The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury

Spinal Cord. 2018 Mar;56(3):259-264. doi: 10.1038/s41393-017-0028-0. Epub 2017 Nov 29.


Study design: Prospective cross-sectional study.

Objectives: Validate the Neurogenic Bladder Symptom Score (NBSS) for people with spinal cord injury (SCI).

Setting: United States (recruitment from community/tertiary neurourology clinics).

Methods: We used data from a prospective observational study of people with a SCI who enrolled during December 2015-September 2016. Participants completed the NBSS and other measurement tools (SF-12 and SCI-QOL Bladder Management Complications tool). Data were used to determine the internal consistency (Cronbach's alpha), validity (hypothesis testing), and test-re-test reliability (using an intraclass correlation coefficient).

Results: 609 people with a SCI had complete data. The median NBSS total score was 22 (IQR 15-30), and median quality of life was "mixed". The Cronbach's alpha of the total and the incontinence, storage/voiding, and consequences domains was 0.85, 0.93, 0.76, and 0.49 respectively. All item to domain correlations were ≥0.3, aside from 3/7 of the items from the consequences domain. Appropriate correlations between the NBSS domains and external variables and other questionnaires were observed, such as a moderate correlation between the SCI-QOL Bladder Management complications tool and the NBSS total score. For the reliability assessment, 174 people had 3 month followup data and did not have a significant change to their urologic health. The intraclass correlation coefficients were >0.75 for all subdomains and the overall score.

Conclusions: The NBSS demonstrated good validity and reliability in a large cohort of people with a SCI, and is a suitable tool to assess neurogenic bladder symptoms.

Sponsorship: Patient-Centered Outcomes Research Institute (PCORI) Award CER14092138.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Cohort Studies
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Severity of Illness Index*
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / epidemiology
  • Surveys and Questionnaires
  • United States / epidemiology
  • Urinary Bladder, Neurogenic / diagnosis*
  • Urinary Bladder, Neurogenic / epidemiology
  • Urinary Bladder, Neurogenic / etiology*