Hunkyung Kim1, Hideyo Yoshida, Takao Suzuki. 1. Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Japan. kimhk@tmig.or.jp
Abstract
BACKGROUND:Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence. OBJECTIVES: To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence. DESIGN: Randomized controlled, follow-up trial. SETTINGS: Urban community-based study. PARTICIPANTS: 127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n=63) or the control group (n=64). METHODS:Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month. RESULTS: There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ(2)=21.96, p<0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ(2)=10.28, p=0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR=0.69, 95% confidence interval CI=0.39-0.98), compliance (OR=1.03, 95%CI=1.01-1.16), and BMI reduction (OR=0.67, 95%CI=0.48-0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR=1.13, 95%CI=1.02-1.29) and BMI reduction (OR=0.78, 95%CI=0.60-0.96). CONCLUSIONS: The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.
RCT Entities:
BACKGROUND:Urinary incontinence is one of the most prevalent health problems and a significant cause of disability and dependence in the elderly. Pelvic floor exercise is effective in reducing stress urinary incontinence, but few studies have investigated the effect of behavioral management on urge and mixed incontinence. OBJECTIVES: To determine the effects of multidimensional exercise treatment on reducing urine leakage in elderly Japanese women with stress, urge, and mixed urinary incontinence. DESIGN: Randomized controlled, follow-up trial. SETTINGS: Urban community-based study. PARTICIPANTS: 127 community-dwelling women aged 70 and older with stress, urge, and mixed urinary incontinence were randomly assigned to the intervention (n=63) or the control group (n=64). METHODS: Urine leakage and fitness data were collected at baseline, and after the intervention and follow-up. The intervention group received a multidimensional exercise treatment twice a week for 3-month. After treatment, the participants were followed for 7-month. RESULTS: There were significant differences in changes of functional fitness and incontinence variables between the intervention and control groups. The intervention group showed urine leakage cure rates of 44.1% after treatment and 39.3% after follow-up (χ(2)=21.96, p<0.001); whereas, the control group showed no significant improvement. The multidimensional exercise treatment was significantly effective in decreasing all three types of urinary incontinence. However, the effects of the exercise treatment were greater on stress urinary incontinence than on urge or mixed urinary incontinence. At the 7-month follow-up, while cure rates of all three types of urinary incontinence were significantly maintained, a slight reversal was seen only in the urge and mixed urinary incontinence (χ(2)=10.28, p=0.008). According to the logistic regression model, urine leakage volume (adjusted odds ratio OR=0.69, 95% confidence interval CI=0.39-0.98), compliance (OR=1.03, 95%CI=1.01-1.16), and BMI reduction (OR=0.67, 95%CI=0.48-0.89) were significantly associated with the cure of urine leakage after intervention. The cure rate of urine leakage after the follow-up was significantly associated with compliance (OR=1.13, 95%CI=1.02-1.29) and BMI reduction (OR=0.78, 95%CI=0.60-0.96). CONCLUSIONS: The intervention group showed higher urine leakage cure rates than control group. This result suggests that multidimensional exercise strategies may be effective for all three types of urinary incontinence. BMI reduction and compliance to the intervention was the consistent predictor for the effectiveness of the exercise treatment.
Authors: Ananias C Diokno; Diane K Newman; Lisa K Low; Tomas L Griebling; Michael E Maddens; Patricia S Goode; Trivellore E Raghunathan; Leslee L Subak; Carolyn M Sampselle; Judith A Boura; Ann E Robinson; Donna McIntyre; Kathryn L Burgio Journal: JAMA Intern Med Date: 2018-10-01 Impact factor: 21.873