Promoting and maintaining urinary continence: Follow‐up from a cluster‐randomized trial of elderly village women in Bangladesh

Abstract

Aims: Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors.Methods: Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions Results: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors Conclusions: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention. K E Y W O R D Sadherence, Bangladesh, group exercises, paramedics, PFMT, rural health, urinary incontinence

Age‐friendly interventions in rural and remote areas: A scoping review

“…Many studies recognised the limited access to healthcare services in rural and remote areas particularly for the treatment and management of common chronic conditions like diabetes 32,33 . There were studies that indicated the limited access to services such as palliative care, general health clinics, mental health, and specialty health services 15,34,35 . Factors such as geographical isolation, 36 financial constraints, 30,37 transportation issues, 18,38 and lack of rural health facilities and healthcare staff 39,40 were identified as complicating access to healthcare.…”

Long‐term effect of extracorporeal magnetic innervation for post‐prostatectomy urinary incontinence: 1‐year follow‐up

“…In our programme, both PFMT and ExMI were followed by maintenance exercise to be performed over the whole follow‐up period. Such exercises are necessary for maintaining the ability of patients to promptly activate their pelvic muscles in situations at risk for urine leakages (e.g., sneezing, coughing, lifting heavy objects) 23 . In the present study, all patients in each group were taught the same exercises by a nurse specialist.…”

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