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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] [What about the content of this article? (0)] [Affiliation(s)] [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/.
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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
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McClurg D, Campbell P, Pollock A, Hagen S, Elders A, Hill D, Hazelton C. Conservative interventions for urinary incontinence in women: an overview of Cochrane systematic reviews. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McClurg D, Coyle J, Long A, Moore K, Cottenden A, May C, Fader M. A two phased study on health care professionals' perceptions of single or multi-use of intermittent catheters. Int J Nurs Stud 2017; 72:83-90. [PMID: 28505559 DOI: 10.1016/j.ijnurstu.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 04/23/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
Abstract
AIMS This two phase study aimed to explore health care professionals' teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization. INTRODUCTION Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals' perspectives is one of the keys to developing a multi-use intervention. DESIGN A qualitative research framework using in-depth interviews to inform an on line survey. METHOD In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions - continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters. RESULTS Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about 'minimising health risk' and maximising 'normalcy' for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered. CONCLUSIONS For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life. RELEVANCE TO CLINICAL PRACTICE This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users.
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Affiliation(s)
- D McClurg
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - J Coyle
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - A Long
- Cx Products & Services, Sheffield, S6 5SQ, UK.
| | - K Moore
- University of Alberta, Faculty of Nursing, Edmonton, Canada.
| | - A Cottenden
- Dept. Medical Physics and Biomedical Engineering, First Floor Wolfson House, 2-10 Stephenson Way, University College London, London, WC1E 6BT, UK.
| | - C May
- Southampton University faculty of Health Sciences, Southampton University, SO16 6YD, UK.
| | - M Fader
- University of Southampton, Faculty of Health Sciences, Southampton General Hospital, Clinical Academic Facility,South Academic Block, Southampton, Hampshire, SO16 6YD, UK.
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Brady MC, Jamieson K, Bugge C, Hagen S, McClurg D, Chalmers C, Langhorne P. Caring for continence in stroke care settings: a qualitative study of patients' and staff perspectives on the implementation of a new continence care intervention. Clin Rehabil 2015; 30:481-94. [PMID: 26048436 DOI: 10.1177/0269215515589331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/09/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Investigate the perspectives of patients and nursing staff on the implementation of an augmented continence care intervention after stroke. DESIGN Qualitative data were elicited during semi-structured interviews with patients (n = 15) and staff (14 nurses; nine nursing assistants) and analysed using thematic analysis. SETTING Mixed acute and rehabilitation stroke ward. PARTICIPANTS Stroke patients and nursing staff that experienced an enhanced continence care intervention. RESULTS Four themes emerged from patients' interviews describing: (a) challenges communicating about continence (initiating conversations and information exchange); (b) mixed perceptions of continence care; (c) ambiguity of focus between mobility and continence issues; and (d) inconsistent involvement in continence care decision making. Patients' perceptions reflected the severity of their urinary incontinence. Staff described changes in: (i) knowledge as a consequence of specialist training; (ii) continence interventions (including the development of nurse-led initiatives to reduce the incidence of unnecessary catheterisation among patients admitted to their ward); (iii) changes in attitude towards continence from containment approaches to continence rehabilitation; and (iv) the challenges of providing continence care within a stroke care context including limitations in access to continence care equipment or products, and institutional attitudes towards continence. CONCLUSION Patients (particularly those with severe urinary incontinence) described challenges communicating about and involvement in continence care decisions. In contrast, nurses described improved continence knowledge, attitudes and confidence alongside a shift from containment to rehabilitative approaches. Contextual components including care from point of hospital admission, equipment accessibility and interdisciplinary approaches were perceived as important factors to enhancing continence care.
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Affiliation(s)
- M C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - K Jamieson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - C Bugge
- Department of Nursing and Midwifery, University of Stirling, Stirling, UK
| | - S Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - D McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - C Chalmers
- Stroke Services, NHS Lanarkshire, Lanarkshire, UK
| | - P Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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McClurg D, Frawley H, Hay-Smith J, Dean S, Chen SY, Chiarelli P, Mair F, Dumoulin C. Limited effects from limited adherence: using behavioural theory to underpin pelvic floor muscle training programs and outcomes. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hay-Smith J, Dean S, Frawley H, McClurg D, Dumoulin C. Exercise adherence: integrating theory, evidence and behaviour change techniques. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McClurg D, Cheater FM, Eustice S, Burke J, Jamieson K, Hagen S. A multi-professional UK wide survey of undergraduate continence education. Neurourol Urodyn 2012; 32:224-9. [PMID: 22847225 DOI: 10.1002/nau.22284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 05/23/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Findings from national audits and enquiries continue to report that care for patients with continence problems is often substandard and inadequate education is often cited as one of the probable causes. These factors combined with the forecasted increase in the number of people with incontinence prompted us to undertake a survey of all UK Higher Education Institutes (HEIs) to establish the amount of undergraduate continence education within relevant healthcare programs--medical, adult nursing, mental health nursing, learning disabilities nursing, children's nursing, midwifery, physiotherapy, and occupational therapy. DESIGN An on line questionnaire targeted course program leads (n = 362) in all 86 HEIs in which undergraduate professional healthcare programs were provided (n = 362). MAIN OUTCOME MEASURE Eighty-six HEIs were approached, 85 agreed to participate in the survey. A response rate of 81% (n = 294/362 programs) was obtained: 14% (n = 42) of respondents reported that there was no continence-related education within their undergraduate program. The mean number of hours was 4.7 (SD 4.3), and ranged from 2.5 (SD 3.5) hr (Occupational Therapy) to 7.3 (SD 4.8) hr (Adult Nursing). CONCLUSION The survey results indicate that the amount of undergraduate education has changed little. Further research is needed to identify the most appropriate methods of delivering continence education and translate knowledge into improved patient outcomes. Adequate undergraduate continence education directed by the General Medical Council, Royal Colleges and Health Professional Council is required.
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Affiliation(s)
- D McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
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Wagg A, Duckett J, McClurg D, Harari D, Lowe D. To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit. BJOG 2011; 118:1592-600. [DOI: 10.1111/j.1471-0528.2011.03100.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Parkhurst CS, Doyle WF, Silverman LA, Singh S, Andersen MP, McClurg D, Wnek GE, Uhlmann DR. Siloxane Modified Sio2-TiO2 Glasses Via Sol-Gel. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-73-769] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTPolydimethylsiloxane [PDMS]-modified SiO2-TiO2, glasses have been prepared via the sol-gel route. Polymer compositions varied between 17 and 67 wt% PDMS, using PDMS of molecular weights 1,700 and 36,000. Also varied was the Si/Ti ratio for a given polymer content and the nature of the Ti alkoxide.A general synthetic procedure was found which made optically clear samples. Dense monolithic structures were obtained at room temperature for all compositions. The room temperature densification is attributed to relaxation and flow in the sample due to the presence of the polymer. The effects on properties of the overall composition and molecular weight of the polymer are reported, and implications in terms of structural models are considered.
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McClurg D, Ashe RG, Lowe-Strong AS. Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis— A double blind, placebo controlled, randomised clinical trial. Neurourol Urodyn 2008; 27:231-7. [PMID: 17705160 DOI: 10.1002/nau.20486] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Lower urinary tract dysfunction affects up to 75% of the multiple sclerosis population. Results from our recent Pilot Study (McClurg et al., 2006) indicated that a combined programme of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation modalities may alleviate some of the distressing symptoms within this population. This clinical trial aimed to evaluate further the efficacy of these interventions and to establish the benefit of neuromuscular electrical stimulation above and beyond that of EMG biofeedback and pelvic floor muscle training. METHODS 74 multiple sclerosis patients who presented with lower urinary tract dysfunction were randomly allocated to one of two groups - Group 1 received Pelvic Floor Muscle Training, Electromyography Biofeedback and Placebo Neuromuscular Electrical Stimulation (n=37), and Group 2 which received Pelvic Floor Muscle Training, Electromyography Biofeedback, and Active Neuromuscular Electrical Stimulation (n=37). Treatment was for nine weeks with outcome measures recorded at weeks 0, 9, 16 and 24. The Primary Outcome Measure was the number of leakage episodes. Within group analysis was by Paired Samples t-test. Group differences were analysed using Repeated Measures Analysis of Variance and Post-hoc tests were used to determine the significance of differences between Groups at each time point. RESULTS The mean number of incontinence episodes were reduced in Group 2 by 85% (p=0.001) whereas in Group 1 a lesser reduction of 47% (p=0.001) was observed. However, there was a statistically superior benefit in Group 2 when compared to Group 1 (p=0.0028). This superior benefit was evident in all other outcome measures. CONCLUSIONS The addition of Active Neuromuscular Electrical Stimulation to a programme of Pelvic Floor Muscle Training and Electromyography Biofeedback should be considered as a first-line option in alleviating some of the symptoms of lower urinary tract dysfunction associated with multiple sclerosis.
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Affiliation(s)
- D McClurg
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland, UK.
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McClurg D, Ashe RG, Marshall K, Lowe-Strong AS. Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: A randomized pilot study. Neurourol Urodyn 2006; 25:337-48. [PMID: 16637070 DOI: 10.1002/nau.20209] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Bladder dysfunction affects up to 90% of the multiple sclerosis (MS) population. Interventions such as Pelvic Floor Training and Advice (PFTA), Electromyography (EMG) Biofeedback, and Neuromuscular Electrical Stimulation (NMES) have received limited research attention within this population. This study aimed to determine the effectiveness of a combined programme of PFTA, EMG Biofeedback, and NMES for bladder dysfunction in MS. METHODS Females (n = 30) who fulfilled strict inclusion/exclusion criteria were recruited. Outcome measures (weeks 0, 9, 16, and 24) included: 3-day Voiding Diary; 24 hr Pad-Test; Uroflowmetry; Pelvic Floor Muscle Assessment; Incontinence Impact Questionnaire (IIQ); Urogenital Distress Inventory (UDI); King's Health Questionnaire (KHQ), and the Multiple Sclerosis Quality of Life-54 Instrument (MSQoL-54). Following baseline (week 0) assessment, participants were randomly allocated, under double blind conditions, to one of the three groups: Group 1 (PFTA); Group 2 (PFTA and EMG Biofeedback); and Group 3 (PFTA, EMG Biofeedback, and NMES). Treatment was for 9 weeks. RESULTS Baseline severity (measured by number of leaks and pad weight) showed some variation between groups, although not statistically significant (P > 0.05); with the caveat that this baseline imbalance makes interpretation difficult, a picture emerges that at week 9, Group 3 demonstrated superior benefit as measured by the number of leaks and pad test than Group 2, with Group 1 showing less improvement when compared to week 0; this was statistically significant between Groups 1 and 3 for number of leaks (P = 0.014) and pad tests (P = 0.001), and Groups 1 and 2 for pad tests (P = 0.001). A similar pattern was evident for all other outcome measures. CONCLUSION Results suggest that these treatments, used in combination, may reduce urinary symptoms in MS. Further research will establish the effectiveness of these interventions.
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Affiliation(s)
- D McClurg
- Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland
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