Creation and testing of the Geriatric Self-Efficacy Index for Urinary Incontinence

Defining and prioritizing modifiable risk factors towards the co-creation of a urinary incontinence self-management intervention for older men: A sequential multimethod study protocol

Urinary incontinence (UI), characterized by involuntary urine leakage is a chronic, embarrassing and stigmatizing condition that is under-reported and under-treated). UI is under-prioritized and under-researched, particularly in older men (defined here as men 65+), and there have been calls for more targeted research focusing on this specific group. No existing self-management interventions focus on the needs of older men and none incorporate the perspectives of older men into their development. Furthermore, health inequalities and disparities in continence services for men, and a low level of health seeking behavior in men with UI make it crucial to incorporate their perspectives into intervention development to ensure optimal outcomes. The study will identify risk factors for UI that are potentially amenable to self-management in older men, assess their self-efficacy in managing UI, and determine what modifiable risk factors older men feel are pragmatic to include as part of a self-management program. We will conduct and report a sequential multi-method design consisting of a Delphi study among healthcare experts and a survey among older men with UI, according to the Guidance on Conducting and Reporting Delphi Studies (CREDES) Checklist and the Checklist for Reporting Of Survey Studies (CROSS). A geographically dispersed, multidisciplinary group of 30 health care professionals (urologists, geriatricians, family physicians, and nurses) involved in continence care and a representative sample of at least 128 ethnically diverse older men will participate in a Delphi survey and an older men's survey respectively. The healthcare experts will evaluate an evidence-synthesized list of UI risk factors to determine those potentially amenable to self-management. Delphi rounds will be repeated until consensus threshold of 75% is reached. Thereafter, older men recruited via stratified sampling of population subgroups will rate a list of expert-identified potentially modifiable risk factors to indicate which factors they deem practicable and can prioritize. Older men's survey questionnaires will capture information on patients' characteristics (socio-demographics and UI-related items). The Geriatric Self-Efficacy Index for UI (GSE-UI Index) as well as a Likert scale to assess perceived capability and willingness to modify the expert-identified UI modifiable risk factors will be included. Data will be analyzed quantitatively and qualitatively.

NITES, a nocturnal bladder score to aid diagnosis during the transition to older age care

BACKGROUND

As adults transition to older age, bothersome nocturnal lower urinary tract symptoms (LUTS) become common. There is need for a reliable assessment metric to detect and measure specific symptoms.

OBJECTIVE

To subject the nocturnal LUTS score for older individuals, Nocturia, Incontinence, Toileting and Enuresis Symptom Score (NITES), to psychometric analysis.

MATERIAL AND METHODS

Factor analysis of the metric was conducted with completed questionnaires from 151 older individuals who were either admitted to a tertiary hospital or attending an outpatient continence clinic. Test re-test reliability involved 18 older community dwelling individuals attending a Geriatrician clinic completing the metric at two timepoints separated by at least 1 week. Intra-class correlation coefficients were determined for reliability of each factor and item.

RESULTS

The NITES metric was completed by 98 hospitalized older individuals and 53 attending a continence clinic (mean age 83.2 years [SD 7.0]). Factor analysis demonstrated that one item had a floor effect and two items had poor endorsement. After test re-test reliability analysis, a further three items were removed: one due to poor correlation between timepoints and two demonstrating inadequate internal consistency. The final NITES metric is comprised of three factors: Sleep 4-items, Incontinence 4-items, and Personal Bother 2-items. A 4-item short form for symptom screening was extracted from the longer measure.

CONCLUSION

The final NITES metric is a 10-item questionnaire with an embedded 4-item short symptom screen. It has utility utilized to detect nocturnal bladder symptoms in both community dwelling and hospitalized older adults.

Self-efficacy and positive thinking as predictors of health-related quality of life in women with stress urinary incontinence

Background

Stress urinary incontinence (SUI), which causes involuntarily leakage of urine, has an impact on many women and may affect self-efficacy, which, in turn, can lead to poor health-related quality of life (QOL). This study aimed to explore the effects of sociodemographic and health information, symptom distress, self-efficacy, and positive thinking on the health-related QOL (general QOL and urinary incontinence-specific QOL) of women with SUI.

Methods

A cross-sectional study design was used. Women with SUI were recruited from the obstetrics and gynecology outpatient department and urodynamics examination room of a hospital by convenience sampling from August 2021 to March 2022. Participants were surveyed on the following questionnaires: Urogenital Distress Inventory, Geriatric Self-efficacy Index for Urinary Incontinence, Positive Thinking Scale, 12-Item Short-Form Health Survey (SF-12), and Incontinence Impact Questionnaire Short Form.

Results

Participants (N = 135) had a mean age of 53.76 years old. The mean SF-12 physical component summary score was 48.48 (physical QOL), and the mental component summary score was 46.56 (mental QOL). The urinary incontinence-specific QOL score was 16.01. Women with greater positive thinking and higher self-efficacy for urinary incontinence had better physical and mental QOL. Women with less symptom distress of urinary incontinence and higher self-efficacy for urinary incontinence had better urinary incontinence-specific QOL.

Conclusion

The health-related QOL of women with SUI is affected by many factors, including positive thinking, self-efficacy, and symptom distress. Healthcare professionals can provide multifaceted programs to improve the health-related QOL of women with SUI.

Do levels of self-efficacy affect urinary incontinence, falls, quality of life, sleep, and physical activity in elderly people with urinary incontinence?

BACKGROUND

Our study aims to determine whether different self-efficacy (SE) levels affect urinary incontinence symptoms, falls, quality of life, sleep, and physical activity in elderly individuals with incontinence. Our secondary aim is to examine the relationship between SE levels and urinary incontinence severity, quality of life, sleep status, fear of falling, and physical activity level.

METHODS

One hundred twenty elderly individuals (median age: 71 years) with urinary incontinence participated in the cross-sectional study. Participants were divided into 3 groups as levels of low, moderate, and high according to their Geriatric SE Index for Urinary Incontinence (GSE-UI). Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Incontinence Quality of Life Scale (I-QOL), Pittsburgh Sleep Quality Index (PSQI), Fall Efficacy Scale (FES), Rapid Assessment Physical Activity (RAPA), and International Physical Activity Questionnaire Short Form (IPAQ-SF) assessments associated with incontinence were performed. Data were analyzed using Mann-Whitney U, Kruskal-Wallis tests, and Spearman's correlation.

RESULTS

A significant difference was found in UDI-6, IIQ-7, I-QOL, and FES belonging to three groups according to GSE-UI levels (p ˂0.01, p ˂0.01, p ˂0.01). It was determined that the group with low GSE-UI level had the highest incontinence symptoms, fear of falling, and the lowest quality of life statistically significant. A negative moderate significant correlation was found between GSE-UI scores and UDI-6 (r: - .67, p ˂0.01), IIQ-7 (r: - .67, p ˂0.01), and FES (r: - .46, p ˂0.01).

CONCLUSION

In elderly individuals with urinary incontinence, the level of SE may affect incontinence symptoms, severity, fear of falling, and quality of life and may be an important factor for incontinence. An increased level of SE may lead to positive effects on the user interface. Further studies in this field are needed.

A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine

INTRODUCTION

Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these.

METHODS

Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included.

RESULTS

85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF).

CONCLUSIONS

Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.

Adaptation, validity and reliability of geriatric self-efficacy index for urinary incontinence (GSE-UI) in geriatric incontinents

PURPOSE

The purpose of this study was to translate and culturally adapt the GSE-UI for use with a Turkish population and to determine its validity and reliability.

METHODS

120 elderly with UI aged 60 and over years (mean 72.89 ± 9.59 years) participated in this study. An interview was held to determine the type, severity and frequency if any, incontinence. Then, the Mini-Mental State Examination, IIQ-7, UDI-6 and I-QOL questionnaires were administered to the participants. After translating the tool to Turkish, test and retest was performed with an interval of 7-14 days.

RESULTS

The internal consistency of the first test of the GSE-UI-Turkish was excellent, with a Cronbach α of 0.95. The test-retest reliability of the GSE-UI-Turkish was found to be excellent (ICC = 0.94, 95% CI 0.92-0.96). The correlation coefficient between the GSE-UI-Turkish and the UDI-6, IIQ-7, I-QOL were found to be good to excellent (r = 0.68, r = 0.67, r = 0.81, r = 0.45, respectively; p < 0.0001).

CONCLUSION

Results of our study GSE-UI of Turkish version, self-efficacy evaluation in geriatric incontinence was a valid and reliable survey that can be used in clinical practice.

An evidence-based self-management package for urinary incontinence in older women: a mixed methods feasibility study

Background

Urinary incontinence (UI) is a distressing condition that limits women’s quality of life and places a heavy burden on health care services. Behavioural treatments are recommended as a first-line treatment. An evidence-based self-management package was developed following the Medical Research Council (MRC) framework for complex interventions. This study aimed to evaluate the feasibility and acceptability of the intervention.

Methods

A mixed-methods approach was undertaken, namely a randomised controlled feasibility study with nested qualitative study. Fifty women aged 55 or over living with UI, recruited from community centres were randomly assigned to either a 3-month course with the package with a support session or a control group to receive the same package only 3 months later. Principal outcome measures were: self-reported quality of life, UI severity, self-efficacy and psychological status. Analysis of covariance was undertaken to estimate within- and between- group changes for all outcomes. Acceptability was explored using individual interviews at follow-up.

Results

Fifty women were randomised (24 to intervention, 26 to control); mean age of 69.7 (±9.1) years and mean UI frequency 2.2 (±2.2) episodes/day at baseline. Overall, 49 women (98%) completed 3-month follow-up (24 in the intervention, 25 in the control). A positive trend was detected in the impact of UI on their personal relationships (− 3.89, p = 0.088), symptom severity (− 1.77, p = 0.025), UI symptoms scale (− 1.87, p = 0.031) and anxiety status (− 2.31, p = 0.001), respectively. Changes in quality of life and self-efficacy did not differ significantly between groups. Majority of women (71%) in the intervention group reported subjective improvement after 3 months. Spearman correlation coefficient was 0.43 (p < 0.05) between their subjective perception of change and self-efficacy. Women perceived the package being acceptable and described that the package had the potential to increase their knowledge and confidence to manage symptoms and improve quality of life.

Conclusions

The study demonstrated that the self-management package is feasible and acceptable for older women with UI. Further studies are needed with a large sample size in clinical settings to evaluate the effectiveness of this package.

Trial registration

ISRCTN17194896. Registered on 11th September 2019 (retrospectively registered).

Small-Group, Community-Member Intervention for Urinary and Bowel Incontinence: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effects of Mind Over Matter: Healthy Bowels, Healthy Bladder, a small-group intervention, on urinary and bowel incontinence symptoms among older women with incontinence.

METHODS

In this individually randomized group treatment trial, women aged 50 years and older with urinary, bowel incontinence, or both, were randomly allocated at baseline to participate in Mind Over Matter: Healthy Bowels, Healthy Bladder immediately (treatment group) or after final data collection (waitlist control group). The primary outcome was urinary incontinence (UI) improvement on the Patient Global Impression of Improvement at 4 months. Validated instruments assessed incontinence, self-efficacy, depression, and barriers to care-seeking. Intent-to-treat analyses compared differences between groups. Target sample size, based on an anticipated improvement rate of 45% in treated women vs 11% in the control group, 90% power, type I error of 0.05, with anticipated attrition of 25%, was 110.

RESULTS

Among 121 women randomized (62 treatment group; 59 control group), 116 (95%) completed the 4-month assessment. Most participants were non-Hispanic white (97%), with a mean age of 75 years (SD 9.2, range 51-98); 66% had attended some college. There were no significant between-group differences at baseline. At 4 months, 71% of treated women vs 23% of women in the control group reported improved UI on Patient Global Impression of Improvement (P<.001); 39% vs 5% were much improved (P<.001). Regarding bowel incontinence, 55% of treated women vs 27% of women in the control group improved on Patient Global Impression of Improvement (P<.005), with 35% vs 11% reporting much improvement (P<.005). Treated women improved significantly more than women in the control group on all validated instruments of incontinence severity, quality of life, and self-efficacy. Care-seeking rates were similar between groups.

CONCLUSION

Participation in a small-group intervention improves symptoms of both urinary and bowel incontinence in older women. Mind Over Matter is a feasible model with potential to bring effective behavioral solutions to the community.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT03140852.

Assessment of the Effectiveness of Pelvic Floor Muscle Training (PFMT) and Extracorporeal Magnetic Innervation (ExMI) in Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial

Objective

The purpose of this study is to assess the effectiveness of pelvic floor muscle training and extracorporeal magnetic innervation in treatment of urinary incontinence in women with stress urinary incontinence.

Methods

The randomized controlled trial enrolled 128 women with stress urinary incontinence who were randomly allocated to either one out of two experimental groups (EG1 or EG2) or the control group (CG). Subjects in the experimental group 1 (EG1) received 12 sessions of pelvic floor muscle training, whereas subjects in the experimental group 2 (EG2) received 12 sessions of extracorporeal magnetic innervation. Subjects in the control group (CG) did not receive any therapeutic intervention. The following instruments were used to measure results in all study groups at the initial and final assessments: Revised Urinary Incontinence Scale (RUIS), Beck Depression Inventory (BDI-II), General Self-Efficacy Scale (GSES), and King's Health Questionnaire (KHQ).

Results

In both experimental groups, a statistically significant decline in depressive symptoms (BDI-II) and an improvement in urinary incontinence severity (RUIS) and quality of life (KHQ) were found in the following domains: “social limitations,” “emotions,” “severity measures,” and “symptom severity scale.” Moreover, self-efficacy beliefs (GSES) improved in the experimental group that received ExMI (EG2). No statistically significant differences were found between all measured variables in the control group. Comparative analysis of the three study groups showed statistically significant differences at the final assessment in the quality of life in the following domains: “physical limitations,” “social limitations,” “personal relationships,” and “emotions.” Conclusion. Pelvic floor muscle training and extracorporeal magnetic innervation proved to be effective treatment methods for stress urinary incontinence in women. The authors observed an improvement in both the physical and psychosocial aspects.

Performance of a Bayesian Approach for Imputing Missing Data on the SF-12 Health-Related Quality-of-Life Measure

BACKGROUND

Missing data in health-related quality-of-life outcomes are an ongoing problem. The 12-item short form health survey (SF-12) scores are no exception. Data imputation is complicated, because missingness may be partially predicted by the missing data themselves.

OBJECTIVES

To compare the performance of a Bayesian method for imputing SF-12 data with previously described frequentist imputation methods.

METHODS

SF-12 data were extracted from a trial assessing continence promotion on health-related quality of life in older women (n = 1052); the data set was split into a model development cohort for creating predictive models and a validation cohort to validate these models. Algorithms were constructed using data from the model development cohort to compute SF-12-related scores (physical health composite scale, the mental health composite scale, and the six-dimensional health state short form utilities). The Bayesian models used missing at random and missing not at random algorithms to impute missing SF-12 answers as categorical data. Comparative models replaced missing data with 0, used the mean weight of the sample, and regressed parameters from sociodemographic predictors. Data randomly deleted from the validation cohort were imputed with each algorithm, and the mean absolute error was used to gauge goodness of fit.

RESULTS

Each cohort included 526 persons; mean age was 78.1 ± 7.8 years. In the model development cohort, 15.6% of the participants had missing data. For the physical health composite scale, the mental health composite scale, and the six-dimensional health state short form utilities, the Bayesian model with missing at random data significantly outperformed all five comparison models, including the Bayesian models with missing not at random data.

CONCLUSIONS

Bayesian imputation was superior to other previously described methods for computing missing SF-12 data.

Validity, Reliability, and Responsiveness of the Spanish Version of the OPTIMAL Instrument

BACKGROUND

The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a self-report instrument developed to measure the ability to perform mobility actions.

OBJECTIVE

To validate a Spanish version of the OPTIMAL instrument.

DESIGN

Cross-cultural adaptation and validation study.

SETTING

Primary and specialized outpatient care settings.

PARTICIPANTS

Three hundred seven patients beginning physical therapy treatment and 30 subjects from the general population.

METHODS

A 2-part study was designed based on guidelines for cultural adaptation of patient-reported outcome measures.

OUTCOMES

Reliability was estimated by internal consistency (Cronbach α), SE of measurement, and test-retest reliability (intraclass correlation coefficient) at 2 weeks. Confirmatory factor analysis was performed to examine structural validity. The association with the Physical Functioning Subscale was assessed with Spearman correlation coefficients. OPTIMAL scores across different groups were compared with Mann-Whitney U and Kruskal-Wallis tests. Effect size, standardized response mean, and minimal detectable change were determined for responsiveness.

RESULTS

The Spanish version of the OPTIMAL instrument showed a similar structure to the original English questionnaire. Cronbach α was 0.95 for the difficulty and confidence scales. Intraclass correlation coefficient was 0.91 (95% CI 0.87-0.94) for the difficulty scale and 0.90 (95% CI 0.85-0.93) for the confidence scale. The SE of measurement was 5.11 for the difficulty scale and 6.54 for the confidence scale. The association with the Physical Functioning Subscale was strong and significant (P < .001). The 2 scales showed significantly different scores for each of the established patient groups. The effect size was 0.61 (95% CI 0.48-0.74) for the difficulty scale and 0.53 (95% CI 0.38-0.69) for the confidence scale. The standardized response mean was 0.97 (95% CI 0.78-1.13) for the difficulty scale and 0.76 (95% CI 0.48-1.01) for the confidence scale. The minimal detectable change, of a possible score of 100, was 14.2 for the difficulty scale and 18.1 for the confidence scale.

CONCLUSION

The Spanish version of the OPTIMAL has appropriate reliability, validity, and responsiveness and it is an adequate self-report instrument for the assessment of mobility actions.

LEVEL OF EVIDENCE

III.

Group physiotherapy compared to individual physiotherapy to treat urinary incontinence in aging women: study protocol for a randomized controlled trial

Background

Urinary incontinence (UI), one of the most prevalent health concerns confronting women aged over 60 years, affects up to 55% of older community-dwelling women—20–25% with severe symptoms. Clinical practice guidelines recommend individualized pelvic floor muscle training (PFMT) as a first-line treatment for stress or mixed UI in women, although lack of human and financial resources limits delivery of this first-line treatment. Preliminary data suggest that group-based treatments may provide the answer. To date, no adequately powered trials have evaluated the effectiveness or cost-effectiveness of group compared to individual PFMT for UI in older women. Given demographic projections, high prevalence of UI in older women, costly barriers, and group PFMT promising results, there is a clear need to rigorously compare the short- and long-term effectiveness and cost-effectiveness of group vs individual PFMT.

Methods/Design

The study is designed as a non-inferiority randomized controlled trial, conducted in two facilities (Montreal and Sherbrooke) in the Canadian province of Quebec. Participants include 364 ambulatory, community-dwelling women, aged 60 years and older, with stress or mixed UI. Randomly assigned participants will follow a 12-week PFMT, either in one-on-one sessions or as part of a group, under the supervision of a physiotherapist. Blinded assessments at baseline, immediately post intervention, and at one year will include the seven-day bladder diary, the 24-h pad test, symptoms and quality of life questionnaires, adherence and self-efficacy questionnaire, pelvic floor muscle function, and cost assessments. Primary analysis will test our main hypothesis that group-based treatment is not inferior to individualized treatment with respect to the primary outcome: relative (%) reduction in the number of leakages.

Discussion

Should this study find that a group-based approach is not less effective than individual PFMT, and more cost-effective, this trial will impact positively continence-care accessibility and warrant a change in clinical practice.

Trial registration

ClinicalTrials.gov, NCT02039830. Registered on 12 December 2013; Study protocol version 2; 21 November 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2261-4) contains supplementary material, which is available to authorized users.

Assessing the stigma content of urinary incontinence intervention outcome measures

The goal of this narrative review is to evaluate the efficacy of available questionnaires for assessing the outcomes of “continence difficulty” interventions and to assess the selected questionnaires concerning aspects of stigmatization. The literature was searched for research related to urinary incontinence, as well as questionnaires and rating scale outcome measurement tools. The following sources were searched: Cochrane Library, EMBASE, Medline, and PubMed. The following keywords were used separately or in combination: “Urinary incontinence,” “therapy,” ”treatment outcome,” “patient satisfaction,” “quality of life,” “systematic reviews,” “aged 65+ years,” and “questionnaire.” The search yielded 194 references, of which 11 questionnaires fit the inclusion criteria; 6 of the 11 questionnaires did not have any stigma content and the content regarding stigma that was identified in the other five was very limited. A representative model of how stigma impacts continence difficulty interventions was proposed. While the 11 incontinence specific measurement tools that were assessed were well researched and designed specifically to measure the outcomes of incontinence interventions, they have not been used consistently or extensively and none of the measures thoroughly assess stigma. Further studies are required to examine how the stigma associated with continence difficulty impacts upon health care interventions.

Self-management oriented 5A colorectal stoma care improves patient self-efficacy

AIM: To investigate the influence of self-management oriented 5A colorectal stoma care on patient self-efficacy.

METHODS: One hundred patients with colorectal stoma treated at our hospital from January 2013 to June 2015 were divided into an observation group and a control group, with 50 cases in each group. The observation group received self-management oriented 5A care, and the control group received routine care. All the patients were followed for 6 mo after stoma creation. Self-efficacy, quality of life and complications were compared between the two groups.

RESULTS: Self-efficacy(34.9 ± 5.0 vs 27.1 ± 4.2), quality of life and complications [4 (8.0) vs 22 (44.0)] were significantly better in the observation group than in the control group (P < 0.05).

CONCLUSION: Self-management oriented 5A care can improve self-efficacy and quality of life, and reduce the incidence of complications in patients with colorectal stoma.

Implications of the minimal clinically important difference for health-related quality-of-life outcomes: a comparison of sample size requirements for an incontinence treatment trial

BACKGROUND

Sample size calculations for treatment trials that aim to assess health-related quality-of-life (HRQOL) outcomes are often difficult to perform. Researchers must select a target minimal clinically important difference (MCID) in HRQOL for the trial, estimate the effect size of the intervention, and then consider the responsiveness of different HRQOL measures for detecting improvements. Generic preference-based HRQOL measures are usually less sensitive to gains in HRQOL than are disease-specific measures, but are nonetheless recommended to quantify an impact on HRQOL that can be translated into quality-adjusted life-years during cost-effectiveness analyses. Mapping disease-specific measures onto generic measures is a proposed method for yielding more efficient sample size requirements while retaining the ability to generate utility weights for cost-effectiveness analyses.

OBJECTIVES

This study sought to test this mapping strategy to calculate and compare the effect on sample size of three different methods.

METHODS

Three different methods were used for determining an MCID in HRQOL in patients with incontinence: 1) a global rating of improvement, 2) an incontinence-specific HRQOL instrument, and 3) a generic preference-based HRQOL instrument using mapping coefficients.

RESULTS

The sample size required to detect a 20% difference in the MCID for the global rating of improvement was 52 per trial arm, 172 per arm for the incontinence-specific HRQOL outcome, and 500 per arm for the generic preference-based HRQOL outcome.

CONCLUSIONS

We caution that treatment trials of conditions for which improvements are not easy to measure on generic HRQOL instruments will still require significantly greater sample size even when mapping functions are used to try to gain efficiency.

Spanish version of the broome pelvic muscle self-efficacy scale: validity and reliability

BACKGROUND

Self-efficacy appears to be an important predictor of functional recovery for women with urinary incontinence, but no specific Spanish-language questionnaires for measuring pelvic-floor exercise self-efficacy exist.

OBJECTIVE

The aim of this study was to design a valid and reliable Spanish version of the Broome Pelvic Muscle Self-Efficacy Scale to measure self-efficacy, as perceived by women with urinary incontinence, in performing pelvic-floor exercises.

DESIGN

This was an observational validation study.

METHODS

Translation-back translation was used to design the survey, and then the survey was validated with a sample of 119 women who were incontinent and had undergone a pelvic-floor exercise training program. The reliability and construct validity of the questionnaire were assessed. Descriptive statistics were used to score the questionnaire. Internal consistency was evaluated with the Cronbach alpha coefficient and the Pearson correlation coefficient. Exploratory factor analysis with both the principal components extraction method and the varimax rotation method was used to assess construct validity.

RESULTS

The reliability coefficient (Cronbach alpha=.91) and the correlations among items were high. The factor analysis revealed that 6 main factors accounted for 75.8% of the variance.

LIMITATIONS

Conclusions regarding the validity of the questionnaire should be drawn with caution because of the inability to assess criterion-related validity.

CONCLUSIONS

The Spanish version of the Broome questionnaire for self-efficacy appears to be useful as a measuring tool for a psychometrically accurate, clinically relevant estimation of women's self-efficacy in performing pelvic-floor exercises.

Prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence

Background

Several medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients.

Methods

A cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms.

Results

The prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR = 4.9, 95% CI = 3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity. No associations were detected between specific medication classes and the type or severity of urinary symptoms in this cohort.

Conclusion

The prevalence of use of medications potentially causing urinary symptoms is high among incontinent older adults. More research is needed to determine whether de-prescribing these medications results in improved urinary symptoms.

Responsiveness and clinical utility of the geriatric self-efficacy index for urinary incontinence

OBJECTIVES

To report on the responsiveness testing and clinical utility of the 12-item Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).

DESIGN

Prospective cohort study.

SETTING

Six urinary incontinence (UI) outpatient clinics in Quebec, Canada.

PARTICIPANTS

Community-dwelling incontinent adults aged 65 and older.

MEASUREMENTS

The abridged 12-item GSE-UI, measuring older adults' level of confidence for preventing urine loss, was administered to all new consecutive incontinent patients 1 week before their initial clinic visit, at baseline, and 3 months posttreatment. At follow-up, a positive rating of improvement in UI was ascertained from patients and their physicians using the Patient's and Clinician's Global Impression of Improvement scales, respectively. Responsiveness of the GSE-UI was calculated using Guyatt's change index. Its clinical utility was determined using receiver operating curves.

RESULTS

Eighty-nine of 228 eligible patients (39.0%) participated (mean age 72.6+5.8, range 65-90). At 3-month follow-up, 22.5% of patients were very much better, and 41.6% were a little or much better. Guyatt's change index was 2.6 for patients who changed by a clinically meaningful amount and 1.5 for patients having experienced any level of improvement. An improvement of 14 points on the 12-item GSE-UI had a sensitivity of 75.1% and a specificity of 78.2% for detecting clinically meaningful changes in UI status. Mean GSE-UI scores varied according to improvement status (P<.001) and correlated with changes in quality-of-life scores (r=0.7, P<.001) and reductions in UI episodes (r=0.4, P=.004).

CONCLUSION

The GSE-UI is responsive and clinically useful.