- The Neurogenic Bladder Symptom Score (NBSS) is a comprehensive and discriminative tool designed by Welk et al. (2013) for patients with neurogenic lower urinary tract dysfunction.
- In 2020, Welk et al developed a short version of NBSS (NBSS-SF) composed of 10 items exploring the same three domains as the NBSS original long version (Welk et al. 2020).
Clinical Considerations
The NBBS has been validated for neurological patients to measure urinary symptoms, signs, quality of life and consequences/complications of neurogenic lower urinary tract dysfunction, thus, NBSS evaluates the effects of a broad range of bladder problems.
ICF Domain
Body Functions ▶ Digestive, Metabolic and Endocrine
Administration
Self-reported.
Number of Items
- NBSS, 24 items:
- Incontinence, 8 questions.
- Storage and Voiding, 7 questions.
- Consequences, 7 questions
- 2 additional questions.
- NBSS-SF, 10 items:
- Incontinence, 3 questions.
- Storage and Voiding, 3 questions.
- Consequences, 2 questions.
- 2 additional questions.
*The two additional questions in both versions are related to the method of bladder management, and the second one is about how the current bladder management method affects the quality of life.
Equipment
N/A
Scoring
Higher scores indicate more severe symptoms:
- NBSS: Score from 0 to 74.
- NBSS-SF: Score from 0 to 28.
The domains have been validated as independent subscales, so they can be used in combination or separately, according to clinical utility (Welk et al. 2014).
Languages
- NBSS: English, Polish, Turkish, Spanish, and Brazilian Portuguese.
- NBSS-SF: English, Arabic, French
Training Required
None
Availability
NBSS and/or NBSS-SF permission for use can be requested here.
Measurement Property Summary
# of studies reporting psychometric properties: 3
Interpretability
Higher scores on the NBSS indicate more severe bladder symptoms.
- MCID: not established in SCI.
- SEM:
- Incontinence: 3.2
- Storage and voiding: 1.7
- Consequences: 1.5
- NBSS QOL Question: 0.5
- NBSS total: 4.7
(Welk et al. 2018; N=609, 410 males, 119 females; 285 cervical SCI, 265 thoracic SCI, 42 lumbar/sacral SCI; 167 ASIA A, 75 ASIA B, 61 ASIA C, 42 ASIA D; mean time since injury = 11.5 years)
- MDC: not established in SCI
Typical Values
Mean score (SD):
- Incontinence: 9.2 (6.9)
- Storage and voiding: 6.9 (4.2)
- Consequences: 6.6 (4.2)
- NBSS QOL Question: 2.0 (1.2)
- NBSS total: 22.7 (10.3)
(Welk et al. 2018; N=609, 410 males, 119 females; 285 cervical SCI, 265 thoracic SCI, 42 lumbar/sacral SCI; 167 ASIA A, 75 ASIA B, 61 ASIA C, 42 ASIA D; mean time since injury = 11.5 years)
Reliability – High
NBSS
- Internal consistency is High for the NBSS total score (Cronbach’s a = 0.85 – 0.89) and the NBSS domains: Incontinence (Cronbach’s a = 0.93), Storage and Voiding (Cronbach’s a = 0.76) and Consequences (Cronbach’s a = 0.49).
- Test-retest reliability is High for the NBSS total score (ICC = 0.79 – 0.91) and the NBSS domains: Incontinence (ICC = 0.78), Storage and Voiding (ICC = 0.83).
(Welk et al. 2018; N=609, 410 males, 119 females; 285 cervical SCI, 265 thoracic SCI, 42 lumbar/sacral SCI; 167 ASIA A, 75 ASIA B, 61 ASIA C, 42 ASIA D; mean time since injury = 11.5 years)
(Welk et al. 2014; N=230, 35% SCI)
NBSS-SF
- Internal consistency is High for the NBSS-SF (Cronbach’s a = 0.70 – 0.76).
- Test-retest reliability is High for the NBSS-SF (ICC = 0.86-0.91).
(Welk et al. 2020; Cohort 1, n=230; Cohort 2, n=1479; and Cohort 3, n=68; NBSS-SF version)
Validity – Low to High
- High Correlation between NBSS and NBSS-SF:
r = 0.90-094
(Welk et al. 2020; Cohort 1, n=230; Cohort 2, n=1479; and Cohort 3, n=68; NBSS-SF version)
- Moderate Correlation between NBSS and:
Qualiveen-SF: r = 0.53
American Urological Association (AUA) Symptom Score: r = 0.76
International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI): r = 0.46
(Welk et al. 2020; Cohort 1, n=230; Cohort 2, n=1479; and Cohort 3, n=68; NBSS-SF version)
- Moderate Correlation between NBSS consequences domain and SCI-QOL Bladder Management Complications tool:
r = 0.50 - Low Correlation between NBSS total score and Bladder management complications score:
r = 0.28
(Welk et al. 2018; N=609, 410 males, 119 females; 285 cervical SCI, 265 thoracic SCI, 42 lumbar/sacral SCI; 167 ASIA A, 75 ASIA B, 61 ASIA C, 42 ASIA D; mean time since injury = 11.5 years)
Responsiveness
Effect size:
- SMD:
- Incontinence: 3.5
- Storage and voiding: 2.1
- Consequences: 1.5
- NBSS QOL Question: 0.6
- NBSS total: 5.2
(Welk et al. 2018; N=609, 410 males, 119 females; 285 cervical SCI, 265 thoracic SCI, 42 lumbar/sacral SCI; 167 ASIA A, 75 ASIA B, 61 ASIA C, 42 ASIA D; mean time since injury = 11.5 years)
Floor/Ceiling Effect
No values were reported for the presence of floor/ceiling effects in the NBSS for the SCI population.
Reviewers
Jane Hsieh, Dr. Carlos Leonardo Cano-Herrera, Matthew Querée
Date Last Updated
31 December 2024
Welk B, Morrow SA, Madarasz W, Potter P, Sequeira K. The conceptualization and development of a patient-reported neurogenic bladder symptom score. Res Rep Urol. 2013; 5: 129–37.
https://pubmed.ncbi.nlm.nih.gov/24400244/
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; 192: 452–7.
https://pubmed.ncbi.nlm.nih.gov/24518764/
Welk B, Lenherr S, Elliott S, Stoffel J, Presson AP, Zhang C, et al. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord. 2018; 56: 259–64.
https://pubmed.ncbi.nlm.nih.gov/29184133/
Welk B, Carlson K, Baverstock R. A pilot study of the responsiveness of the Neurogenic Bladder Symptom Score (NBSS). Can Urol Assoc J. 2017; 11: 376–8.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5962943/
Welk B, Lenherr S, Elliott S, Stoffel J, Gomes CM, de Bessa J, et al. The creation and validation of a short form of the Neurogenic Bladder Symptom Score. Neurourol Urodyn. 2020; 35: 8.
https://pubmed.ncbi.nlm.nih.gov/32196732/
