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Prompted voiding for the management of urinary incontinence in adults

  • Review
  • Intervention

Authors


Abstract

Background

Prompted voiding is a behavioural therapy used mainly in North American nursing homes. It aims to improve bladder control for people with or without dementia using verbal prompts and positive reinforcement.

Objectives

To assess the effects of prompted voiding for the management of urinary incontinence in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 31 January 2006) and reference lists of relevant articles. We contacted investigators in the field to locate extra studies.

Selection criteria

All randomised or quasi-randomised trials which addressed prompted voiding for the management of urinary incontinence. The trials included adult men and women, with or without cognitive impairment, diagnosed as having urinary incontinence as identified by the trialists, either by symptom classification or by urodynamic investigation.

Data collection and analysis

The identified reports were assessed for eligibility. Two reviewers independently reviewed the selected studies for methodological quality. Data describing six pre-specified outcomes were extracted independently by each reviewer and consensus reached when there was disagreement. Trial investigators were consulted when clarification or further detail was required. A third reviewer was recruited to proof read the review at different stages.

Main results

Nine trials were included in the review. These involved 674 elderly people, the majority of whom were women. Prompted voiding was compared with no prompted voiding in nine trials. The limited evidence suggested that prompted voiding increased self-initiated voiding and decreased incontinent episodes in the short-term. There was no evidence about whether these effects are sustained over a long period of prompted voiding, or persist after stopping prompted voiding.

Authors' conclusions

There was insufficient evidence to reach firm conclusions for practice. There was suggestive evidence of short-term benefit from prompted voiding, but longer-term effects are not known, and prompted voiding has significant resource implications.

摘要

背景

利用誘導排尿治療成人尿失禁

誘導排尿是北美洲醫護療養院常見的一種行為治療。透過語言刺激或是正向強化方式,以增進失智症或無失智症患者膀胱控制的能力。

目標

評估誘導排尿治療成人尿失禁的效果

搜尋策略

我們搜尋了Cochrane Incontinence Group Specialised Trials Register(2006年1月31日)以及相關參考資料列表。並且和該領域的研究人員保持交流,以協助定位其他方面的研究。

選擇標準

所有誘導排尿治療成人尿失禁的隨機或半隨機試驗,當中包含成年男性、成年女性;有或無認知功能障礙;經由試驗委員根據臨床症狀、尿動力學檢驗診斷為尿失禁患者。

資料收集與分析

這些報告經由評估以決定是否被選用。兩位專家分別回顧研究方法的品質。每位專家各自選用了描述六種未特定結果的數據,當有不同意見出現時互相討論以達到一致看法。當需要更多說明或是細節時,再請教試驗的研究人員。最後,請第三位專家證實該報告,並在不同的階段進行回顧。

主要結論

這篇回顧包含九項試驗。674名老年人參與,其中大多數是女性患者。九項試驗中誘導排尿和無誘導排尿作比較。有限的證據顯示誘導排尿可以在短期內增加自主排尿控制,並且減少尿失禁的發生。但是卻無法證實誘導排尿是否可以長期達到效果,或者在停止該治療後可否維持其功效。

作者結論

沒有足夠的證據作出肯定的結論以實際執行。證據顯示誘導排尿在短期內的確有其成效,然而長期的作用仍然未知,另外誘導排尿治療須一筆可觀的資源支出。

翻譯人

本摘要由中國醫藥大學附設醫院郭芷霖翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

對於長期住在醫院或療養院患有尿失禁的成年人,最常見的治療方法是定期提醒他們上廁所。而誘導排尿是北美洲醫護療養院主要的一種行為治療。透過語言刺激或是正向強化方式,以增進失智症或無失智症患者膀胱控制的能力。 這篇回顧顯示誘導排尿治療短期內有其功效,但卻無法得知其效果是否可以持續。誘導排尿治療須投注較多的醫療人力資源、較多的治療時間,因而影響其推廣普及性。同時沒有證據證明其長期的作用。

Plain language summary

Regular reminding to prompt going to the toilet for the management of urinary incontinence in adults

Urinary incontinence is very common amongst elderly long-term residents of nursing homes or hospitals. Prompted voiding is a behavioural therapy used mainly in North American nursing homes. It aims to improve bladder control for people with or without dementia using verbal prompts and positive reinforcement. The review found that although there is suggestive evidence of short-term benefit from prompted voiding, it is not known if these persist. Prompted voiding is also resource-intensive for nursing staff. Prompted voiding can take up a lot of carers time and this hinders its wider use. There was no evidence about long-term effects.

Laienverständliche Zusammenfassung

Regelmäßige Erinnerungen, unverzüglich zur Toilette zu gehen, zur Handhabung von Harninkontinenz bei Erwachsenen

Harninkontinenz ist sehr verbreitet bei älteren Langzeitbewohnern von Pflegeeinrichtungen und Krankenhäusern. Toilettentraining ist eine Art von Verhaltenstherapie, die vorwiegend in nordamerikanischen Pflegeeinrichtungen angewendet wird. Das Ziel ist es, die Kontrolle über die Blase und damit über das Wasserlassen bei Patienten mit oder ohne Demenz zu verbessern. Dabei werden die Patienten regelmäßig zum Wasserlassen aufgefordert und in diesem Verhalten bestärkt. Diese Übersichtsarbeit zeigt, dass es Evidenz gibt, die auf den kurzzeitigen Nutzen des Toilettentrainings hinweist, jedoch ist unbekannt, ob dieser Nutzen fortbesteht. Toilettentraining ist außerdem sehr ressourcen-intensiv für das Pflegepersonal. Es kann in der Pflege sehr viel Zeit beanspruchen und dies verhindert, dass es breiter eingesetzt wird. Es gab keine Evidenz zur langfristigen Wirkung.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz.

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