 |
|
Behavioral Training With and Without Biofeedback in the Treatment of Urge Incontinence in Older Women
A Randomized Controlled Trial
Kathryn L. Burgio, PhD;
Patricia S. Goode, MD;
Julie L. Locher, PhD;
Mary G. Umlauf, PhD;
David L. Roth, PhD;
Holly E. Richter, PhD, MD;
R. Edward Varner, MD;
L. Keith Lloyd, MD
JAMA. 2002;288:2293-2299.
Context Previous research on urge urinary incontinence has demonstrated that multicomponent behavioral training with biofeedback is safe and effective, yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy.
Objective To examine the role of biofeedback in a multicomponent behavioral training program for urge incontinence in community-dwelling older women.
Design Prospective, randomized controlled trial conducted from April 1, 1995, to March 30, 2001.
Setting University-based outpatient continence clinic in the United States.
Patients A volunteer sample of 222 ambulatory, nondemented, community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern. Patients were stratified by race, type of incontinence (urge only vs mixed), and severity (frequency of accidents).
Interventions Patients were randomly assigned to receive 8 weeks (4 visits) of biofeedback-assisted behavioral training (n = 73), 8 weeks (4 visits) of behavioral training without biofeedback (verbal feedback based on vaginal palpation; n = 74), or 8 weeks of self-administered behavioral treatment using a self-help booklet (control condition; n = 75).
Main Outcome Measures Reduction in the number of incontinence episodes as documented in bladder diaries, patients' perceptions and satisfaction, and changes in quality of life.
Results Intention-to-treat analysis showed that behavioral training with biofeedback yielded a mean 63.1% reduction (SD, 42.7%) in incontinence, verbal feedback a mean 69.4% reduction (SD, 32.7%), and the self-help booklet a mean 58.6% reduction (SD, 38.8%). The 3 groups were not significantly different from each other (P = .23). The groups differed significantly regarding patient satisfaction: 75.0% of the biofeedback group, 85.5% of the verbal feedback group, and 55.7% of the self-help booklet group reported being completely satisfied with treatment (P = .001). Significant improvements were seen across all 3 groups on 3 quality-of-life instruments, with no significant between-group differences.
Conclusions Biofeedback to teach pelvic floor muscle control, verbal feedback based on vaginal palpation, and a self-help booklet in a first-line behavioral training program all achieved comparable improvements in urge incontinence in community-dwelling older women. Patients' perceptions of treatment were significantly better for the 2 behavioral training interventions.
Author Affiliations: Department of Veterans Affairs Medical Center, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Ala (Drs Burgio and Goode); and School of Medicine (Drs Burgio, Goode, Locher, Richter, Varner, and Lloyd), Center for Aging (Drs Burgio, Goode, Locher, Umlauf, Roth, Richter, Varner, and Lloyd), School of Nursing (Dr Umlauf), and School of Public Health (Dr Roth), University of Alabama at Birmingham.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Behavioral Therapy to Enable Women with Urge Incontinence to Discontinue Drug Treatment: A Randomized Trial
Burgio et al.
ANN INTERN MED 2008;149:161-169.
ABSTRACT
| FULL TEXT
Rating improvements in urinary incontinence: do patients and their physicians agree?
Tannenbaum et al.
Age Ageing 2008;37:379-383.
ABSTRACT
| FULL TEXT
Systematic Review: Randomized, Controlled Trials of Nonsurgical Treatments for Urinary Incontinence in Women
Shamliyan et al.
ANN INTERN MED 2008;148:459-473.
ABSTRACT
| FULL TEXT
Urinary Stress Incontinence in Women
Rogers
NEJM 2008;358:1029-1036.
FULL TEXT
Non-surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress (ATLAS) trial
Richter et al.
Clin Trials 2007;4:92-101.
ABSTRACT
Questionnaire to Distinguish between Stress and Urge Urinary Incontinence
Brown et al.
ANN INTERN MED 2006;145:935-936.
FULL TEXT
Pelvic Floor Surgery in the Older Woman: Enhanced Compared With Usual Preoperative Assessment
Richter et al.
Obstet Gynecol 2005;105:800-807.
ABSTRACT
| FULL TEXT
Update in Women's Health
Carnes and Mahoney
ANN INTERN MED 2004;140:538-544.
FULL TEXT
Management of Urinary Incontinence in Women: Scientific Review
Holroyd-Leduc and Straus
JAMA 2004;291:986-995.
ABSTRACT
| FULL TEXT
Management of Overactive Bladder
Ouslander
NEJM 2004;350:786-799.
FULL TEXT
Predictors of Outcome in the Behavioral Treatment of Urinary Incontinence in Women
Burgio et al.
Obstet Gynecol 2003;102:940-947.
ABSTRACT
| FULL TEXT
Effect of Behavioral Training With or Without Pelvic Floor Electrical Stimulation on Stress Incontinence in Women: A Randomized Controlled Trial
Goode et al.
JAMA 2003;290:345-352.
ABSTRACT
| FULL TEXT
Expanding Treatment Options for Stress Urinary Incontinence in Women
Resnick and Griffiths
JAMA 2003;290:395-397.
FULL TEXT
Behavioural training plus biofeedback or verbal feedback did not differ from self administered behavioural training in urge incontinence
Wooldridge
Evid. Based Nurs. 2003;6:87-87.
FULL TEXT
ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med. 2003;8:67-67.
FULL TEXT
More Evidence for Effectiveness of Behavioral Training in Urge Incontinence
JWatch Women's Health 2002;2002:8-8.
FULL TEXT
Use It or Lose It: Activity May Be the Best Treatment for Aging
Cassel
JAMA 2002;288:2333-2335.
FULL TEXT
|
