Occupational Therapy Interventions for Urinary Dysfunction in Primary Care: A Case Series

Abstract

Urinary dysfunction is commonly reported in primary care contexts. A shortage of primary care providers is affecting access to relevant services. Occupational therapy practitioners work in primary care settings and typically address urinary dysfunction in an outpatient context. Evidence regarding the delivery of occupational therapy interventions for urinary dysfunction in primary care has been limited. In this study, 3 women received 9-14 occupational therapy sessions in a primary care setting to address urinary symptoms. Plan-of-care duration, assessments, and urinary dysfunction interventions were individualized to accommodate personal and environmental factors. Across all case-series participants, Canadian Occupational Performance Measure scores demonstrated clinically significant improvement. Mixed results were found for SF-36 health-related quality-of-life subscale scores. Assessment scores specific to urinary dysfunction decreased, indicating reduced symptom severity and functional impact. This article provides preliminary evidence regarding the feasibility of occupational therapy interventions addressing urinary dysfunction in primary care settings. T ypical urinary function can be disrupted by motor deficits, sensory deficits, or a combined presentation. Depending on the type of dysfunction, symptoms such as urinary urgency, frequency, retention, incontinence, and hesitancy can occur (Newman & Wein, 2009). People with urinary dysfunction tend to present with secondary issues, including sleep disturbance, falls, social isolation, and comorbid anxiety and depression (Mishra et al., 2015; Pahwa et al., 2016). Urinary dysfunction is a frequent complaint among middle-age and older women, with higher rates of urinary incontinence among women older than age 85 yr (Coyne et al., 2009; Wiers & Keilman, 2017). Recognized treatment methods for urinary dysfunction address behavioral, lifestyle, psychosocial, emotional, and physical issues. Behavioral and lifestyle interventions are the recommended first-line treatment for urinary dysfunction (Newman & Wein, 2009). Techniques include bladder training, food and fluid management, compensatory strategies, and urge control techniques (Newman & Wein, 2009). Psychosocial and emotional interventions focus on increasing the ability to cope with urinary symptoms while reducing pain and sympathetic nervous system activation. Relaxation and mindfulness training increase awareness of pelvic floor and urinary function and can decrease related pain and muscle tension (

Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team

“…Understanding that nonpharmacological behavioral interventions are generally recommended as the first strategy to address lifestyle-sensitive health issues, in the special section of this issue Cunningham and Valasek (2019) present a case series that illustrates the impact that collaborative occupational therapy services can have on comprehensive and coordinated primary care. By improving function, promoting a return to meaningful activities (including paid work), and reducing disability claims and pharmacological dependence, occupational therapy practitioners can significantly reduce the impact of chronic conditions, including pain ( Gatchel & Okifuji, 2006 ; Hart & Parsons, 2015 ).…”