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Factors Affecting Dropout Rate in Patients Undergoing Percutaneous Tibial Nerve Stimulation
William T. Berg, MD, Wai Lee, MD, Charles A. Loeb, BA, Chris Du, BA, Andrew Chen, BS, Jason Kim, MD.
Stony Brook University, Stony Brook, NY, USA.
BACKGROUND: Percutaneous tibial nerve stimulation (PTNS) has shown to be an efficacious treatment for overactive bladder, with a standard initial therapy of 12 weekly sessions. Outside of clinical trials, no study to date has characterized compliance with treatment or the etiology of dropout. We sought to identify the common etiologies of dropout and correlate demographic variables with noncompliance.
METHODS: All patients who underwent PTNS from January 2014 to November 2016 were identified by CPT code 64566. Patients who completed all 12 sessions were compared to those who did not. Multiple variables were tested for correlation with dropout, including age, BMI, gender, marital status, employment status, smoking status, distance from clinic, and patient perceived improvement.
RESULTS: A total of 65 patients were identified. 66% (43/65) of patients completed all 12 sessions. Significant differences between those who did not complete 12 sessions versus those who did were found for smoking status (p=0.009) and patient perceived improvement (p=0.008). There was no significant difference between groups in age (p=0.48), BMI (p=0.74), gender (p=0.09), marital status (p=0.37), employment status (p=0.94), or distance from clinic (p=0.15). The patients who dropped out completed a median of 8 sessions (IQR 6-9). The most common reasons for dropout included perceived lack of efficacy (n=5), required time commitment (n=5), and other health problems (n=4). In a multivariable regression model, smoking status (p=0.02) and perceived improvement in symptoms (p=0.014) remained significant predictors of completing all 12 sessions. After dropping out, 23% of patients subsequently underwent other third line overactive bladder therapies (5/23).
CONCLUSIONS: Not surprisingly, the most likely predictor of completing all standard initial sessions of PTNS is patient perceived improvement in symptoms. Additionally, smoking status appears to have a significant influence on completing all 12 sessions. The most common cited reasons for dropout are lack of efficacy and time commitment. More research is necessary to further delineate the causes of dropout in order to improve patient compliance.
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