Objectives: To determine whether combining behavioral urinary incontinence (UI) treatments with physical activity improves UI in frail older women. Design: Single-blind, two-arm pilot randomized controlled trial. Setting: Senior apartments. Participants: Frail women (mean age 84.9 ± 6.4) without dementia (n = 42). Intervention: Twelve-week program of customized behavioral UI treatments: 150 minutes of weekly walking and twice weekly strength training classes. Measurements: UI was measured using 3-day bladder diaries, the International Consultation on Incontinence Questionnaire (ICIQ), and UI global improvement questions. Toileting skills were measured using the Performance Oriented Timed Toileting Instrument (POTTI) and the Minnesota Toileting Skills Questionnaire (MTSQ). Physical function was measured using the Short Physical Performance Battery. UI-related quality of life was measured using the Incontinence Impact Questionnaire and Urogenital Distress Inventory. Results: The treatment group reported a 50% reduction in daily leaks using bladder diaries, and the control group reported no change (P =.04). Although there were no group differences in total ICIQ scores (P =.66), the treatment group reported significantly greater improvement on the ICIQ item for urine leakage (P =.01). More than 81% of the treatment group and 36% of the control group reported improvement in UI (χ2 = 4.84, P =.01), with mean estimated percentage improvement of 65.3 ± 32.0 versus 34.1 ± 41.3 (P =.03). Although the difference was not statistically significant, treatment group participants improved their toileting skills, whereas those of the control group declined (P =.42 POTTI, P =.11 MTSQ). Balance (P =.33) and gait (P =.24) improved more in the treatment group, whereas chair stands improved more in the control group (P =.14). Conclusion: UI may be improved in frail older women by combining behavioral strategies for UI with physical activity, but larger trails are needed to determine whether these findings can be replicated and sustained.
Bibliographical noteFunding Information:
The authors would like to thank Patricia L. Schaber PhD, OTR/L, Associate Professor in the University of Minnesota Program for Occupational Therapy, for her consultation on developing the intervention and Michelle Mathiason Moore, MS for statistical support. Conflict of Interest: Dr. Talley received grant funding from the following agencies to conduct this study: award UL1TR000114 from the National Center for Advancing Translational Sciences of the National Institutes of Health, award K12HD055887 from the Building Interdisciplinary Research Careers in Women's Health Program of the National Institutes of Child Health and Human Development, University of Minnesota Academic Health Center Seed grant program, and the Hartford Center for Geriatric Nursing Excellence at Iowa. Author Contributions: KMT: Study concept and design, acquisition of subjects and data, data analysis and interpretation, drafting manuscript. JFW, UB, BJOK, TCM: Study concept and design, data interpretation, critical review of manuscript. Sponsor's Role: The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.
- older women
- randomized controlled trial
- urinary incontinence