Prevention and Treatment of Urinary Incontinence After Stroke in Adults
2006; Lippincott Williams & Wilkins; Volume: 37; Issue: 3 Linguagem: Inglês
10.1161/01.str.0000204113.54907.79
ISSN1524-4628
AutoresGraeme J. Hankey, Lois Thomas, James Barrett, Stephen Cross, Beverley French, Michael J Leathley, Chris Sutton, Caroline L Watkins,
Tópico(s)Pelvic floor disorders treatments
ResumoHomeStrokeVol. 37, No. 3Prevention and Treatment of Urinary Incontinence After Stroke in Adults Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBPrevention and Treatment of Urinary Incontinence After Stroke in Adults Graeme J. Hankey, Lois H. Thomas, James Barrett, Stephen Cross, Beverley French, Michael Leathley, Christopher Sutton and Caroline Watkins Graeme J. HankeyGraeme J. Hankey From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , Lois H. ThomasLois H. Thomas From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , James BarrettJames Barrett From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , Stephen CrossStephen Cross From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , Beverley FrenchBeverley French From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , Michael LeathleyMichael Leathley From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. , Christopher SuttonChristopher Sutton From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. and Caroline WatkinsCaroline Watkins From the Department of Nursing (L.H.T., B.F., M.L., C.S., C.W.), University of Central Lancashire, Preston, UK; Clatterbridge Hospital (J.B.), Bebington, Wirral, Merseyside, UK; and Hope Hospital (S.C.), Clinical Sciences Building, Stott Lane, Manchester, UK. Originally published2 Feb 2006https://doi.org/10.1161/01.STR.0000204113.54907.79Stroke. 2006;37:929–930Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: February 2, 2006: Previous Version 1 Urinary incontinence can affect 40% to 60% of people admitted to hospital after a stroke, with 25% still having problems on hospital discharge and ≈15% remaining incontinent at 1 year.ObjectivesThe objective of the review was to determine the optimal methods for prevention and treatment of urinary incontinence after stroke in adults.Search StrategyWe searched the Cochrane Incontinence and Stroke Groups specialized registers (searched December 15, 2004 and October 26, 2004, respectively), CINAHL (January 1982 to November 2004), national and international trial databases for unpublished data, and the reference lists of relevant articles.Selection CriteriaRandomized or quasi-randomized controlled trials evaluating the effects of interventions designed to promote continence in people after stroke.Data Collection and AnalysisData extraction and quality assessment were undertaken by 2 reviewers working independently. Disagreements were resolved by a third reviewer.Main ResultsSeven trials with a total of 399 participants were included in the review. Participants were from a mixture of settings, age groups, and phases of stroke recovery. No 2 trials addressed the same comparison.Four trials tested an intervention against usual care, including acupuncture, timed voiding, and 2 types of specialist professional intervention. One crossover trial tested an intervention (estrogen) against placebo. One trial tested a specific intervention (oxybutynin) against another intervention (timed voiding), and 1 trial tested a combined intervention (sensory-motor biofeedback plus timed voiding) against a single component intervention (timed voiding alone).Reported data were insufficient to evaluate acupuncture or timed voiding versus usual care, oxybutynin versus timed voiding, or sensory motor biofeedback plus timed voiding versus usual care. Evidence from a single small trial suggested that structured assessment and management of care in early rehabilitation may reduce the number of people with incontinence at hospital discharge (1 of 21 versus 10 of 13; relative risk [RR], 0.06; 95% CI, 0.01 to 0.43) and have other benefits. Evidence from another trial suggested that assessment and management of care by continence nurse practitioners in a community setting may reduce the number of urinary symptoms (48 of 89 versus 38 of 54; RR, 0.77; 95% CI, 0.59 to 0.99) and increase satisfaction with care.Reviewers' ConclusionsThere was suggestive evidence that specialist professional input through structured assessment and management of care and specialist continence nursing may reduce urinary incontinence after stroke. Data from trials of other physical, behavioral, complementary, and anticholinergic drug interventions are insufficient to guide continence care of adults after stroke.Implications for PracticeThere is very little evidence from stroke-specific studies to guide practice. The lack of trials testing the same category of intervention means that recommendations for practice are based on the results of single, usually small, trials. Two trials provide some evidence to suggest that specialized professional input using systematic methods to assess and manage continence problems may improve some outcomes. The limited evidence suggests that the greatest impact on urinary incontinence may be in the acute phase of rehabilitation after stroke. However, specialist input and individualized care management may improve the number of symptoms of urinary incontinence even in the longer term.Implications for ResearchThere is a need for larger trials, in particular of the use of individualized assessment and goal setting to tailor interventions to neurological and functional problems.As well as the need for trials of methods to promote continence, methods of managing continuing urinary incontinence such as intermittent catheterization or the use of catheter valves are also needed.There is a need for more well-designed studies. For example, further research should use standardized definitions and classification systems to record details of the type and severity of stroke and the type and severity of urinary incontinence. Specific details of structured assessment and intervention protocols need to be given, with standardization of treatment, measures of between groups contamination or differences, and tailoring of intervention to the early or later phases of rehabilitation. Outcome measures of urinary incontinence and of urinary symptoms should be standardized, with attention to their validity and reliability and the blinding of outcome assessment. The time periods for review should be standardized for the acute, early, and later phases of rehabilitation. Finally, sample size calculations and securely concealed randomization at either the cluster or individual patient level should be used appropriately and reported accordingly.Note: The full text of this review is available in the Cochrane Library (for subscribers http://www.mrw.interscience.wiley. com/cochrane/clsysrev/articles/CD004462/frame.html). The full article should be cited as: Thomas LH, Barrett J, Cross S, French B, Leathley M, Sutton C, Watkins C. Prevention and treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev. 2005. Issue 3.This work was supported by the University of Central Lancashire (£10 000). The review was conceived and designed by L.T. Searching was completed by B.F. Trials were considered for inclusion independently by 2 reviewers (L.T. and B.F.). Data extraction and review of the methodological quality of the eligible studies were then independently conducted by 2 reviewers for each study (C.S., M.L., S.C., and B.F.). Extracted data and quality assessment were cross-checked and any disagreements discussed and, if necessary, resolved by L.T. L.T. and B.F. wrote the text of the review. J.B. and C.W. acted as external reviewers and contributed to constructing the implications for practice and research.FootnotesCorrespondence to Dr Lois Thomas, Department of Nursing, University of Central Lancashire, Preston PR1 2HE UK. E-mail [email protected] eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kuru K, Ansell D, Jones M, Watkinson B, Caswell N, Leather P, Lancaster A, Sugden P, Briggs E, Davies C, Oh T, Bennett K and De Goede C (2020) Intelligent autonomous treatment of bedwetting using non-invasive wearable advanced mechatronics systems and MEMS sensors, Medical & Biological Engineering & Computing, 10.1007/s11517-019-02091-x, 58:5, (943-965), Online publication date: 1-May-2020. Kuru K, Ansell D, Jones M, De Goede C and Leather P (2018) Feasibility study of intelligent autonomous determination of the bladder voiding need to treat bedwetting using ultrasound and smartphone ML techniques, Medical & Biological Engineering & Computing, 10.1007/s11517-018-1942-9, 57:5, (1079-1097), Online publication date: 1-May-2019. March 2006Vol 37, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000204113.54907.79 Manuscript receivedDecember 8, 2005Manuscript acceptedJanuary 5, 2006Originally publishedFebruary 2, 2006 Keywordsurinary incontinencecerebrovascular accidentPDF download Advertisement
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