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Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women.

ABSTRACT: To determine whether combining behavioral urinary incontinence (UI) treatments with physical activity improves UI in frail older women.Single-blind, two-arm pilot randomized controlled trial.Senior apartments.Frail women (mean age 84.9 ± 6.4) without dementia (n = 42).Twelve-week program of customized behavioral UI treatments: 150 minutes of weekly walking and twice weekly strength training classes.UI was measured using 3-day bladder diaries, the International Consultation on Incontinence Questionnaire (ICIQ), and UI global improvement questions. Toileting skills were measured using the Performance Oriented Timed Toileting Instrument (POTTI) and the Minnesota Toileting Skills Questionnaire (MTSQ). Physical function was measured using the Short Physical Performance Battery. UI-related quality of life was measured using the Incontinence Impact Questionnaire and Urogenital Distress Inventory.The treatment group reported a 50% reduction in daily leaks using bladder diaries, and the control group reported no change (P = .04). Although there were no group differences in total ICIQ scores (P = .66), the treatment group reported significantly greater improvement on the ICIQ item for urine leakage (P = .01). More than 81% of the treatment group and 36% of the control group reported improvement in UI (?2 = 4.84, P = .01), with mean estimated percentage improvement of 65.3 ± 32.0 versus 34.1 ± 41.3 (P = .03). Although the difference was not statistically significant, treatment group participants improved their toileting skills, whereas those of the control group declined (P = .42 POTTI, P = .11 MTSQ). Balance (P = .33) and gait (P = .24) improved more in the treatment group, whereas chair stands improved more in the control group (P = .14).UI may be improved in frail older women by combining behavioral strategies for UI with physical activity, but larger trails are needed to determine whether these findings can be replicated and sustained.

SUBMITTER: Talley KMC

PROVIDER: S-EPMC5478439 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women.

Talley Kristine M C KMC Wyman Jean F JF Bronas Ulf U Olson-Kellogg Becky J BJ McCarthy Teresa C TC

Journal of the American Geriatrics Society 20170301 6

<h4>Objectives</h4>To determine whether combining behavioral urinary incontinence (UI) treatments with physical activity improves UI in frail older women.<h4>Design</h4>Single-blind, two-arm pilot randomized controlled trial.<h4>Setting</h4>Senior apartments.<h4>Participants</h4>Frail women (mean age 84.9 ± 6.4) without dementia (n = 42).<h4>Intervention</h4>Twelve-week program of customized behavioral UI treatments: 150 minutes of weekly walking and twice weekly strength training classes.<h4>Me ...[more]

PMID: 28248418

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Project description:ImportanceUrinary incontinence is one of the most prevalent health concerns experienced by older women (aged ≥60 years). Individual pelvic floor muscle training (PFMT) is the recommended first-line treatment for stress or mixed urinary incontinence in women, but human and financial resources limit its delivery. Whether group-based PFMT performs as well as individual PFMT in this population remains unclear.ObjectiveTo assess the efficacy of group-based PFMT relative to individual PFMT for urinary incontinence in older women.Design, setting, and participantsThe Group Rehabilitation or Individual Physiotherapy (GROUP) study is a single-blind, randomized, noninferiority trial conducted in 2 Canadian research centers, from July 1, 2012, to June 2, 2018. A total of 362 community-dwelling women aged 60 years or older with symptoms of stress or mixed urinary incontinence were enrolled.InterventionsAfter an individual session conducted to learn how to contract pelvic floor muscles, participants completed 12-week PFMT as part of a group of 8 women (n = 178) or in individual sessions (n = 184).Main outcomes and measuresThe primary outcome measure was the percentage reduction in urinary incontinence episodes at 1 year, as reported in a 7-day bladder diary and relative to pretreatment baseline. Secondary outcomes included lower urinary tract-related signs, symptoms, and quality of life immediately following treatment and at 1 year. Per-protocol analysis was used.ResultsAmong 362 women who were randomized (mean [SD] age, 67.9 [5.8] years), 319 women (88%) completed the 1-year follow-up and were included in the per-protocol analysis. Median percentage reduction in urinary incontinence episodes was 70% (95% CI, 44%-89%) in individual PFMT compared with 74% (95% CI, 46%-86%) in group-based PFMT. The upper boundary of the 95% CI for the difference in the percentage reduction in urinary incontinence episodes at 1 year was lower than the prespecified margin for noninferiority of 10% (difference, 4%; 95% CI, -10% to 7%; P = .58), confirming noninferiority. Individual PFMT and group-based PFMT had similar effectiveness for all secondary outcomes at 1 year. Adverse events were minor and uncommon.Conclusions and relevanceResults of the GROUP study suggest that group-based PFMT is not inferior to the recommended individual PFMT for the treatment of stress and mixed urinary incontinence in older women. Widespread use in clinical practice may help increase continence-care affordability and treatment availability.Trial registrationClinicalTrials.gov Identifier: NCT02039830.

Project description:BackgroundUp to 40% of older women living in the community experience urinary incontinence. In community settings, urinary incontinence impacts the quality of life, morbidity, and mortality rates. However, little is known about urinary incontinence and its impact on older women admitted to hospitals.ObjectivesThis scoping review aims to establish the current knowledge of urinary incontinence during hospital admission for women (⩾ 55 years of age) with three key objectives: (a) What is the prevalence/incidence of urinary incontinence? (b) What health conditions are associated with urinary incontinence? (c) Is there an association between urinary incontinence and mortality?Eligibility criteriaEmpirical studies were included in assessing the incidence/prevalence of urinary incontinence during hospital admissions and its related morbidities and mortality rates. Studies which only included men or younger women (< 55 years of age) were excluded. Only articles written in English and conducted between 2015 and 2021 were included.Sources of evidenceA search strategy was developed, and CINAHL, MEDLINE, and Cochrane databases were searched.Charting methodsData from each article meeting the criteria were pulled into a table, including study design, study population, and setting, aims, methods, outcome measures, and significant findings. A second researcher then reviewed the populated data extraction table.ResultsOverall, 383 papers were found: 7 met inclusion/exclusion criteria. Prevalence rates ranged from 22% to 80% depending on the study cohort. Several conditions were associated with urinary incontinence, including frailty, orthopaedics, stroke, palliative care, neurology, and cardiology. There was a potential positive association between mortality and urinary incontinence, although only two papers reviewed reported mortality.ConclusionA dearth of literature determined the prevalence, incidence, and mortality rates for older women admitted to hospitals. Limited consensus on associated conditions was found. Further research is needed to fully explore urinary incontinence in older women during hospital admissions, particularly concerning prevalence/incidence and its association with mortality.

Dataset Information

Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women.

Publications

Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women.

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