SECTION IV: METHODS AND RESULTS CHAPTERS
SEXUAL FUNCTION
Overall, few patients were shown to have sexual dysfunction per se.
However specific problems were identified and a reduction in sexual activity
and difficulty communincating with partner in particular were the
commonest findings.
The GRISS is a 28 item, five point Likert type scale. Each item is awarded
a raw score which is then transformed to produce a score for each of the
seven dimensions, as well as an overall score. Scores of five and above
indicate sexual dysfunction. The mean scores for each dimension were as
follows: vaginismus, 2.72 (SD 2): anorgasmia, 3.79 (SD 13.29); non
communication 4.37 (SD 2); infrequency, 6.44 (SD 1.9); dissatisfaction,
3.24 (SD 1.95); avoidance 2.75 (SD 2.09) and non sensuality, 3.13 (SD
2.11). The majority of patients had scores of <5 for the dimensions on
dissatisfaction (23), avoidance (21), non sensuality (21), vaginismus (22)
and anorgasmia (21). For the dimensions of infrequency Fig. 8 and non
communication Fig. 9, the number of patients with scores equal to or >5
were 22 (75.8%) and 14 (48.2%) respectively. The total scores achieved on
F1G.8 INFREQUENCY OF SEXUAL ACnVTTV ( n ^ 9)
Score 8-9 S Score 5-7 c% Score 1-4
Ninnber of PatietTts
FIG 9 NON COMMUNICATION WITH PARTNER (n = ^ )
c/3 Score 8-9 g Score 5-7 a ■i Score 3-4 Score 0-2 10 —< 12 Number of Patients MOOD STATE
This scale consisted of 41 items making up the five dimensions of tension,
dimension. The means and standard deviations (SD) of the scores are given
in table 5. The highest scores obtained were for the factors of depression
and fatigue. TABLE 5. Mean SD Range Tension 7.95 5.70 3.25-11.75 Anger 6.55 4.31 3.25-9.0 Depression 11.98 8.07 5.0-17.5 Fatigue 10.30 4.33 7.0-14.75 Vigor -4.43 3.70 -6.75- -2
The Spearman correlation coefficients were computed to examine the
relationships between scores in the five mood factors of the POMS. Results
are given in table 6. Because the majority of the intercorrelations were not
significant, the use of the total mood disturbance (TMD) score was not
justified.
TABLE 6.
fiitercorrelations of POMS dimensions
Tension Anger Fatigue Depression Vigor
Tension 1.0 0.555 0.499 0.311 0.795
Anger 0.555 1.0 0.368 0.208 0.429
Fatigue 0.449 0.368 1.0 0.360 0.344
Depression 0.311 0.208 0.360 1.0 0.451
PERCEIVED CONTROL
The distribution of scores for perceived control can be examined in figure
10. The maxbnum total score possible was 45. The higher the score the
greater the behef in powerful others or chance; the lower the score the
greater the behef in personal control. The mean total score obtained was 22
with scores ranging from 12-38 (SD 7.91). The majority of patients
demonstrated greater behefs in personal control.
Twenty-nine (72.5%) agreed with the statement 'T don't let MS rule my
life". Nine (22%) felt that there was nothing they could do about their
bladder problems. A majority (65%) reported that if they arranged things so
that they did not get too tired, then they could do most things they wanted.
Fifteen (33.5%) did not beheve there was much they could do to alter their
syn^toms. Approximately two-thirds (65%) commented that it didn't
matter how much help they received, in the end it was their own efforts
which counted the most. Luck played a large part in the management of MS
in eight (20%) patients. Twenty-eight (70%) felt very determined and on
the whole could manage their bladder symptoms. MS stopped eight (20%)
patients from doing most things and just over half (52.5%) of the sample
FIG.IO DISTRIBUTION OF PERCEIVED CONTROL (PC) (n=MO) .ÊP JS - -3 a Score 31-40 -g Score 21-30 S 2
II
w) “ Score 11-20II
Score 0-10 10 15 Number of Patients 25 QUALITY OF LIFEPatients were asked to describe their quality of life (QOL) on a five point
scale ranging fi-om "very good" to "very poor". QOL was reported as very
good by five (12.5%) patients, good by ten (25%), fair by ten (25%), poor
by eleven (27.5%) and very poor by four patients (10%). Tlie distribution
of the reported effects of bladder symptoms on QOL can be examined in
n C l l EFFECT OF BLADDER SYMPTOIVIS ON QÜAUTV OF UFE(nNO) Agreatdeal 20%(8) Moderately 20% (8) Not at all 25%(10) Sli^ly 35% (14)
RELATIONSHIPS BETWEEN THE VARIABLES
Relationships between variables were calculated using the Spearman Rank
Correlation Coefficient, the Kruskal Wallis test and the Cbisquare test.
Significant relationships were found to exist between a number of variables
relatmg to mobibty and level of disabibty and these supported the original
hypotheses. The Spearman Rank Correlation coefficient was used to
calculate the degree of association between the total score of the Rivermead
Mobibty Index (RMI) and the timed walk. There was a significant positive
correlation (r = 0.923, p <0.0005). Significant positive correlations also
existed between the RMI score and the global perceived level of disabibty
(GPLOD) (Kruskal-Wallis test H = 19.82, p <0.0001), the RMI and the
perceived level of disabibty in terms of walking (H = 22.45, p <0.0001) and
the Expanded Disability Status Scale score and the GPLOD (H = 13.91, p
<0.001) (Fig. 12).
FIG 12 RELATIQNSHIP BETWEEN EDSS AND CTLOD (dfMO)
EDSS 10 T GPLOD ON On m m m NUMBER OF PAITENTS
The Profile of Mood State was examined for associations between several
variables. It had been predicted that a positive relationship would exist
between depression and perceptions of personal control and this hypothesis
was supported (r = 0.489, p<0.002). It had been expected that the factor of
depression would be positively associated with a reduction in the j&equency
of sexual activity as well as a greater degree of overall sexual dysfimction as
measured by the GRISS. These hypotheses were not supported as no
significant relationships were found in either case (r = 0.070 and r = 0.012
respectively). Depression was not related to disease duration or to the
duration of symptoms, nor did it correlate with mobihty-related activities
GPLOD, disease and syiq)tom duration had no relationship to levels of PC
and these findings were consistant with the original hypotheses. The
prediction that there would be a significant positive correlation between
greater internal PC and quality of life was supported (Kruskal-Wallis H =
16.36, p 0.003). It had been predicted that those patients who reported
incontinence would perceive that their bladder symptoms had had a greater
effect on their quahty of life than those who did not report incontinence.
This was supported in that QOL was affected moderately or a great deal in
those who were incontinent conq>ared to not at ah or only shghtly in those
who were not incontinent. The difference between the two groups was
significant (Chisquare = 6.808, p<0.01) (table 7).
Incontinence however was not associated with a decrease in the fi*equency
of sexual intercourse (Kruskal Walhs H = 0.88, p 0.349) or with sexual
dysfimction (Kruskal Walhs H = 1.35, p 0.246) per se as measured by the
GRISS. Similarly the patients' level of mobihty, as determined by the RMI
scores, was not related to a reduction in sexual activity (r = -0.013).
Therefore the hypotheses regarding relationships between incontinence and
TABLE 1.
Differences in the perception of the effect of the bladder on quality of life in
patients with and without urge incontinence. (Expected frequencies in
brackets). Urge incontinence No Urge incontinence No/slight effect (BQOL) 9(12.97) 14(10.03) Moderate/Great deal of effect (BQOL) 13 (9.03) 3 (6.97)
CHAPTER 11