Camille P Vaughan1,2, Kathryn L Burgio3,4, Patricia S Goode3,4, Jorge L Juncos5, Gerald McGwin3,6, Lisa Muirhead1,7, Alayne D Markland3,4, Theodore M Johnson1,2. 1. Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta VA Health System, Atlanta, Georgia. 2. Division of General Medicine & Geriatrics, Department of Medicine, Emory University, Decatur, Georgia. 3. Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham VA Health System, Birmingham, Alabama. 4. Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 5. Department of Neurology, Emory University, Atlanta, Georgia. 6. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. 7. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Abstract
AIM: Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. METHODS: Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). RESULTS:Fifty-three participants randomized and 47 reported 8-week outcomes including 26behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (-6.2 ± 8.7) and control participants (-6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (-3.1 ± 2.8 vs -1.9 ± 2.2, P = 0.19); however quality of life (-22.6 ± 19.1 vs -7.0 ± 18.4, P = 0.048) and bother (-12.6 ± 17.2 vs - 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy. CONCLUSION: Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.
RCT Entities:
AIM: Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. METHODS: Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). RESULTS: Fifty-three participants randomized and 47 reported 8-week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (-6.2 ± 8.7) and control participants (-6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (-3.1 ± 2.8 vs -1.9 ± 2.2, P = 0.19); however quality of life (-22.6 ± 19.1 vs -7.0 ± 18.4, P = 0.048) and bother (-12.6 ± 17.2 vs - 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy. CONCLUSION: Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.
Authors: Theodore M Johnson; Camille P Vaughan; Patricia S Goode; Donald L Bliwise; Alayne D Markland; Carrie Huisingh; David T Redden; Gerald McGwin; Rina Eisenstein; Joseph G Ouslander; Muta Issa; Kathryn L Burgio Journal: Clin Ther Date: 2016-10-28 Impact factor: 3.393
Authors: James A G Crispo; Allison W Willis; Dylan P Thibault; Yannick Fortin; Harlen D Hays; Douglas S McNair; Lise M Bjerre; Dafna E Kohen; Santiago Perez-Lloret; Donald R Mattison; Daniel Krewski Journal: PLoS One Date: 2016-03-03 Impact factor: 3.240
Authors: Phat L Chang; Felicia C Goldstein; Kathryn L Burgio; Jorge L Juncos; Gerald McGwin; Lisa Muirhead; Alayne D Markland; Theodore M Johnson; Camille P Vaughan Journal: Neurourol Urodyn Date: 2022-02-19 Impact factor: 2.696
Authors: Jacqueline A Osborne; Rachel Botkin; Cristina Colon-Semenza; Tamara R DeAngelis; Oscar G Gallardo; Heidi Kosakowski; Justin Martello; Sujata Pradhan; Miriam Rafferty; Janet L Readinger; Abigail L Whitt; Terry D Ellis Journal: Phys Ther Date: 2022-04-01