis. Multiple regression
analysis was used to evaluate the correlation of QOL and treatment satisfaction.
Survey participants comprised 65 individuals (37 men, 28 women). Mean age was 70.4 years(standard deviation, 11.2 years). Participants were generally satisfied with their current OAB
drug treatment. Treatment satisfaction correlated positively with health-related QOL (HRQOL).
Multiple regression analysis revealed that the emotional and social domains of HRQOL
correlated independently with treatment satisfaction.
The findings of this survey regarding satisfaction with drug treatment among patients with
OAB indicate that investigating the relationship between patient health and treatment
satisfaction could reveal useful information about pharmacotherapy compliance andcontinuation. In OAB drug treatment, caregivers may find that focusing on the QOL for thepatients with OAB they care for will help in building stronger relationships with these patients.
Key words; Overactive bladder; Pharmacotherapy; Quality of life; Treatment satisfaction
Received September 14, 2021; Accepted November 9, 2021
Department of Pharmaceutical Regulatory Science, School of Pharmacy, Nihon University, Chiba, Japan
Medical Regulatory Affairs Department, Otsuka Pharmaceutical Co., Ltd. Tokyo, Japan3
Department of Urology, Inagi Municipal Hospital, Tokyo, Japan*Corresponding author: Shinji Hidaka, Department of Pharmaceutical Regulatory Science, School of Pharmacy,
Nihon University, 7-7-1, Narashinodai, Funabashi-City, Chiba 274-8555, Japan
Phone : +81 47-465-6281 Fax : +81 47-465-6281 E-mail : hidaka.shinji@nihon-u.ac.jp
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Japanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

refractory to treatment with anticholinergic drugs
1． Introduction

should be carefully re-evaluated to identify
potential hidden medical conditions 19). Evaluating
drug treatment for patients with OAB in association

Overactive bladder (OAB) syndrome is often
characterized by four elements: urinary urgency,

withpollakiuria, nocturia, and urge incontinence. This

improvements is thus important to improvecondition is clinically diagnosed on the basis ofinteractions with patients in a manner mindful of

unpleasant storage symptoms. OAB syndrome

maximizing treatment compliance. A recent long-requiresinvolves

term observation of HRQOL and health in men andpollakiuria and nocturia, and does not require urge

women with OAB based on the OAB-q evaluatedincontinence 1-3). Experts in lower urinary tract

the clinical benefits of drug treatment 20). An

dysfunction, however, have yet to reach a consensus

investigation of the effects of drug treatment on the

regarding how best to manage and treat OAB 4). The

HRQOL of men with OAB using OABSS and thefrequency of OAB attacks and the refractory nature

King’s Health Questionnaire concluded that theof this chronic condition impact quality of life

mental health of patients must be considered in(QOL)urinary

2,4,5)

urgency,normally

treatment

expectations

and

QOL

decision-making about OAB drug treatment 21). A.

Many forms of behavioural therapy, lifestylesurvey of patient satisfaction with drug treatment

guidance, drug treatment and neuromodulation haverevealed that satisfaction can be reduced by poor

been developed to treat OAB. However, after initial

efficacy and the presence of adverse events 22).

behavioural therapy and lifestyle guidance, OAB is

These studies involved observations made withprimarily treated using drugs. Anticholinergic drugs

OAB-specific health questionnaires and evaluated

are the most commonly used drugs for treating OAB.

satisfaction in terms of treatment-specific adverse

Anticholinergic drugs such as solifenacin 6-9) andevents such as thirst and constipation.

fesoterodine

10,11)

pollakiuria,

nocturia,

To the best of our knowledge, no study has beenrelieve the urinary urgency,
and

urge

conducted to evaluate treatment satisfaction inincontinence

associated with OAB. Moreover, anticholinergic

Japanesedrugs significantly improved QOL for patients withmultidimensional approach that includes the

OAB as measured with the Overactive Bladderconvenience of medication use and informationquestionnaire (OAB-q) in a placebo-controlled

provided by healthcare professionals. Our study

12)

patients

with

OAB

based

on

a

, improved symptom bother and health-evaluated treatment satisfaction among outpatients

related quality of life (HRQOL) associated withof a community hospital with subjective symptoms

study

13,14), and were associated with alleviation ofof OAB who were receiving drug treatment.

symptoms as evaluated with the Overactive Bladder

Treatment satisfaction was assessed using patient-

OAB

Symptom Score (OABSS)

15,16)

completed questionnaires. The objective was toand QOL as

evaluated with the OAB-q 14,17,18).

investigate the relationship between QOL and

Anticholinergic drugs are the most important

treatment satisfaction in patients with OAB toform of drug treatment for OAB, but OAB

identify factors relevant to treatment satisfaction.
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Nishino et al.；Treatment satisfaction in OAB patientsbother scale; and a 13 ‐ item HRQOL scale.
2.

Methods

Authorization to use the OAB-q SF was obtained
from the Pfizer Co., Ltd 23).
We investigated the satisfaction level with drug

1. Study design

therapy for patients with OAB using a questionnaire.

In a community hospital, we conducted aquestionnaire

The treatment satisfaction questionnaire for OAB

toevaluate

treatment

adult

male

femalemedication contains 5 subscales. This treatment

outpatients who had been diagnosed with OAB. The

satisfaction questionnaire consists of 13 items withpatients provided written informed consent for the

5 domains, and the sum of direct scores for thesepublication of any associated data. If there were any

items yields a total score between 0 and 70, whichquestions about the questionnaire, the medical staff

is then transformed into a 0–100 scale. The fiveprovidedthesubscales are also summed separately, with eachquestionnaire once completed. For treatment

transformed into scores of 0–100. Treatment

satisfaction results, we compared the relationshipsatisfaction domain scores range from 0 to 100, with

with QOL among OAB patients.

higher scores representing higher satisfaction on

satisfaction

surveyamong

explanations

and

and

collectedthat domain. The questionnaire was reviewed by theauthors, including urologists, and domains and2. Participants
The survey targeted outpatients who werequestions were created. Factors influencing patient-

visiting Inagi Municipal Hospital of Japan.

reported treatment satisfaction were analyzed inParticipants were OAB patients judged to have acomparison with the QOL of patients.

urinary urgency score≧2 and a total score≧3 basedon the OABSS 16) and who had been taking

4. Statistical analysis
A sample size of at least 50 participants wastherapeutic agents for≧1 month. Other inclusion
criteria were being fluent and literate in Japanese.

considered

Exclusion criteria comprised urinary diversion, aquestionnaires 24). We therefore aimed to include

history of/or active malignant tumour of the urinary

more than 50 patients. Data are expressed as thetract, haematuria, bladder stones, neurogenic

mean (± standard deviation), and some as the

bladder,andmedian. Statistical analyses were performed using

symptomatic urinary tract infection. Patients were

IBM SPSS Statistics, version 26.0 (IBM Corp.,

enrolled between May 2015 and March 2017.

Armonk, NY, USA). Values of P < 0.05 were

dementia,

mentalretardation,adequateforvalidationof

considered indicative of statistical significance. We
used the following statistical methods depending on

3. Assessments
The Overactive Bladder-questionnaire Shortthe type of data. The Mann-Whitney U test,

Form (OAB-q SF) was used to assess QOL of OAB

Kruskal-Wallis test, Steel-Dwass test and Friedman

patients. The OAB-q SF contains two main

rank-sum test were used to analyse differences

subscales of symptom bother and HRQOL. The

between groups. Using principal component

OAB-q SF includes 19 items: a 6‐item symptom

analysis, we investigated the nature of the data from38
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Japanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

the interrelationships between domains of treatment

principles outlined in the Declaration of Helsinki.

satisfaction. Spearman’s rank correlation test was

Before participation, each subject was given a

performed to detect correlation coefficients between

description of the purpose of the survey andfactors.

provided written informed consent.

Principal

component

analysiswasperformed by the Varimax method with Kaiser
3.

normalization. The method terminates when no

Results

more variables are eligible for inclusion or removal.
1. Descriptive and univariate analyses

This method is based on both probability-to-enter(Pin = 0.05) and probability-to-remove (Pout = 0.10).

In the study, 37 men and 28 women (total, 65

For relationship between QOL and treatment

participants) were enrolled. Mean age wassatisfaction in OAB patients, a regression equation

70.4 ±11.2 years. All questionnaires were fully

was derived using the least squares method, and thecompleted. Table 1 shows the demographic

coefficient of determination(R2) and P-value werecharacteristics of participants as determined using

derived from Pearson’s product moment correlation

the OAB-q SF. A higher score on the symptom

coefficient. Multiple linear regression analysis withbother scale indicates greater symptom severity,a stepwise forward-backward selection method waswhereas a higher score on the HRQOL scale

used to examine whether treatment satisfaction was

indicates better HRQOL, so these scores are

independently associated with QOL. This included

inversely related. QOL scores showed no significant

adjustment for covariates of symptom bother anddifferences when analyzed in subgroups according

HRQOL subscales. We also added gender, duration

to sex, age, duration of drug use, therapeuticof medication, and medicine used to the variables.

classification of the drug used, dosing regimen, andMulticollinearity was assessed using the variancemedication adherence. However, a significant

inflation factor coefficient. Friedman’s test was also

difference in OAB-q SF symptom bother score orused for the nonparametric data that were repeatedly

HRQOL score was present between patients on

measured by changing three or more conditions forfesoterodine and patients on solifenacin (P<0.05) or

one sample without following a normal distribution.

imidafenacin (P<0.05).

Furthermore, if a significant difference wasobserved, a multiple comparison method was

2. Treatment satisfaction among OAB patients

performed using EZR version 4.0.3 25).

Median total treatment satisfaction score among
patients with OAB was 70.0 (interquartile range,

5. Ethical regulation
The

questionnaire

61.4–75.7; mean, 68.1). In addition, mediansurveyprocedures

andefficacy score was 50.0 (interquartile range, 50.0–

procedure for obtaining informed consent were66.7; mean, 53.6), median adverse event score wasapproved by the Ethics Research Committee of

100 (interquartile range, 87.5–100; mean, 92.0), andInagi Municipal Hospital and Nihon University,

median convenience, information, and general

School of Pharmacy (approval no. 15-002). Thissatisfaction scores were each 66.7 (interquartile

study was conducted in accordance with therange, 61.1–66.7, 50.0–66.7, and 50.0–66.7; means,3939

Nishino et al.；Treatment satisfaction in OAB patients

Table 1 Patient characteristics and baseline outcomes of measurements for QOL
Characteristicn (%)

No. patients
Gendermale
femaleAge (years)<60
60≦ <69
70≦ <7980≦
70.4 ± 11.2
Duration of medication1≦ <5 months
5≦ <12 months
1≦ < 4 years
4 years ≦Medicine used
Classification by action mechanism
Anticholinergics
β3-adrenergic agonists
Anticholinergics + α1-adrenoceptor antagonists
Anticholinergics + β3-adrenergic agonists
β3-adrenergic agonists +α1-adrenoceptor antagonists
Drugs
Anticholinergics
Solifenacin
Fesoterodine
Imidafenacin
Propiverine
Tolterodine
Oxybutynin
Solifenacin + Fesoterodine
Fesoterodine + Imidafenacin
β3-adrenergic agonists
Mirabegron
Anticholinergics + α1-adrenoceptor antagonists
Imidafenacin + Naftopidil
Imidafenacin + Silodosin
Propiverine + Silodosin
Anticholinergics + β3-adrenergic agonists
Solifenacin + Mirabegron
Fesoterodine + Mirabegron
β3-adrenergic agonists + α1-adrenoceptor antagonists
Mirabegron + Naftopidil
Mirabegron + Silodosin
Other drugs
Fesoterodine + Goshajinkigan(kampo formula)
Propiverine + Imipramine
Fesoterodine + Imidafenacin + Flavoxate
How to take medicine
Once a day
Twice a day
Several times a day
Several times a week
Medication adherence
Use as instructed
Use roughly as instructed
Do not use much as instructed
Do not use as instructed65

OAB-q SF Symptom bother†score
P value

QOL
OAB-q SF HRQOL‡
score
P value

27.9 ± 21.0

0.1319a25.8 ± 22.3
30.8 ± 18.7
0.9350b30.3 ± 19.1
27.6 ± 20.7
28.6 ± 22.7
25.0 ± 18.5)

74.5 ± 20.1
0.5246a74.8 ± 22.6
73.5 ± 18.8
0.3875b66.3 ± 18.8
77.9 ± 15.9
73.9 ± 20.7
78.1 ± 22.9

0.6075b33.1 ± 22.9
30.3 ± 27.2
26.7 ± 18.3
20.8 ± 13.7

0.2773b70.2 ± 23.8
74.0 ± 23.4
73.4 ± 16.0
83.7 ± 15.4

51 (78.5)
4 (6.2)3 (4.6)2 (3.1)2 (3.1)0.5527b27.2 ± 21.3
37.5 ± 15.7
14.4 ± 8.3
30.0 ± 0.0
40.0 ± 36.7
0.0023b0.1091b74.8 ± 19.3
60.4 ± 27.4
93.3 ± 7.4
75.4 ± 12.3
50.8 ± 12.3
0.0040b23 (35.4)
13 (20.0)
7 (10.8)
4 (6.2)
1 (1.5)
1 (1.5)
1 (1.5)
1 (1.5)25.1 ± 16.2
42.6 ± 22.6
10.0 ± 7.6*
14.2 ± 15.3
73.3
3.3
40.0
13.3

82.9 ± 11.7*
56.2 ± 20.9
83.1 ± 8.1*
80.8 ± 16.4
44.6
96.9
49.2
80.0

4 (6.2)37.5 ± 15.7

60.4 ± 27.4

1 (1.5)
1 (1.5)
1 (1.5)

23.3
3.3
16.7

83.1
100.0
96.9

1 (1.5)
1 (1.5)

30.0
30.0

63.1
87.7

1 (1.5)
1 (1.5)

3.3
76.7

63.1
38.5

1 (1.5)
1 (1.5)
1 (1.5)

46.7
33.3
16.7

81.5
87.7
87.7

37 (56.9)
28 (43.1)
10 (15.4)
17 (26.2)
26 (40.0)
12 (18.5)
65
18 (27.7)
10 (15.4)
25 (38.5)
12 (18.5)

49 (75.4)
13 (20.0)
2 (3.1)1 (1.5)60 (27.7)
5 (15.4)－－

0.3232b30.2 ± 21.4
19.7 ± 19.1
28.3 ± 11.7
23.3
0.3614a27.6 ± 21.5
32.0 ± 13.1

0.5571b74.0 ± 20.7
78.1 ± 19.5
66.2 ± 4.6
67.7
0.3886a74.7 ± 11.0
71.4 ± 11.0

Values are number of patients (%) or mean ± standard deviation where appropriate.
†The score ranges from 0 to 100, where 0 = minimal symptom severity and 100 = grt symptom severity.
‡The score ranged from 0 to 100, where 0 = worst HRQOL outcome/response and 100 = best HRQOL outcome/response.
P values indicate the association with sex, age, duration of medication, medicine used (classification by mechanism of action and drugs), how to take medicine or
medication adherence.
QOL, quality of life; HRQOL, health-related quality of life; OAB-q SF, overactive bladder quality of life short-form questionnaire.
－: None., aMann-Whitney U test., bKruskal-Wallis test., *p < 0.05 versus fesoterodine, Steel-Dwass test.

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Japanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

Figure 1

Results for the principal component analysis

Left Figure: Score plots of principal component, Right Figure: Component plots after varimax rotation.

Table 2Analysis of the factor loading for question items related to thedegree of treatment satisfaction among patients.

Variable
Efficacy
Adverse event
Convenience
Information
General satisfaction
Eigenvalues
Variance explained (%)

principal component
1
Reliability
0.791
0.095
0.781
0.864
0.689
2.464
49.29

2
Security feeling
0.296
0.960
0.0002
0.079
0.459
1.226
24.52

Commonality (h2)
0.713
0.931
0.609
0.752
0.685
3.690
73.81

Principal component analysis; Varimax method, an orthogonal rotation method that minimizes the number of variables thathave high loadings on each factor.
Only principal components with eigenvalues greater than 1 were used.

64.9, 63.2, and 60.5, respectively). The results forwere efficacy, convenience, information, andthe principal component analysis were shown ingeneral satisfaction. Adverse events showing

Figure 1. Outliers were found on the principal

limited incidence contributed little. This component

component score plots, and treatment satisfaction

represents 49% of the total. The main variable

was low in these patients. Variance in principal

making up the second principal component wascomponents was as shown in Table 2, and theadverse events.

cumulative contribution was 73.81%. The main
3. Factors affecting treatment satisfaction

variables making up the first principal component
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Nishino et al.；Treatment satisfaction in OAB patients

Table 3

Association between demographic characteristics and total treatment satisfaction score

Characteristics

All patients (n=65)

P value
0.582a0.539b0.579bGender28(43.1)
Age (years)
70.4 ± 11.2
Duration of medication(months)
25.6 ± 22.8
Medicine used
Classification by action mechanism n, (%)
Anticholinergics
51 (78.5)
β3-adrenergic agonists
4 (6.2)
Anticholinergics + α1-adrenoceptor antagonists
3 (4.6)
Anticholinergics + β3-adrenergic agonists
2 (3.1)β3-adrenergic agonists +α1-adrenoceptor antagonists 2 (3.1)
Drugs n, (%)
Solifenacin
23 (35.4)
Fesoterodine
13 (20.0)
Imidafenacin
7 (10.8)
Propiverine
4 (6.2)
Mirabegron
4 (6.2)
How to take medicine n, (%)
Once a day
49 (75.4)
Twice a day
13 (20.0)
Several times a day
2 (3.1)
Several times a week
1 (1.5)
Medication adherence n, (%)
Use as instructed
60 (27.7)
Use roughly as instructed
5 (15.4)
OAB-q SF
Symptom bother (score)
27.9 ± 21.0
HRQOL (score)
74.5 ± 20.1

0.299c0.363c0.512c0.711a0.029b0.001bValues are number of patients (%) or mean ± standard deviation where appropriate.
P values indicate the association with total treatment satisfaction score.
OAB-q SF, overactive bladder quality of life short-form questionnaire; HRQOL, health-related quality of life.
aMann-Whitney U test.
b
Speaman’s rank correlation.
c
Kruskal-Wallis test.

Associations between total treatment satisfaction

emotional/social was independently associated withscore and the demographic characteristics of thetotal treatment satisfaction score (total treatment

patients are shown in Table 3. The total treatment

satisfaction score = 0.192 × emotional/social +satisfaction score was significantly correlated with

52.149; R2 = 0.122, P < 0.01) (Table 4).

OAB-q SF symptom bother score and HRQOL
4.

score. Moreover, OAB-q SF HRQOL score showed

Discussion

a significant positive correlation with totaltreatment satisfaction score (Figure 2). We

The less-than-satisfactory rates of treatment

performed multiple regression analysis including

compliance and continuation in the drug treatment

symptom bother and HRQOL subscales asof OAB 26) must be addressed. In addition, treatment

covariates. This analysis revealed that HRQOL

satisfaction as rated by OAB patients agrees poorly
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Figure 2

Relationship between quality of life and treatment satisfaction in overactive bladder patients

In the study population, higher symptom bother scores tended to be associated with lower treatment satisfaction, and higher
HRQOL scores were associated with higher treatment satisfaction.
HRQOL, health-related quality of life.

Table 4 Multiple regression analysis of treatment satisfaction
Unstandardized coefficient
VariableβStandard error 95% CI of βt Standard coefficient VIF

P value

Emotional/Social

0.192

0.065

0.062

2.955 0.349

0.004

Constant

52.1495.550

41.059 63.238

HRQOL
0.322

9.397

1.000

< 0.001

Adjusted R2 = 0.122, ANOVA P < 0.01

with that rated by the treating physicians,that the emotional and social aspects of OAB

highlighting the need to measure satisfaction frompatients are associated with treatment satisfaction.

27). The present study

With regard to baseline patient characteristics,

evaluated QOL and satisfaction with treatment

the study population included many elderly patients.

among community hospital outpatients with OAB

The drug class most widely used by participants was

confirmed by OABSS (i.e., urinary urgency score≧

anticholinergic drugs, followed by β3-adrenergic

2; total score≧3) who had been taking a drug toagonists in a small number of participants. This isalleviate OAB symptoms for at least 1 month as ofconsidered to be similar to the current state of drug

the start of the study. The objective was to identify

use for OAB patients. Mean OAB-q SF symptom

factors impacting treatment satisfaction. The results

bother and OAB-q SF HRQOL scores inof a cross-sectional questionnaire showed that theparticipants resembled those in evaluations of QOL

total composite score for treatment satisfaction

among Japanese men and women with OAB 14,28,29).

increased

with

Treatment appears to have had a certain effect inincreasing HRQOL score. The results also suggest

participants with subjective symptoms (Table 1).

the perspective of the patientsignificantlyinassociation

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Nishino et al.；Treatment satisfaction in OAB patients

The Japanese version of the OAB-q SF has
demonstrated

reliability

and

18)

validity

with OAB should therefore be managed byanddetermining treatment satisfaction in addition toestablished tabulation procedures. OAB, which

evaluating QOL. Median total treatment satisfaction

14,30),

score among patients with OAB in this study wasis preferably evaluated in terms of symptom bother70.0 (interquartile range, 61.4–75.7), indicatingand HRQOL. Characterizing the symptoms ofgeneral satisfaction with treatment. Principal

patients with OAB using a QOL questionnaire

component analysis of treatment satisfaction was

should help improve the quality of treatment.

performed because the individual variables are

Studiestreatment

combined. The main variables making up the firstsignificantly alleviated symptom bother andprincipal component were efficacy, convenience,

improved HRQOL associated with OAB 13) and that

information, and general satisfaction, suggesting

alleviation of symptoms as measured with OABSS

that participants trusted their treatments andcorrelates with improved QOL as measured withconsidered the treatments effective. The main

impacts QOL in a variety of lifestyle domains

14)

have

shown

that

drug

establishedvariable making up the second principal component

efficacy and safety profiles in the treatment of OAB

was adverse events, and general satisfaction, as part

among elderly patient≧65 years old and contributeof the first principal component, also contributed

to better QOL in this population 31). Participants inmoderately. This finding, taken alone, suggests thatthe present study showed good medication

participants felt secure about their drug treatments

adherence, with drug treatment providing a certain(Table 2). A study of men and women with OAB on

effect in terms of QOL, and no significant

anticholinergic drugs found that OAB symptoms,

differences were seen among scores classified

clinical efficacy, and adverse events (thirst andaccording to sex, age, or therapeutic classification

constipation) are related to patient satisfaction, withof the drug used. However, as the primary objective

clinical efficacy being the most relevant 22). Otherof the study was to survey the drug therapies usedstudies have revealed that the OAB voiding

by patients with OAB in a community hospital,

symptom of nocturia was associated with less night-

further investigation with a larger sample size istime sleep and poorer sleep quality 34) and this could

necessary to evaluate the effects of individual drugs

consequently reduce physical and mental health 35).

on QOL.

Nocturia is considered the main factor behind

OAB-q .

Anticholinergics

haveStudies have shown that at least 65% of patients

reduced QOL and treatment satisfaction

22,36).

with OAB experience OAB symptoms that

Although the survey of satisfaction in the present

adversely affect QOL 32), and that about 30% of

study was not intended to compare satisfaction

patients with OAB are dissatisfied with both

among variables, our findings suggest that drug

33).

treatment efficacy is associated with the treatment

Anticholinergic drugs are generally safe, effective,

satisfaction of patients with OAB, highlighting theand well tolerated in OAB and improve QOL scores,

need for caregivers to approach drug treatment with

but treatment compliance and continuation are not

a commitment to determining the OAB subjective

always satisfactory 26). Drug treatment for patients

symptoms of their patients. Fourteen of the 65

bladder symptoms and drug treatments

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Japanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

participants (21.5%) reported having experienced

characterize the relationship between QOL andan adverse event. The median treatment satisfaction

treatment satisfaction in this population and thus

score for these patients was 57.9(interquartile range,

support treatment compliance and continuation. The

54.6–68.2), which was found to be low. Thirst and

HRQOL and total treatment satisfaction scores inconstipation attributable to drug use impact thethe study population were related, showing that

22,37).

HRQOL affects treatment satisfaction (Figure 2).

Thirst, constipation, and other physical adverse

From this result, it was suggested that the treatment

events can impact the satisfaction of patients withsatisfaction was properly evaluated. Moreover, theOAB and may even reduce satisfaction in terms ofstudy results suggest that the emotional and social

adverse events. Since this likely substantiallycomponents of HRQOL correlate with treatment

affects the treatment satisfaction of patients withsatisfaction among patients with OAB. One factor

OAB, adequate monitoring for adverse events isbehind this finding is likely the fact that thecritical in routine clinical settings. Instruments used

emotional/social score of 83.3 ± 19.1 was

to gauge satisfaction in patients with OAB include

significantly higher than the other scores of 69.7 ±the Patient Satisfaction with Treatment Benefits

26.8 and 67.8 ± 28.9 (P < 0.001, Friedman’s test).

38), which considers OAB

OAB appears to create few impediments to thesymptoms, and the condition-specific Overactive

emotional and social functioning of OAB patients

Bladder

Questionnairein daily settings. We believe that tailoring the care

(OAB-S) 39). In addition, there is also the treatment

and treatment of patients through an understanding

satisfaction questionnaire to be used in manyof what is important to the specific patient will help

different disease contexts40), but studies in OAB

improve patient satisfaction.

satisfaction of Japanese patients with OAB(PSTB) questionnaire
Treatment

Satisfaction

patients has not been reported. Since no survey

This study had several limitations. First, OAB

methodology for properly evaluating treatment

symptoms were not qualitatively evaluated at thesatisfaction in Japanese patients with OAB has been

start of the study, because the study population

established, our findings cannot readily becomprised patients put on drug treatment after

compared with those of previous reports because ofpreviously receiving an OABSS-based diagnosis ofthedifferent

participantcharacteristics

and

OAB. The relationship of OAB severity to QOL andmethodologies

involved.

However,thetreatment satisfaction was therefore not considered.

multidimensional nature of the survey form used in

Second, QOL scores differed for some of thethe present study consisted of questions suited to

anticholinergic drugs that participants used. Thesepatients with OAB, and we are convinced that theydifferences may have affected satisfaction. Data

successfully gauged treatment satisfaction in thisfrom more patients are needed to better evaluate

population, at least to a certain extent.

different drugs in consideration of differences inmuscarinic receptor affinity. Third, since studies of

The primary objectives of this study were to use
a QOL survey to determine the status of drug

satisfaction

treatment and then determine treatment satisfaction

questionnaire validated for reliability, suitability,in patients with subjective symptoms of OAB, toand participant responsiveness, the questionnaire
45
45

shouldbeconducted

withaNishino et al.；Treatment satisfaction in OAB patients

Victor A, Wein A, The standardisation ofform we used will be validated in the future.

terminology of lower urinary tract function:

In conclusion, this study determined QOL andevaluated the clinical benefit of drug treatment in areportpopulationofcommittee of the International Continencecomorbidities that could impact OAB symptoms.

Society, Neurourol Urodyn, 21, 167-178

The drug treatments of the study population are(2002).

ofpatients

with

OAB

free

2)

therefore reflective of treatments in patients with

from

the

Standardisation

Sub-

Abrams P, Cardozo L, Fall M, Griffiths D,

OAB in general. The study population—patients

Rosier P, Ulmsten U, van Kerrebroeck P,

with OAB treated at a community hospital—were

Victor A, Wein A, The standardisation ofgenerally satisfied with their drug treatments, andterminology in lower urinary tract function:

HRQOL was associated with treatment satisfaction.

report from the standardisation sub-committee

These findings should help inform efforts toof the International Continence Society,improve

Urology, 61, 37-49 (2003).

drug

treatmentcomplianceand3)

continuation. In OAB drug treatment, caregivers

Haylen BT, de Ridder D, Freeman RM, Swiftmay find that focusing on the QOL of the patients

SE, Berghmans B, Lee J, Monga A, Petri E,

with OAB they care for will help in building

Rizk DE, Sand PK, Schaer GN, An

stronger relationships with these patients.

International Urogynecological Association(IUGA)/International

Continence

Society(ICS) joint report on the terminology for

Acknowledgement

female pelvic floor dysfunction, Neurourol
Urodyn, 29, 4-20 (2010).

We wish to thank Tatsuaki Daimon, M.D. and
4)

Minoru Horinaga, M.D. from Inagi Municipal

Lee UJ, Scott VC, Rashid R, Behniwal A,

Hospital for their cooperation in collecting theWein AJ, Maliski SL, Anger JT, Defining andquestionnaires.

managing overactive bladder: disagreement
among the experts, Urology, 81, 257-262(2013).

Conflict of Interest
5)

Gormley EA, Lightner DJ, Burgio KL, Chai

None of authors has any conflict of interest to

TC, Clemens JQ, Culkin DJ, Das AK, Foster

declare. Junichi Nishino is currently an employee of

HE Jr, Scarpero HM, Tessier CD,Vasavada SP,

Otsuka Pharmaceutical Co., Ltd.; however, thisDiagnosis and treatment of overactive bladderwork is completely unrelated to the author’s work

(non-neurogenic)

with Otsuka Pharmaceutical Co., Ltd.

guideline, J Urol, 188, 2455-2463 (2012).
6)inadults:

AUA/SUFU

Yamaguchi O, Marui E, Kakizaki H, Itoh N,
Yokota T, Okada H, Ishizuka O, Ozono S,

References

Gotoh M, Sugiyama T, Seki N, Yoshida M,
1)

Abrams P, Cardozo L, Fall M, Griffiths D,

Randomized,

Rosier P, Ulmsten U, van Kerrebroeck P,

propiverine-controlled trial of the once-daily
46
46

double-blind,placebo-andJapanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

7)

8)

antimuscarinic agent solifenacin in Japanesewith urgency incontinence: a double-blind,patients with overactive bladder, BJU Int, 100,placebo controlled trial, J Urol, 191, 395-404

579-587 (2007).

(2014).
13) Vardy MD, Mitcheson HD, Samuels TA,

Cardozo L, Hessdörfer E, Milani R, Arañó P,
Dewilde L, Slack M, Drogendijk T, Wright M,

Wegenke

JD,

Forero-Schwanhaeuser

S,

Bolodeoku J, Solifenacin in the treatment ofMarshall TS, He W, Effects of solifenacin on

urgency and other symptoms of overactive

overactive bladder symptoms, symptom botherbladder: results from a randomized, double-

and other patient-reported outcomes: results

blind, placebo-controlled, rising-dose trial,from VIBRANT - a double-blind, placebo-

BJU Int, 102, 1120-1127 (2008).

controlled trial, Int J Clin Pract, 63, 1702-1714

Karram MM, Toglia MR, Serels SR, Andoh M,(2009).

S,

14) Gotoh M, Kobayashi T, Sogabe K, Impact ofTreatment with solifenacin increases warning

symptom improvement on patients' bother andtime and improves symptoms of overactive

quality of life in female patients withbladder: results from VENUS, a randomized,

overactive bladder treated by solifenacin (SET-

double-blind, placebo-controlled trial, Urology,

Q), Int J Urol, 21, 505-511 (2014).

FakhouryA,

Forero-Schwanhaeuser73, 14-18 (2009).

15) Homma Y, Gotoh M, Symptom severity andToglia MR, Ostergard DR, Appell RA, Andohpatient perceptions in overactive bladder: how

M, Fakhoury A, Hussain IF, Solifenacin for

are they related?, BJU Int, 104, 968-972 (2009).

overactive bladder: secondary analysis of data16) Homma Y, Kakizaki H, Yamaguchi O,

from VENUS based on baseline continence

Yamanishi T, Nishizawa O, Yokoyama O,

status, Int Urogynecol J, 21, 847-854 (2010).

Takeda M, Seki N,Yoshida M, Assessment of10) Chapple C, Van Kerrebroeck P, Tubaro A,

overactive bladder symptoms: comparison ofHaag-Molkenteller C, Forst HT, Massow U,

3-day bladder diary and the overactive bladder

Wang J, Brodsky M, Clinical efficacy, safety,

symptoms score, Urology, 77, 60-64 (2011).

and tolerability of once-daily fesoterodine in17) Homma Y, Gotoh M, Development andsubjects with overactive bladder, Eur Urol, 52,

linguistic validation of the Japanese version of1204-1212 (2007).

the overactive bladder questionnaire (OAB-q),

9)11) Chapple CR, Van Kerrebroeck PE, Jünemann

J Neurogenic Bladder Soc, 17, 241-249 (2006).

KP, Wang JT, Brodsky M, Comparison of18) Homma Y, Gotoh M, Yokoyama O, Nishizawa

fesoterodine and tolterodine in patients withO, Yamanishi T, Takei M, Yoshida M, Takeda

overactive bladder, BJU Int, 102, 1128-1132

M, Kakizaki H, Yamaguchi O, Psychometric(2008).

properties of the Japanese version of the12) Dubeau CE, Kraus SR, Griebling TL, Newman

overactive bladder questionnaire (OAB-q), J

DK , Wyman JF, Johnson TM II , Ouslander

Neurogenic Bladder Soc, 17, 250-256 (2006).

JG, Sun F, Gong J, Bavendam T, Effect of19) Nitti VW, Kopp Z, Lin AT, Moore KH,

fesoterodine in vulnerable elderly subjects

Oefelein M, Mills IW, Can we predict which
47
47

Nishino et al.；Treatment satisfaction in OAB patientspatient will fail drug treatment for overactive

statistics, Bone Marrow Transplant, 48, 452-

bladder? A think tank discussion, Neurourol

458 (2013).
26) Chapple CR, Khullar V, Gabriel Z, Muston D,

Urodyn, 29, 652-657 (2010).

Bitoun CE, Weinstein D, The effects of20) Freeman R, Foley S, Arias JR, Vicente E, Grill
R, Kachlirova Z, Stari A, Huang M,

antimuscarinic

treatmentsinoveractive

Choudhury N, Mirabegron improves quality-

bladder: an update of a systematic review andof-life, treatment satisfaction, and persistencemeta-analysis, Eur Urol, 54, 543-562 (2008).

in patients with overactive bladder: a multi-27) Bunyavejchevin S, Symptom score change andcenter, non-interventional, real-world, 12-patient versus doctor satisfaction in overactive

month study, Curr Med Res Opin, 34, 785-793

bladder before and after anti-muscarinic(2018).

treatment, J Obstet Gynaecol Res, 41, 957-961(2015).

21) Yi QT, Gong M, Chen CH, Hu W, Zhu RJ,
Epidemic investigation of benign prostatic28) Pharmaceuticals and Medical Devices Agency.

obstruction with coexisting overactive bladder

Re-examinations report of solifenacinin Shanghai Pudong New Area and its impact

succinate, pp.16-18, https://www.pmda.go.j

on the health-related quality of life, BMC Urol,p/drugs_reexam/2016/P20160322003/800126

19, 82 (2019).

000_21800AMZ10357_A100_1.pdf.
Accessed 20 March, 2021.

22) Akino H, Namiki M, Suzuki K, Fuse H,
Kitagawa Y, Miyazawa K, Fujiuchi Y,29) Yamaguchi O, Nishizawa O, Takeda M,

Yokoyama O, Factors influencing patient

Yoshida M, Choo MS, Lee JG, Tong-Long Lin

satisfaction with antimuscarinic treatment of

A , Lin HH, Yip WA, Isowa H, Hiro S, Efficacy,

overactive bladder syndrome: results of a real-safety and tolerability of fesoterodine in Asianlife clinical study, Int J Urol, 21, 389-394

patients with overactive bladder, LUTS, 3, 43-(2013).

50 (2011).

23) Pfizer, Inc. Overactive Bladder Questionnai30) Kinsey D, Pretorius S, Glover L, Alexander T,

re short form (OAB-q SF). https://www. p

The psychological impact of overactive

fizerpcoa.com/overactive-bladder-questionnai

bladder: a systematic review, J Health Psychol,re-oab-q-sf-4-week-recall. Accessed Jun 9,

21, 69-81 (2016).
31) Natalin

2021.

R,

Lorenzetti

F,

Dambros

M,

Management of OAB in those over age 65,24) Terwee CB, Bot SD, de Boer MR, van derCurr Urol Rep, 14, 379-385 (2013).

Windt DA, Knol DL, Dekker J, Bouter LM, deVet HC, Quality criteria were proposed for32) Milsom I, Abrams P, Cardozo L, Roberts RG,

measurement properties of health status

Thüroff J, Wein AJ, How widespread are thequestionnaires, J Clin Epidemiol, 60, 34-42

symptoms of an overactive bladder and how(2007).

arethey

managed?

A population-based25) Kanda Y, Investigation of the freely available

prevalence study, BJU Int, 87, 760-766 (2001).

easy-to-use software ’EZR’ for medical

33) Ito H, Akino H, Hosokawa K, Yoshida H,
48
48

Japanese Journal of Community Pharmacy Vol.9, No.2, 36-49 (2021)

Iwahori Y, Moriyama N, Fujita T, Nakamura N,

with questionnaire for the overactive bladder

Mihara S, Hirata A, Tsukahara K, Sugata T,

patients, Jpn J Urol Surg, 27, 1645-1649

Fukushima K, Yokoyama O, Antimuscarinic(2014). （in Japanese）

with

38) Zinner N, Kobashi K, Koochaki P, Fix D,

overactive bladder: is a change of medicine

Egermark M, Patient satisfaction with theeffective?, Jpn J Urol Surg, 23, 1751-1758

benefits of overactive bladder treatment:(2010).（in Japanese）

exploration

treatmentsatisfactionofpatientsofinfluencing

factorsand34) Irwin DE, Abrams P, Milsom I, Kopp Z, Reilly

development of a satisfaction assessment

K, Understanding the elements of overactive

instrument, Neurourol Urodyn, 30, 62-68

bladder: questions raised by the EPIC study,(2011).
39) Piault E, Evans CJ, Espindle D, Kopp Z,

BJU Int, 101, 1381-1387 (2008).

Brubaker L, Abrams P, Development and35) van Dijk L, Kooij DG, Schellevis FG, Kaptein
AA, Boon TA, Wooning M, Nocturia: impact

validation

of

the

Overactiveon quality of life in a Dutch adult population,

Satisfaction

BJU Int, 93, 1001-1004 (2004).

Neurourol Urodyn, 27, 179-190 (2008).

(OAB-S)

Bladder

Questionnaire,36) Rantell A, Cardozo L, Khullar V, Personal40) Ruiz MA, Pardo A, Rejas J, Soto J, Villasantegoals and expectations of OAB patients in theF, Aranguren JL, Development and validation

UK, Neurourol Urodyn, 36, 1194-1200 (2017).

of the "Treatment Satisfaction with Medicines37) Yumura Y, Hattori Y, Noguchi K, Satomi Y,

Questionnaire" (SATMED-Q), Value Health,11, 913-926 (2008).

Iwasaki A, Sato K, Takeshima T, Investigationof efficacy and satisfaction of anticholinergic

4949