1
|
Sheyn D, Chakraborty N, Chen YB, Mahajan ST, Hijaz A. Use of a Digital Conversational Agent for the Management of Overactive Bladder. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:536-544. [PMID: 37930265 DOI: 10.1097/spv.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
IMPORTANCE Conservative therapy is effective for the treatment of overactive bladder (OAB) but may be limited by accessibility to care. OBJECTIVE The objective of this study was to evaluate the efficacy of a digital conversational agent (CeCe) for the treatment of OAB. STUDY DESIGN This was a prospective observational trial utilizing a digital conversational agent developed by Renalis University Hospitals (Cleveland, Ohio) for the treatment of OAB. Patients were given access to CeCe over an 8-week period and were instructed on how to perform bladder training and pelvic floor exercises and taught about bladder health. The primary outcome was a decrease in the International Consultation on Incontinence-Overactive Bladder Quality-of-Life Questionnaire (ICIQ-OAB-QoL) score from week 1 to week 8. Patients also completed the 36-item Short-Form Health Survey and Generalized Anxiety Disorder Questionnaire at the same intervals and voiding diaries at weeks 1, 4, and 8. A power analysis was performed and determined that a total of 30 patients would be needed to demonstrate a significant difference in symptom scores after use of CeCe with 80% power and an α error of 5%. RESULTS Twenty-nine patients completed all data collection. The ICIQ-OAB-QoL scores were significantly different between weeks 1 and 8 (62 [IQR], 49-75) vs 32 [IQR, 24-43]; P < 0.001). Patients also reported a decrease in frequency pretreatment and posttreatment (7 [IQR, 6-10] vs 5 [IQR, 4-7]; P = -0.04), nocturia (2 [IQR, 1-3] vs 1 [IQR, 1-2]; P = 0.03), and urge urinary incontinence (2 [IQR, 1-5] vs 0 [IQR, 0-3]; P = 0.04). Consumption of alcohol decreased from week 1 to week 8 (24 oz [IQR, 12-36 oz) to 14 oz (IQR, 9-22 oz]; P = 0.02). CONCLUSION The use of a digital conversational agent effectively reduced the severity of symptoms and improved quality of life in patients with OAB.
Collapse
Affiliation(s)
- David Sheyn
- From the Department of Urology, University Hospitals Cleveland
| | | | | | - Sangeeta T Mahajan
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH
| | - Adonis Hijaz
- From the Department of Urology, University Hospitals Cleveland
| |
Collapse
|
2
|
Buck J, Fromings Hill J, Collins R, Booth J, Fleming J. Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials. Age Ageing 2024; 53:afae126. [PMID: 38941119 PMCID: PMC11212545 DOI: 10.1093/ageing/afae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home. METHODS Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised. RESULTS A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria. CONCLUSION There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.
Collapse
Affiliation(s)
- Jackie Buck
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Julia Fromings Hill
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Rachael Collins
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Booth
- Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jane Fleming
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| |
Collapse
|
3
|
Chen H, Hoi MPM, Lee SMY. Medicinal plants and natural products for treating overactive bladder. Chin Med 2024; 19:56. [PMID: 38532487 DOI: 10.1186/s13020-024-00884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Overactive bladder (OAB) presents a high prevalence of 16-18% worldwide. The pathophysiology of OAB is still poorly understood while effective therapy or countermeasure are very limited. On the other hand, medicinal plants and herbal remedies have been utilized for treating lower urinary tract symptoms (LUTS) in both Eastern and Western cultures since ancient times. In recent years, accumulating progress has also been made in OAB treatment research by using medicinal plants. METHODS Relevant literature on the studies of medicinal plants and herbs used to treat OAB was reviewed. The medicinal plants were summarized and categorized into two groups, single-herb medications and herbal formulations. RESULTS The present review has summarized current understanding of OAB's pathophysiology, its available treatments and new drug targets. Medicinal plants and natural products which have been used or have shown potential for OAB treatment were updated and comprehensively categorized. Studies on a wide variety of medicinal plants showed promising results, although only a few phytochemicals have been isolated and identified. Until now, none of these herbal compounds have been further developed into clinical therapeutics for OAB. CONCLUSIONS This review provides the basis for discovering and designing new phytopharmaceutical candidates with effective and well-tolerated properties to treat OAB. Increasing evidences indicate new strategies with alternative herbal treatment for OAB have high efficacy and safety, showing great promise for their clinical use. Future studies in a rigorously designed controlled manner will be beneficial to further support the eligibility of herbal treatment as OAB therapeutics.
Collapse
Affiliation(s)
- Huanxian Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao, China
| | - Maggie Pui Man Hoi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao, China
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, University of Macau, Macao, China
| | - Simon Ming Yuen Lee
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao, China.
- Department of Pharmaceutical Sciences, Faculty of Health Sciences, University of Macau, Macao, China.
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China.
| |
Collapse
|
4
|
Kalideen L, Govender P, van Wyk JM. Standards and quality of care for older persons in long term care facilities: a scoping review. BMC Geriatr 2022; 22:226. [PMID: 35303830 PMCID: PMC8933989 DOI: 10.1186/s12877-022-02892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for older persons has become a global necessity to ensure functional ability and healthy ageing. It is of paramount importance that standards of care are monitored, especially for older persons who live in long term care facilities (LTCF). We, therefore, scoped and summarised evidence relating to standards and the quality of care for older persons in LTCFs in gerontological literature globally. METHODS We conducted a scoping review using Askey and O'Malley's framework, including Levac et al. recommendations. PubMed, CINAHL, Health Sources, Scopus, Cochrane Library, and Google Scholar were searched with no date limitation up to May 2020 using keywords, Boolean terms, and medical subject headings. We also consulted the World Health Organization website and the reference list of included articles for evidence sources. This review also included peer-reviewed publications and grey literature in English that focused on standards and quality of care for older residents in LTCFs. Two reviewers independently screened the title, abstract, and full-text of evidence sources screening stages and performed the data extraction. Thematic content analysis was used, and a summary of the findings are reported narratively. RESULTS Sixteen evidence sources published from 1989 to 2017 met this study's eligibility criteria out of 73,845 citations obtained from the broader search. The majority of the studies were conducted in the USA 56% (9/16), and others were from Canada, Hong Kong, Ireland, Norway, Israel, Japan, and France. The included studies presented evidence on the effectiveness of prompted voiding intervention for urinary incontinence in LTCFs (37.5%), the efficacy of professional support to LTCF staff (18.8%), and the prevention-effectiveness of a pressure ulcer programme in LTCFs (6.3%). Others presented evidence on regulation and quality of care (12.5%); nursing documentation and quality of care (6.3%); medical, nursing, and psychosocial standards on the quality of care (6.3%); medication safety using the Beer criteria (6.3%); and the quality of morning care provision (6.3%). CONCLUSION This study suggests most studies relating to standards and quality of care in LTCFs focus on effectiveness of interventions, few on people-centredness and safety, and are mainly conducted in European countries and the United States of America. Future studies on people-centerdness, safety, and geographical settings with limited or no evidence are recommended.
Collapse
Affiliation(s)
- Letasha Kalideen
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.
| | - Pragashnie Govender
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| | - Jacqueline Marina van Wyk
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa
| |
Collapse
|
5
|
Gibson W, Johnson T, Kirschner-Hermanns R, Kuchel G, Markland A, Orme S, Ostaszkiewicz J, Szonyi G, Wyman J, Wagg A. Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence. Neurourol Urodyn 2021; 40:38-54. [PMID: 33085806 DOI: 10.1002/nau.24549] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evidence-based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. AIMS To summarize the available evidence relating to the management of urinary incontinence in frail older people published since the 5th International Consultation on Incontinence. MATERIALS AND METHODS A series of systematic reviews and evidence updates were performed by members of the working group to update the 2012 recommendations. RESULTS Along with the revision of the treatment algorithm and accompanying text, there have been significant advances in several areas of the management of lower urinary tract symptoms in frail older people. DISCUSSION The committee continues to note the relative paucity of data concerning frail older persons and draw attention to knowledge gaps and research opportunities. Clinicians treating older people with lower urinary tract symptoms should use the available evidence from studies of older people combined with careful extrapolation of those data from younger subjects. Due consideration to an individual's frailty and wishes is crucial.
Collapse
Affiliation(s)
- William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore Johnson
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - George Kuchel
- UConn Center on Aging, University of Connecticut, Farmington, Connecticut, USA
| | - Alayne Markland
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susie Orme
- Care of the Elderly Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Joan Ostaszkiewicz
- Director of Aged Care, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - George Szonyi
- Department of Geriatric Medicine, Balmain Hospital, Sydney, New South Wales, Australia
| | - Jean Wyman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
ANDAÇ T, CAN GÜRKAN Ö, DEMİRCİ N. Üriner İnkontinansta Kanıt Temelli Tamamlayıcı ve Alternatif Tedaviler. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.605439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Booth J, Aucott L, Cotton S, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O’Dolan C, Skelton DA, Surr C, Treweek S. ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial. Trials 2019; 20:723. [PMID: 31843002 PMCID: PMC6915984 DOI: 10.1186/s13063-019-3723-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents' dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences. METHODS This is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. DISCUSSION TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. TRIAL REGISTRATION ClinicalTrials.gov, NCT03248362. Registered on 14 August 2017. ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
Collapse
Affiliation(s)
- J. Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - L. Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - S. Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - C. Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - S. Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - D. Harari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - A. Lowndes
- Playlist for Life, Unit 1/14, Govanhill Workspace, Glasgow,, UK
| | - L. Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - G. MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - H. Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - D. McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Glasgow, UK
| | - J. Norrie
- Usher Institute, Edinburgh University, Edinburgh, UK
| | | | - C. O’Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - D. A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Glasgow, G4 0BA UK
| | - C. Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - S. Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| |
Collapse
|
8
|
Relationship Satisfaction of Intimate Partners of Persons Living With Urinary Incontinence. J Wound Ostomy Continence Nurs 2019; 46:228-234. [PMID: 31022126 DOI: 10.1097/won.0000000000000537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine effects of urinary incontinence (UI) on midlife women's relationships with their intimate partners, from the perspective of both women and their partners. DESIGN A cross-sectional, mixed-methods design. SUBJECTS AND SETTING Purposive, convenience/snowball sampling strategies and community-based recruitment strategies were used to enroll partnered, midlife women living with UI. Participants were 43 community-dwelling midlife couples residing in the southwestern United States; female participants had stress, urgency, or mixed UI by self-report. Data were also collected from their intimate partners. METHODS Participants completed confidential mailed study packets comprising questionnaires on demographic information and lower urinary tract symptom profile, valid measures of the quality of the relationship, and open-ended questions to explore the effect of UI on the relationship in the participants' own words. The packet included several validated instruments: the Incontinence Severity Index, Couples Satisfaction Index, Sexual Quality of Life-Female/Male, Relational Ethics Scale, and Couples' Illness Communication Scale. Quantitative data were analyzed using tests of differences between groups and correlation analysis. Qualitative data were explored for themes and tested for significant differences in word choice by z-score analysis. RESULTS We found no significant differences between women and their partners in measures of the relationship and no significant associations between UI symptom severity and relationship satisfaction. Distressed partners had significantly poorer scores on sexual quality of life (P < .001), relational ethics (P = .002), and communication about UI (P = .03). Distressed couples used significantly more words than did nondistressed couples who described the woman's withdrawal from shared activities (P = .005) and avoidance of physical intimacy (P = .003), which they attributed to UI. CONCLUSIONS Distressed couples demonstrated the negative effects of UI on emotional and physical intimacy. Distress was attributed to how the woman coped with symptoms but not with the severity of UI symptoms.
Collapse
|
9
|
|
10
|
Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL. Interventions for treating urinary incontinence after stroke in adults. Cochrane Database Syst Rev 2019; 2:CD004462. [PMID: 30706461 PMCID: PMC6355973 DOI: 10.1002/14651858.cd004462.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary incontinence can affect 40% to 60% of people admitted to hospital after a stroke, with 25% still having problems when discharged from hospital and 15% remaining incontinent after one year.This is an update of a review published in 2005 and updated in 2008. OBJECTIVES To assess the effects of interventions for treating urinary incontinence after stroke in adults at least one-month post-stroke. SEARCH METHODS We searched the Cochrane Incontinence and Cochrane Stroke Specialised Registers (searched 30 October 2017 and 1 November 2017 respectively), which contain trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearched journals and conference proceedings. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction, risk of bias assessment and implemented GRADE. MAIN RESULTS We included 20 trials (reporting 21 comparisons) with 1338 participants. Data for prespecified outcomes were not available except where reported below.Intervention versus no intervention/usual careBehavioural interventions: Low-quality evidence suggests behavioural interventions may reduce the mean number of incontinent episodes in 24 hours (mean difference (MD) -1.00, 95% confidence interval (CI) -2.74 to 0.74; 1 trial; 18 participants; P = 0.26). Further, low-quality evidence from two trials suggests that behavioural interventions may make little or no difference to quality of life (SMD -0.99, 95% CI -2.83 to 0.86; 55 participants).Specialised professional input interventions: One trial of moderate-quality suggested structured assessment and management by continence nurse practitioners probably made little or no difference to the number of people continent three months after treatment (risk ratio (RR) 1.28, 95% CI 0.81 to 2.02; 121 participants; equivalent to an increase from 354 to 453 per 1000, 95% CI 287 to 715).Complementary therapy: Five trials assessed complementary therapy using traditional acupuncture, electroacupuncture and ginger-salt-partitioned moxibustion plus routine acupuncture. Low-quality evidence from five trials suggested that complementary therapy may increase the number of participants continent after treatment; participants in the treatment group were three times more likely to be continent (RR 2.82, 95% CI 1.57 to 5.07; 524 participants; equivalent to an increase from 193 to 544 per 1000, 95% CI 303 to 978). Adverse events were reported narratively in one study of electroacupuncture, reporting on bruising and postacupuncture abdominal pain in the intervention group.Physical therapy: Two trials reporting three comparisons suggest that physical therapy using transcutaneous electrical nerve stimulation (TENS) may reduce the mean number of incontinent episodes in 24 hours (MD -4.76, 95% CI -8.10 to -1.41; 142 participants; low-quality evidence). One trial of TENS reporting two comparisons found that the intervention probably improves overall functional ability (MD 8.97, 95% CI 1.27 to 16.68; 81 participants; moderate-quality evidence).Intervention versus placeboPhysical therapy: One trial of physical therapy suggests TPTNS may make little or no difference to the number of participants continent after treatment (RR 0.75, 95% CI 0.19 to 3.04; 54 participants) or number of incontinent episodes (MD -1.10, 95% CI -3.99 to 1.79; 39 participants). One trial suggested improvement in the TPTNS group at 26-weeks (OR 0.04, 95% CI 0.004 to 0.41) but there was no evidence of a difference in perceived bladder condition at six weeks (OR 2.33, 95% CI 0.63 to 8.65) or 12 weeks (OR 1.22, 95% CI 0.29 to 5.17). Data from one trial provided no evidence that TPTNS made a difference to quality of life measured with the ICIQLUTSqol (MD 3.90, 95% CI -4.25 to 12.05; 30 participants). Minor adverse events, such as minor skin irritation and ankle cramping, were reported in one study.Pharmacotherapy interventions: There was no evidence from one study that oestrogen therapy made a difference to the mean number of incontinent episodes per week in mild incontinence (paired samples, MD -1.71, 95% CI -3.51 to 0.09) or severe incontinence (paired samples, MD -6.40, 95% CI -9.47 to -3.33). One study reported no adverse events.Specific intervention versus another interventionBehavioural interventions: One trial comparing a behavioural intervention (timed voiding) with a pharmacotherapy intervention (oxybutynin) contained no useable data.Complementary therapy: One trial comparing different acupuncture needles and depth of needle insertion to assess the effect on incontinence reported that, after four courses of treatment, 78.1% participants in the elongated needle group had no incontinent episodes versus 40% in the filiform needle group (57 participants). This trial was assessed as unclear or high for all types of bias apart from incomplete outcome data.Combined intervention versus single interventionOne trial compared a combined intervention (sensory motor biofeedback plus timed prompted voiding) against a single intervention (timed voiding). The combined intervention may make little or no difference to the number of participants continent after treatment (RR 0.55, 95% CI 0.06 to 5.21; 23 participants; equivalent to a decrease from 167 to 92 per 1000, 95% CI 10 to 868) or to the number of incontinent episodes (MD 2.20, 95% CI 0.12 to 4.28; 23 participants).Specific intervention versus attention controlPhysical therapy interventions: One study found TPTNS may make little or no difference to the number of participants continent after treatment compared to an attention control group undertaking stretching exercises (RR 1.33, 95% CI 0.38 to 4.72; 24 participants; equivalent to an increase from 250 to 333 per 1000, 95% CI 95 to 1000). AUTHORS' CONCLUSIONS There is insufficient evidence to guide continence care of adults in the rehabilitative phase after stroke. As few trials tested the same intervention, conclusions are drawn from few, usually small, trials. CIs were wide, making it difficult to ascertain if there were clinically important differences. Only four trials had adequate allocation concealment and many were limited by poor reporting, making it impossible to judge the extent to which they were prone to bias. More appropriately powered, multicentre trials of interventions are required to provide robust evidence for interventions to improve urinary incontinence after stroke.
Collapse
Affiliation(s)
- Lois H Thomas
- University of Central LancashireFaculty of Health and WellbeingRoom 416Brook BuildingPrestonLancashireUKPR1 2HE
| | - Jacqueline Coupe
- University of Central LancashireFaculty of Health and WellbeingRoom 416Brook BuildingPrestonLancashireUKPR1 2HE
| | - Lucy D Cross
- University of Central LancashireResearch Support Team, Faculty of Health and WellbeingBrook BuildingVictoria StreetPrestonLancashireUKPR1 2HE
| | - Aidan L Tan
- National University HospitalDepartment of Preventive Medicine5 Lower Kent Ridge RoadSingapore119074
| | - Caroline L Watkins
- University of Central LancashireFaculty of Health and WellbeingRoom 416Brook BuildingPrestonLancashireUKPR1 2HE
| | | |
Collapse
|
11
|
Bruce BK, Weiss KE, Harrison TE, Allman DA, Petersen MA, Luedkte CA, Fischer PR. Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report. J Clin Psychol Med Settings 2018; 23:147-59. [PMID: 26538160 DOI: 10.1007/s10880-015-9438-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of postural orthostatic tachycardia syndrome (POTS) in adolescents and young adults has been increasing during the past decade. Despite this increase, documentation regarding treatment of these patients is just beginning to emerge. In addition, despite a call for a multidisciplinary or interdisciplinary approach, no studies have examined the efficacy of such an approach to treatment. This paper describes a case study of a 19-year-old male with debilitating POTS seen at a tertiary clinic for evaluation and subsequent intensive interdisciplinary treatment. The treatment approach is described and outcomes are presented.
Collapse
Affiliation(s)
- Barbara K Bruce
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. .,Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Karen E Weiss
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Daniel A Allman
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Matthew A Petersen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Connie A Luedkte
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
12
|
|
13
|
Chin WY, Choi EPH, Wan EYF, Chan AKC, Chan KHY, Lam CLK. Evaluation of the outcomes of care of nurse-led continence care clinics for Chinese patients with lower urinary tract symptoms, a 2-year prospective longitudinal study. J Adv Nurs 2016; 73:1158-1171. [PMID: 27859530 DOI: 10.1111/jan.13205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to evaluate the 24-month outcomes of a nurse-led continence care service for Chinese primary care patients with lower urinary tract symptoms. BACKGROUND Most studies evaluating the outcomes of continence care services have had short follow-up durations with limited knowledge on whether benefits are sustained beyond 12 months. DESIGN Twenty-four month cohort study. METHODS Two comparison groups were recruited: (1) Patients with lower urinary tract symptoms attending a nurse-led community-based continence care programme; (2) Primary care patients with lower urinary tract symptoms identified by screening, receiving usual medical care. Self-reported symptom severity, health-related quality of life, patient enablement and general health perception were measured at baseline and 24 months. Data collection occurred from March 2013-August 2015. RESULTS Baseline and 24-month data were available for 170 continence care and 158 usual care subjects. After controlling for baseline characteristics, the continence care group was observed to have greater reductions in symptom severity and larger improvements in disease-specific health-related quality of life, patient enablement and general health perception than the usual care group. Deterioration in the mental components of generic health-related quality of life was observed in the usual care group, but not in the continence care group. CONCLUSION Over 24 months, when compared with usual medical care, nurse-led continence care services were effective in reducing symptom severity and improving health-related quality of life, patient enablement and general health perception and provided protection against deterioration in the mental components of health-related quality of life in patients with lower urinary tract symptoms.
Collapse
Affiliation(s)
- Weng Yee Chin
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| | | | - Eric Y F Wan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Anca K C Chan
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| | - Karina H Y Chan
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| |
Collapse
|
14
|
French B, Thomas LH, Harrison J, Coupe J, Roe B, Booth J, Cheater FM, Leathley MJ, Watkins CL, Hay-Smith J. Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis. J Adv Nurs 2016; 73:21-38. [PMID: 27459911 DOI: 10.1111/jan.13083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Abstract
AIM To evaluate factors influencing uptake and delivery of behavioural interventions for urinary incontinence from the perspective of clients and clinical staff. BACKGROUND Behavioural interventions are recommended as first-line therapy for the management of urinary incontinence. Barriers to and enablers of uptake and delivery of behavioural interventions have not been reviewed. DESIGN Qualitative evidence synthesis. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsychInfo, AMED (inception to May 2013); Proceedings of the International Continence Society (ICS) (2006-2013). REVIEW METHODS Studies where data were collected from clients or staff about their experiences or perceptions of behavioural interventions were included. Two reviewers independently screened records on title and abstract. Full-text papers were obtained for records identified as potentially relevant by either reviewer. Two reviewers independently filtered all full-text papers for inclusion, extracted findings and critically appraised studies. We used an approach akin to Framework, using a matrix of pre-specified themes to classify the data and facilitate its presentation and synthesis. RESULTS Seven studies involving 200 participants identified clients' views. Findings identified from at least one study of moderate quality included increased fear of accidents and convenience of treatment. Factors enabling participation included realistic goals and gaining control. Six studies involving 427 participants identified staff views. Findings identified from at least one study of moderate quality included staff education and perceptions of treatment effectiveness. Enabling factors included teamwork and experience of success. CONCLUSION There is little detailed exploration of clients' experiences of, and responses to, behavioural interventions. Evidence for staff relates predominantly to prompted voiding in long-term residential care. Studies of the uptake and delivery of other behavioural interventions in other settings are warranted.
Collapse
Affiliation(s)
- Beverley French
- School of Health, University of Central Lancashire, Preston, UK
| | - Lois H Thomas
- School of Health, University of Central Lancashire, Preston, UK
| | - Joanna Harrison
- School of Health, University of Central Lancashire, Preston, UK
| | | | - Brenda Roe
- Evidence Based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Joanne Booth
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, UK
| | | | | | - Caroline L Watkins
- School of Health, University of Central Lancashire, Preston, UK.,Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | |
Collapse
|
15
|
Affiliation(s)
- Angie Rantell
- Lead nurse, urogynaecology/nurse cystoscopist, King's College Hospital, Denmark Hill, London
| |
Collapse
|
16
|
Thomas LH, French B, Sutton CJ, Forshaw D, Leathley MJ, Burton CR, Roe B, Cheater FM, Booth J, McColl E, Carter B, Walker A, Brittain K, Whiteley G, Rodgers H, Barrett J, Watkins CL. Identifying Continence OptioNs after Stroke (ICONS): an evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care. PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BackgroundUrinary incontinence (UI) following acute stroke is common, affecting between 40% and 60% of people in hospital, but is often poorly managed.AimTo develop, implement and evaluate the preliminary effectiveness and potential cost-effectiveness of a systematic voiding programme (SVP), with or without supported implementation, for the management of UI after stroke in secondary care.DesignStructured in line with the Medical Research Council framework for the evaluation of complex interventions, the programme comprised two phases: Phase I, evidence synthesis of combined approaches to manage UI post stroke, case study of the introduction of the SVP in one stroke service; Phase II, cluster randomised controlled exploratory trial incorporating a process evaluation and testing of health economic data collection methods.SettingOne English stroke service (case study) and 12 stroke services in England and Wales (randomised trial).ParticipantsCase study, 43 patients; randomised trial, 413 patients admitted to hospital with stroke and UI.InterventionsA SVP comprising assessment, individualised conservative interventions and weekly review. In the supported implementation trial arm, facilitation was used as an implementation strategy to support and enable people to change their practice.Main outcome measuresParticipant incontinence (presence/absence) at 12 weeks post stroke. Secondary outcomes were quality of life, frequency and severity of incontinence, urinary symptoms, activities of daily living and death, at discharge, 6, 12 and 52 weeks post stroke.ResultsThere was no suggestion of a beneficial effect on outcome at 12 weeks post stroke [intervention vs. usual care: odds ratio (OR) 1.02, 95% confidence interval (CI) 0.54 to 1.93; supported implementation vs. usual care: OR 1.06, 95% CI 0.54 to 2.09]. There was weak evidence of better outcomes on the Incontinence Impact Questionnaire in supported implementation (OR 1.22, 95% CI 0.72 to 2.08) but the CI is wide and includes both clinically relevant benefit and harm. Both intervention arms had a higher estimated odds of continence for patients with urge incontinence than usual care (intervention: OR 1.58, 95% CI 0.83 to 2.99; supported implementation: OR 1.73, 95% CI 0.88 to 3.43). The process evaluation showed that the SVP increased the visibility of continence management through greater evaluation of patients’ trajectories and outcomes, and closer attention to workload. In-hospital resource use had to be based on estimates provided by staff. The response rates for the postal questionnaires were 73% and 56% of eligible patients at 12 and 52 weeks respectively. Completion of individual data items varied between 67% and 100%.ConclusionsThe trial was exploratory and did not set out to establish effectiveness; however, there are indications the intervention may be effective in patients with urge and stress incontinence. A definitive trial is now warranted.Study registrationThis study is registered as ISRCTN08609907.Funding detailsThe National Institute for Health Research Programme Grants for Applied Research programme. Excess treatment costs and research support costs were funded by participating NHS trusts and health boards, Lancashire and Cumbria and East Anglia Comprehensive Local Research Networks and the Welsh National Institute for Social Care and Health Research.
Collapse
Affiliation(s)
- Lois H Thomas
- School of Health, University of Central Lancashire, Preston, UK
| | - Beverley French
- School of Health, University of Central Lancashire, Preston, UK
| | | | - Denise Forshaw
- School of Health, University of Central Lancashire, Preston, UK
| | | | | | - Brenda Roe
- Evidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Francine M Cheater
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jo Booth
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Andrew Walker
- Robertson Centre for Biostatistics, Glasgow University, Glasgow, UK
| | - Katie Brittain
- Institute of Health and Society and Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Whiteley
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Helen Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - James Barrett
- Wirral University Teaching Hospitals NHS Foundation Trust, Arrowe Park Hospital, Wirral, Merseyside, UK
| | | | | |
Collapse
|
17
|
Roe B, Flanagan L, Maden M. Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes. J Adv Nurs 2015; 71:1464-83. [DOI: 10.1111/jan.12613] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Brenda Roe
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
- Personal Social Services Research Unit; University of Manchester; UK
| | - Lisa Flanagan
- Countess of Chester Hospital NHS Foundation Trust; UK
| | - Michelle Maden
- Faculty of Health & Social Care; Edge Hill University; Ormksirk UK
| |
Collapse
|
18
|
Leone Roberti Maggiore U, Cardozo L, Ferrero S, Sileo F, Cola A, Del Deo F, Torella M, Colacurci N, Candiani M, Salvatore S. Mirabegron in the treatment of overactive bladder. Expert Opin Pharmacother 2014; 15:873-87. [PMID: 24646053 DOI: 10.1517/14656566.2014.898752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Mirabegron is a selective β3-adrenergic receptor agonist recently developed for the treatment of patients with overactive bladder (OAB), which offers an alternative pharmacological option to the well-established treatment with antimuscarinics (AMs). AREAS COVERED This review offers an explanation of the mechanism of action, of the pharmacokinetics and pharmacodynamics of mirabegron and gives readers a complete overview of Phase II and III studies on the clinical efficacy, tolerability and safety of this agent in the setting of OAB treatment. EXPERT OPINION Both Phase II and III trials have shown that mirabegron is efficacious and safe in treating patients with OAB. Future research should focus on the assessment of mirabegron concentrations in the CNS and on the evaluation of the potential of the combination of mirabegron with AMs. Another field for future research is represented by the investigation of the interaction of mirabegron with CYP2D6 inhibitors. Furthermore, current literature completely lacks studies on the efficacy and safety of mirabegron in the pediatric population and such trials are awaited.
Collapse
|
19
|
Kammerer-Doak D, Rizk DEE, Sorinola O, Agur W, Ismail S, Bazi T. Mixed urinary incontinence: international urogynecological association research and development committee opinion. Int Urogynecol J 2014; 25:1303-12. [PMID: 25091925 DOI: 10.1007/s00192-014-2485-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI. METHODS A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI. RESULTS This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations. CONCLUSIONS The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.
Collapse
Affiliation(s)
- Dorothy Kammerer-Doak
- Women's Pelvic Specialty Care P.C, University of New Mexico Hospital, Albuquerque, NM, USA
| | | | | | | | | | | |
Collapse
|
20
|
Wagg A, Gibson W, Ostaszkiewicz J, Johnson T, Markland A, Palmer MH, Kuchel G, Szonyi G, Kirschner-Hermanns R. Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence. Neurourol Urodyn 2014; 34:398-406. [DOI: 10.1002/nau.22602] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/06/2014] [Indexed: 01/28/2023]
Affiliation(s)
- Adrian Wagg
- University of Alberta; Edmonton Alberta Canada
| | - William Gibson
- Division of Geriatric Medicine; University of Alberta; Edmonton Alberta Canada
| | | | | | - Alayne Markland
- Geriatric Medicine; University of Birmingham Center for Aging; Birmingham Alabama
| | - Mary H. Palmer
- The University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - George Kuchel
- Division of Geriatrics; University of Connecticut Health Center; Farmington Connecticut
| | | | | |
Collapse
|
21
|
Regat-Bikoï C, Vuagnat H, Morin D. L'incontinence urinaire chez des personnes âgées hospitalisées en unité de gériatrie : est-ce vraiment une priorité pour les infirmières ? Rech Soins Infirm 2013. [DOI: 10.3917/rsi.115.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
22
|
Volkmer C, Monticelli M, Reibnitz KS, Brüggemann OM, Sperandio FF. [Female urinary incontinence: a systematic review of qualitative studies]. CIENCIA & SAUDE COLETIVA 2013; 17:2703-15. [PMID: 23099757 DOI: 10.1590/s1413-81232012001000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/18/2011] [Indexed: 05/26/2023] Open
Abstract
Urinary incontinence has broad repercussions on female daily life. The objective of this study was to conduct a systematic review seeking to analyze results of qualitative research concerning female urinary incontinence published prior to 2009. After an electronic search, 53 research reports were identified with 30 fulfilling the exclusion and inclusion criteria. After classification according to the Critical Appraisal Skills Program, 13 constituted the analytical body for review. The data were synthesized according to the meta-ethnographical approach through reciprocal translation. Two categories emerged: life experiences among incontinent women; and proposals for care models for incontinent women. The restructuring of one's personal life metacategory points to individual adjustments necessary for dealing with the problem. In essence, the results reveal the option of the majority of women facing the loss of urine "silently" and point to the need for professionals to understand family perceptions in order to better comprehend the personal, family, and social implications involved in female urinary incontinence.
Collapse
Affiliation(s)
- Cilene Volkmer
- Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil.
| | | | | | | | | |
Collapse
|
23
|
Flanagan L, Roe B, Jack B, Shaw C, Williams KS, Chung A, Barrett J. Factors with the management of incontinence and promotion of continence in older people in care homes. J Adv Nurs 2013; 70:476-96. [DOI: 10.1111/jan.12220] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa Flanagan
- Wirral University Teaching Hospital NHS Foundation Trust; UK
| | - Brenda Roe
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
- Personal Social Services Research Unit; University of Manchester; UK
| | - Barbara Jack
- Personal Social Services Research Unit; University of Manchester; UK
| | - Christine Shaw
- Department of Care Sciences; University of Glamorgan; Pontypridd UK
| | | | - Alan Chung
- Cardiology Department; Birmingham Heartlands Hospital; UK
| | - James Barrett
- Wirral University Teaching Hospitals NHS Foundation Trust; Arrowe Park Hospital; UK
- Evidence-based Practice Research Centre; Faculty of Health & Social Care; Edge Hill University; Ormskirk UK
| |
Collapse
|
24
|
Ostaszkiewicz J, Eustice S, Roe B, Thomas LH, French B, Islam T, O'Connell B, Cody JD. Toileting assistance programmes for the management of urinary incontinence in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Joan Ostaszkiewicz
- Deakin University; School of Nursing and Midwifery; 221 Burwood Hwy Burwood Victoria Australia 3125
| | - Sharon Eustice
- Peninsula Community Health; Truro Health Park; Infirmary Hill Truro Cornwall UK TR1 2LA
| | - Brenda Roe
- Edge Hill University; Evidence based Practice Research Centre (EPRC); St Helens Road Ormskirk Lancashire UK L39 4QP
| | - Lois H Thomas
- University of Central Lancashire; School of Health; Room 434 Brook Building Preston Lancashire UK PR1 2HE
| | - Beverley French
- University of Central Lancashire; Department of Nursing and Caring Sciences; Room 434 Brook Building Preston Lancashire UK PR1 2HE
| | - Tasneem Islam
- Deakin University; School of Nursing and Midwifery; 221 Burwood Hwy Burwood Victoria Australia 3125
| | - Bev O'Connell
- University of Manitoba; Faculty of Nursing; Chancellor's Drive Winnipeg Manitoba Canada
| | - June D Cody
- University of Aberdeen; Cochrane Incontinence Review Group; 2nd Floor, Health Sciences Building Health Sciences Building Foresterhill Aberdeen UK AB25 2ZD
| |
Collapse
|
25
|
Leone Roberti Maggiore U, Scala C, Venturini PL, Ferrero S. Imidafenacin for the treatment of overactive bladder. Expert Opin Pharmacother 2013; 14:1383-97. [DOI: 10.1517/14656566.2013.796930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
26
|
Wesnes SL, Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J 2013; 24:889-99. [DOI: 10.1007/s00192-012-2017-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/01/2012] [Indexed: 11/30/2022]
|
27
|
Grandstaff M, Lyons D. Impact of a Continence Training Program on Patient Safety and Quality. Rehabil Nurs 2012; 37:180-4. [DOI: 10.1002/rnj.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
28
|
Flanagan L, Roe B, Jack B, Barrett J, Chung A, Shaw C, Williams KS. Systematic review of care intervention studies for the management of incontinence and promotion of continence in older people in care homes with urinary incontinence as the primary focus (1966-2010). Geriatr Gerontol Int 2012; 12:600-11. [DOI: 10.1111/j.1447-0594.2012.00875.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Roe B, Flanagan L, Jack B, Shaw C, Williams K, Chung A, Barrett J. Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes. Int J Older People Nurs 2011; 8:29-49. [DOI: 10.1111/j.1748-3743.2011.00300.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Thomas LH, Watkins CL, French B, Sutton C, Forshaw D, Cheater F, Roe B, Leathley MJ, Burton C, McColl E, Booth J. Study protocol: ICONS: identifying continence options after stroke: a randomised trial. Trials 2011; 12:131. [PMID: 21599945 PMCID: PMC3113990 DOI: 10.1186/1745-6215-12-131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/20/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Urinary incontinence following acute stroke is common, affecting between 40%-60% of people in hospital after a stroke. Despite the availability of clinical guidelines for urinary incontinence and urinary incontinence after stroke, national audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training, pelvic floor muscle training and prompted voiding) have been shown to have some effect with participants in Cochrane systematic reviews, but have not had their effectiveness demonstrated with stroke patients. METHODS/DESIGN A cluster randomised controlled pilot trial designed to assess the feasibility of a full-scale cluster randomised trial and to provide preliminary evidence of the effectiveness and cost-effectiveness of a systematic voiding programme for the management of continence after stroke. Stroke services will be randomised to receive the systematic voiding programme, the systematic voiding programme plus supported implementation, or usual care. The trial aims to recruit at least 780 participants in 12 stroke services (4 per arm). The primary outcome is presence/absence of incontinence at six weeks post-stroke. Secondary outcomes include frequency and severity of incontinence, quality of life and cost-utility. Outcomes will be measured at six weeks, three months and (for participants recruited in the first three months) twelve months after stroke. Process data will include rates of recruitment and retention and fidelity of intervention delivery. An integrated qualitative evaluation will be conducted in order to describe implementation and assist in explaining the potential mediators and modifiers of the process. TRIAL REGISTRATION ISRCTN: ISRCTN08609907
Collapse
Affiliation(s)
- Lois H Thomas
- School of Health, University of Central Lancashire, Preston, PR1 2HE, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Development and Validation of an Instrument to Assess Women's Toileting Behavior Related to Urinary Elimination. Nurs Res 2011; 60:158-64. [DOI: 10.1097/nnr.0b013e3182159cc7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Roe B, Flanagan L, Jack B, Barrett J, Chung A, Shaw C, Williams K. Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus. J Adv Nurs 2011; 67:228-50. [PMID: 21105895 PMCID: PMC3132440 DOI: 10.1111/j.1365-2648.2010.05481.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2010] [Indexed: 11/30/2022]
Abstract
AIM This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. BACKGROUND Incontinence is prevalent among residents of care home populations. DATA SOURCES MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. METHODS A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. CONCLUSIONS Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted.
Collapse
Affiliation(s)
- Brenda Roe
- Health Research Evidence-based Practice Research Centre, Faculty of Health, Edge Hill University, UK.
| | | | | | | | | | | | | |
Collapse
|
33
|
Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs 2010; 66:1874-84. [DOI: 10.1111/j.1365-2648.2010.05341.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Vij M, Robinson D, Cardozo L. Overactive Bladder: Diagnosis and Treatment. WOMENS HEALTH 2010; 6:297-310. [DOI: 10.2217/whe.10.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overactive bladder syndrome is a chronic condition that requires long-term management and is associated with a significant impairment in the quality of life of the individual as well as having an economic impact on healthcare. Behavioral interventions, along with lifestyle modifications, are effective, but medical management remains the mainstay of treatment. Challenges to improving the overactive bladder syndrome burden and outcomes include underdiagnosis, undertreatment and patient nonadherence to medication. Recent pharmacological advances, along with behavioral interventions, have helped to improve patient compliance. Healthcare providers should acknowledge the need for education regarding overactive bladder syndrome symptoms, its diagnosis and its management options. This article gives an overview of overactive bladder syndrome, its diagnosis and the different treatment options available, as well as discussing recent advances in the field.
Collapse
Affiliation(s)
- Monika Vij
- Monika Vij Urogynaecology Department, King's College Hospital, Denmark Hill, London SE5 9RS, UK, Tel.: +44 20 3299 3568, Fax: +44 20 3299 3449,
| | - Dudley Robinson
- Dudley Robinson Urogynaecology Department, King's College Hospital, Denmark Hill, London SE5 9RS, UK, Tel.: +44 20 3299 3568, Fax: +44 20 3299 3449,
| | - Linda Cardozo
- Linda Cardozo Urogynaecology Department, King's College Hospital, Denmark Hill, London SE5 9RS, UK, Tel.: +44 20 3299 3568, Fax: +44 20 3299 3449,
| |
Collapse
|
35
|
Kerdraon J, Denys P. [Conservative treatment of female stress urinary incontinence]. J Gynecol Obstet Hum Reprod 2009; 38:S174-S181. [PMID: 20141916 DOI: 10.1016/s0368-2315(09)73577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To synthethise evidence based results related to non surgical management for urinary incontinence in women. MATERIALS AND METHODS Electronic search in Pubmed, Cinahl, Cochrane Library, National Library for Health. RESULTS There were 72 randomized control studies and 8 reviews from the Cochrane Library. CONCLUSION Moderate to high levels of evidence suggest that pelvic muscle training and bladder training may resolve urinary incontinence in women. A weight loss program from obesity state improve urinary continence. The effects of electrical stimulation of pelvic floor, oestrogene therapy were inconstant or inhomogeneous. Duloxetine may improve continence and quality of life but it's range in therapeutic algorithm is still to be defined.
Collapse
Affiliation(s)
- J Kerdraon
- Centre mutualiste de Kerpape, BP 78, 56275 Ploemeur cedex, France.
| | | |
Collapse
|
36
|
Rantell A. Lower urinary tract symptoms in women with multiple sclerosis: 2. ACTA ACUST UNITED AC 2009; 18:920, 922-5. [DOI: 10.12968/bjon.2009.18.15.43561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Booth J, Kumlien S, Zang Y. Promoting urinary continence with older people: key issues for nurses. Int J Older People Nurs 2009; 4:63-9. [DOI: 10.1111/j.1748-3743.2008.00159.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Affiliation(s)
- Angie Rantell
- King's College Hospital, Department of Urogynaecology, Denmark Hill, London SE5 9RS
| | - Riette Vosloo
- King's College Hospital, Department of Urogynaecology, Denmark Hill, London SE5 9RS
| |
Collapse
|
39
|
Dingwall L. Promoting effective continence care for older people: a literature review. ACTA ACUST UNITED AC 2008; 17:166-72. [DOI: 10.12968/bjon.2008.17.3.28405] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lindsay Dingwall
- School of Nursing and Midwifery, University of Dundee, Ninewells Hospital, Tayside
| |
Collapse
|
40
|
Thomas LH, Cross S, Barrett J, French B, Leathley M, Sutton CJ, Watkins C. Treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev 2008; 2008:CD004462. [PMID: 18254050 PMCID: PMC6464794 DOI: 10.1002/14651858.cd004462.pub3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Urinary incontinence can affect 40-60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and 15% remaining incontinent at one year. OBJECTIVES To determine the optimal methods for treatment of urinary incontinence after stroke in adults. SEARCH STRATEGY We searched the Cochrane Incontinence and Stroke Groups specialised registers (searched 15 March 2007 and 5 March 2007 respectively), CINAHL (January 1982 to January 2007), national and international trial databases for unpublished data, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials evaluating the effects of interventions designed to promote continence in people after stroke. DATA COLLECTION AND ANALYSIS Data extraction and quality assessment were undertaken by two reviewers working independently. Disagreements were resolved by a third reviewer. MAIN RESULTS Twelve trials with a total of 724 participants were included in the review. Participants were from a mixture of settings, age groups and phases of stroke recovery. BEHAVIOURAL INTERVENTIONS: Three trials assessed behavioural interventions, such as timed voiding and pelvic floor muscle training. All had small sample sizes and confidence intervals were wide. SPECIALISED PROFESSIONAL INPUT INTERVENTIONS: Two trials assessed variants of professional input interventions. Results tended to favour the intervention groups: in a small trial in early rehabilitation, fewer people had incontinence at discharge from hospital after structured assessment and management than in a control group (1/21 vs. 10/13; RR 0.06, 95% CI 0.01 to 0.43); in the second trial, assessment and management by Continence Nurse Advisors was associated with fewer participants having urinary symptoms (48/89 vs. 38/54; RR 0.77, 95% CI 0.59 to 0.99) and statistically significantly more being satisfied with care. COMPLEMENTARY THERAPY INTERVENTIONS: Three small trials all reported fewer participants with incontinence after acupuncture therapy (overall RR 0.44; 95% 0.23 to 0.86), but there were particular concerns about study quality. PHARMACOTHERAPY AND HORMONAL INTERVENTIONS: There were three small trials that included groups allocated meclofenoxate, oxybutinin or oestrogen. There were no apparent differences other than in the trial of meclofenoxate where fewer participants had urinary symptoms in the active group than in the control group (9/40 vs. 27/40; RR 0.33, 95% CI 0.18 to 0.62). AUTHORS' CONCLUSIONS Data from the available trials are insufficient to guide continence care of adults after stroke. However, there was suggestive evidence that professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence and related symptoms after stroke. Better quality evidence is required of the range of interventions that have been suggested for continence care after stroke.
Collapse
Affiliation(s)
- L H Thomas
- University of Central Lancashire, Department of Nursing, Room 434, Brook Building, Preston, Lancashire, UK, PR1 2HE.
| | | | | | | | | | | | | |
Collapse
|
41
|
Current World Literature. Curr Opin Obstet Gynecol 2007; 19:596-605. [DOI: 10.1097/gco.0b013e3282f37e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|