Behavioral Training With and Without Biofeedback in the Treatment of Urge Incontinence in Older Women

Burgio, Kathryn L.; Goode, Patricia S.; Locher, Julie L.; Umlauf, Mary Grace; Roth, David L.; Richter, Holly E.; Varner, R. Edward; Lloyd, L. Keith

doi:10.1001/jama.288.18.2293

Cited by 275 publications

(185 citation statements)

References 23 publications

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“…Effects and costs of the two behavioral therapies, as well as combined drug and behavioral therapy, were drawn from three published RCTs which followed clearly defined behavioral protocols and focused on urge incontinence in older women [11,12,21]. Both included pelvic floor muscle training, education around urge control strategies, and selfmonitoring with bladder diaries.…”

Section: Treatment Options and Modelsmentioning

confidence: 99%

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Phillips

Tehrani

Langmuir

et al. 2015

Journal of Geriatrics

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Objectives. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. Methods. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). Results. At baseline values costs per QALY gained ranged from US$3696 to $10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was $415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. Conclusion. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US$50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence.

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Section: Treatment Options and Modelsmentioning

confidence: 99%

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Phillips

Tehrani

Langmuir

et al. 2015

Journal of Geriatrics

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“…Dois estudos que avaliaram o impacto de terapias de modificação de comportamentos sobre a IU nos participantes que completaram o tratamento também não encontraram diferenças significativas na redução da incontinência entre grupos que tiveram supervisão do tratamento a cada duas semanas e grupos que fizeram uso de um manual sem supervisão alguma durante todo o período do estudo 29,30 . Contudo, um desses estudos relatou uma elevação da satisfação com o tratamento entre as participantes que receberam supervisão 29 e o outro apontou que a aderência ao tratamento foi inferior entre os participantes que não receberam supervisão 30 .…”

Section: Discussionunclassified

“…Contudo, um desses estudos relatou uma elevação da satisfação com o tratamento entre as participantes que receberam supervisão 29 e o outro apontou que a aderência ao tratamento foi inferior entre os participantes que não receberam supervisão 30 . O fato de o presente estudo ter sido desenvolvido em UBSs e de ter ocorrido melhora tanto da IU quanto da FMP, independentemente de supervisão permanente, demonstra a viabilidade da incorporação do MOED como estratégia preventiva e curativa para a IU na atenção primária à saúde.…”

Section: Discussionunclassified

Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial

Assis

Bernardes

Barbosa

et al. 2015

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVO: Avaliar a efetividade de um manual de orientação de exercícios domiciliares (MOED) para o assoalho pélvico (AP) na promoção da continência urinária em gestantes primigestas. MÉTODOS: Ensaio clínico com 87 participantes, avaliadas 6 vezes durante a gestação e divididas aleatoriamente em 3 grupos: Grupo supervisionado (Gsup), que praticou exercícios com supervisão; Grupo observado (Gobs), que praticou exercícios sem supervisão, e Grupo referência (Gref), que não praticou exercícios. Incontinência urinária (IU) (desfecho primário) e força muscular perineal (FMP) (desfecho secundário) foram avaliadas por intermédio de diário de perdas urinárias e perineometria, respectivamente. Foram utilizados o teste de Kruskal-Wallis, seguido do teste post hoc de Dunn, para variáveis contínuas, e o teste do χ 2 e testes Z, com correções de Bonferroni, para proporções, com nível de significância de 5%. RESULTADOS: O Gsup e o Gobs apresentaram 6,9% de gestantes incontinentes, enquanto o Gref apresentou 96,6% de incontinentes. Quanto à FMP, o Gsup e o Gobs apresentaram valores médios de contração de 10 e 8,9 cmH 2 O, respectivamente, enquanto o Gref apresentou valor de 4,7 cmH 2 O. Ambos os resultados significantes. CONCLUSÃO: A utilização de um MOED é eficaz na promoção da continência urinária e no aumento da FMP em gestantes primigestas, independentemente de supervisão permanente. Registro no clinicaltrials.gov -NCT00740428Abstract PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy. METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%. RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH 2 O, respectively, while Gref had a value of 4.7 cmH 2 O. Both results were significant. CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision. clinicaltrials.gov Registry -NCT00740428

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“…Weitere konservative Ansätze sind die Verhaltens-oder biofeedbackunterstützten sowie die neuromodulatorischen 114 Therapien (Burgio et al, 2002;Latini et al, 2006;Tadic et al, 2007;Vasavada et al, 2007;Wang et al, 2004).…”

Section: äNderungen Des "Life-styles"unclassified

Botulinumtoxin in der Urologie

Schulte-Baukloh

Knispel

2004

Urologe [A]

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Behavioral Training With and Without Biofeedback in the Treatment of Urge Incontinence in Older Women

Cited by 275 publications

References 23 publications

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Effectiveness of an illustrated home exercise guide on promoting urinary continence during pregnancy: a pragmatic randomized clinical trial

Botulinumtoxin in der Urologie

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