Journal of Multiple Sclerosis

Validation of the Monitoring Efficacy of Neurogenic Bowel Dysfunction Treatment on Response (MENTOR) Tool in Individuals with Multiple Sclerosis

Concetta Brugaletta, Valentina Pssananti, Humayra Dervin, Katherine Wickham, Klaus Krogh and Emmanuel A*

Objective: Bowel dysfunction is highly prevalent in patients with Multiple Sclerosis (MS). A tool to help decision-making of neurogenic bowel dysfunction treatment in this population is needed. We present a project to validate in this population the MENTOR tool, a three-dimensional instrument comprised of the Neurogenic Bowel Dysfunction (NBD) score, special attention (‘alarm’) symptoms and patient satisfaction. Methods: 69 individuals with MS completed the MENTOR tool prior to outpatient review. An expert Health Care Professional (HCP) blinded to the MENTOR outcome assessed the participants and made an independent treatment decision. We compared the tool outcome and therapeutic recommendation with the HCP opinion. Results: In our patient cohort, the MENTOR has a specificity of 80%, accuracy of 70% and a sensitivity of 60% with a positive and negative predictive value of 68% and 73% (respectively), a positive and negative likelihood ratio of 3 and 0.5 (respectively). Stronger concordance with HCP evaluation was found in patients that fall in the category “monitoring” (88%), and “change” (71%); the lowest concordance was in the individuals that need “further discuss” (38%). Of note, agreement with HCP evaluation was significant for total NBD score (especially incontinence symptoms of the NBD score) but not for patient’s satisfaction component or special attention symptoms. Conclusion: The MENTOR tool has potential utility in patients with MS with bowel dysfunction. The special attention symptoms and the patient’s subjective report had a less predictable relationship with HCP expert opinion than the NBD component. Optimizing the tool further will be the subject of future work.