Daily ecological momentary assessments of pain and ability to work after ureteroscopy and stenting

Introduction Ureteral stents can cause significant patient discomfort, yet the temporal dynamics and impact on activities remain poorly characterized. We employed an automated tool to collect daily ecological momentary assessments (EMA) regarding pain and ability to work following ureteroscopy with stenting. Our aim was to assess feasability, and better characterize the postoperative patient experience. Methods As an exploratory endpoint within an ongoing clinical trial, patients undergoing ureteroscopy with stenting were asked to complete daily EMAs for 10 days postoperatively, or until the stent was removed. Questionnaires were distributed via text message and included a pain scale (0-10) and a single item from the validated PROMIS Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Results Among the first 65 trial participants, 59 completed at least 1 EMA (overall response rate 91%). Response rates were >85% for each timepoint through POD10. Median respondent age was 58 years (IQR 50-67), 56% were female. Stones were 54% renal and 46% ureteric, with median diameter 9 mm (IQR 7-10). Median stent dwell time was 7 days (IQR 6-8). Pain scores were highest on POD1 (median score 4) and declined with each subsequent day, reaching median score 2 on POD5. 63% of patients on POD1 reported they had trouble performing their usual work at least sometimes, but by POD5 this was <50% of patients. Patients who work or attend school reported a median of 1 day missed (IQR 0-2). Conclusions An automated daily EMA system for capturing patient-reported outcomes was demonstrated to be feasible with sustained excellent engagement. Patients with stents reported the worst pain and interference with work on POD1 with steady improvements thereafter, and by POD5 the majority of patients had minimal pain or trouble performing their usual work.