Urinary Incontinence
Conditions
Keywords
Urinary Incontinence, Menopause, Quality of life, Sexual Function, Beliefs and Coping Strategies, Social Isolation, Self Esteem, Pelvic Floor Muscle Training
Brief summary
Urinary Incontinence (UI) is a public health problem that disrupts the Quality of Life, Productivity, Social Isolation and Sexual Function; its prevalence in peri- and postmenopausal women is around 30-40%. UI remains underreported and undertreated. Previous eHealth interventions have been efficacious with women. Thus, PURI-PRO (Portuguese Urinary Incontinence Project) (FCT Grant 2020.05710.BD) entailed a low-cost 8-week eHealth cognitive-behavioural multidisciplinary intervention aimed at reducing UI symptoms' severity through Pelvic Floor Muscle Training, development of healthy bladder habits, and promotion of adherence to exercises, realistic UI-beliefs, and functional coping strategies. Urinary incontinence symptom severity, frequency and its impact on quality of life, beliefs and strategies regarding urinary incontinence, self-esteem, social isolation, and adherence to pelvic floor muscle excercises were evaluated.
Detailed description
PURI-PRO's intervention followed an experimental design (randomised controlled trial) involving UI intervention (Experimental Group-EG) vs. Health Literacy single-leaflet (Control Group-CG), both delivered through the internet (eHealth). The study was comparative, since the sample was distributed in two groups (EG vs CG) through randomised distribution, and longitudinal, since all the outcome measures were evaluated at four different times.
Interventions
BEHAVIORALExperimental Group: eHealth intervention for UI symptoms improvement
The intervention was theoretically based on the HAPA model (including effective strategies in behaviour change, for example, action planning and coping with obstacles) and Common Sense Model of Self Regulation (beliefs, coping and appraisal), focusing on risk perception, planning, and self-efficacy. The intervention consisted of 8 sessions (90 minutes, once a week). All group intervention sessions, through the Zoom platform, were led by the psychologist responsible for the study, except the second session that was led by a physiotherapist. WhatsApp groups were created, to share experiences, knowledge, doubts and fears, and to create a sense of belonging, understanding and cohesion. All primary and secondary outcome measures were assessed at baseline, mid-intervention (one month later), post-intervention, and in a 3 month follow-up after the intervention.
BEHAVIORALControl Group: Delivery of a Health Literacy single-leaflet
A health literacy single-leaflet was delivered, by e-mail in the first week of the intervention. Beyond this, there was no further interaction with the group. All primary and secondary outcome measures were assessed at baseline, mid-intervention (one month later), post-intervention, and in a 3 month follow-up after the intervention.
Sponsors
Fundação para a Ciência e a Tecnologia
ISPA - Instituto Universitario de Ciencias Psicologicas, Sociais e da Vida
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Age (40-65 years); * Sex (women); * The presence of UI (positive response to a question about experiencing involuntary urine loss during intra-abdominal pressure increment and/or when feeling an incontrollable urge to urinate, occasionally or frequently); * Internet access.
Exclusion criteria
* Pregnancy or delivery in the past 6 months; * Previous UI-related surgery; * History of pelvic prolapse: * Known malignancy in the lower abdomen; * Neurological disease that could affect bladder control; * Substance use disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Brief Assessment of Urinary Incontinence symptoms and impact of Quality of Life | Change from Baseline urinary incontinence symptoms and impact on quality of life adherence to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) |
| UI-related Coping Strategies | Change from Baseline UI-related coping strategies to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by a bi-factorial instrument (hiding coping dimension and defensive coping dimension) developed by our team that entails a set of UI-related maladaptive coping strategies to manage immediate effects of UI. This instrument is based on the work of Diokno and collaborators. |
| UI-related Beliefs | Change from Baseline UI-related beliefs to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by the Portuguese version of the Brief Illness Perception Questionnaire (IPQ-Brief). This instrument is based on the work of Figueiras and collaborators. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Self-esteem | Change from Baseline self-esteem to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by the Rosenberg Self-Esteem Scale (RSS) |
| Social Isolation | Change from Baseline social isolation to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by Social Isolation Questionnaire (tailored to Urinary Incontinence symptoms) (UI-SIQ). This questionnaire is still on the process of being published by our team. |
| Urinary Incontinence symptom severity and impact | Change from Baseline Urinary Incontinence symptom severity and impact to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by King´s Health Questionnaire (KHQ) |
| Pelvic Floor Muscle Exercises Adherence | Change from Baseline pelvic floor muscle exercises adherence to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by a checklist developed by Alewijnse and collaborators that includes items regarding the frequency, ease and satisfaction towards the pelvic floor muscle exercises |
| Pelvic Floor and UI Knowledge | Change from Baseline pelvic floor and UI knowledge to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by Prolapse and Incontinence Knowledge Questionnaire (PIKQ-UI) |
| Self-reported Quality of Life | Change from Baseline quality of life to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by the Portuguese version of the WHO Quality-of-Life-Bref (WHOQOL-Bref). |
| Behavior Change (HAPA) | Change from Baseline behavior to mid-intervention (1 month later), post-intervention (2 months later), and at a 3 month follow-up | Evaluated by the HAPA Questionnaire (tailored to Urinary Incontinence symptoms), based on Renner's and Schwarzer's RACK study |
Countries
Portugal
Outcome results
None listed