ICONS III: Identifying Continence OptioNs after Stroke: developing a combined intervention for stroke survivors with urinary incontinence in the community ICONS III team Chief Investigator: Professor Lois Thomas
Dr Jean Hay-Smith (New Zealand) 2 Professor Joanne Booth (Scotland) 3 Dr Sarah Dean (England 4 Dr Cu Mateus (England) 5 Dr Carol Bugge (Scotland) 6 Dr Rachel Stockley (England) 7 Jacqueline Coupe (England)
8 Lorna Booth (Scotland) 9 Mr Simon Hill (England) 10 Dr Miland Joshi (England) 11 Dr Joan Ostaszkiewicz (Australia) 12 Professor Suzanne Hagen (Scotland) 13 Dr Chantale Dumoulin (Canada) 14 Clare Bolton (England) 15 Professor Brenda Roe (England) Urinary incontinence after stroke is a global problem i)
Up to 8.45 million people affected worldwide annually Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245-54. Urinary incontinence is a global problem ii) Urinary incontinence affects half of stroke survivors in the acute phase 44% remain incontinent at 3 months 38% remain incontinence at 1 year Current practice: care focused on containment (e.g. absorbent pads) rather than promoting continence overuse of indwelling urethral catheters 45% of intervention participants in our ICONS
feasibility trial increased risk of IUC-associated urinary tract infections mortality and resource use increased morbidity, ICONS II Aim: to evaluate the clinical and economic effect of a systematic voiding programme for urinary incontinence (UI) after stroke in secondary care. Systematic voiding programme comprises comprehensive continence assessment protocol for indwelling urethral catheter removal behavioural interventions bladder training or prompted voiding
Pragmatic, multicentre, randomised parallel group trial to compare the effectiveness of the systematic voiding programme (n=512) with usual care (n=512) in reducing the severity of UI in patients with stroke and UI in secondary care. ICONS III writing group aim To be commissioned by NIHR to test a theory-informed combined intervention for patients with UI after stroke in the community Working group plan Update two systematic reviews Combined conservative interventions for urge, stress or mixed incontinence in adults Qualitative narrative review of barriers and facilitators to behavioural interventions for urinary incontinence from the
perspective of patients and clinical staff Conduct a critical review of continence programmes for urinary incontinence Develop a theory-informed intervention to treat both urge and stress urinary incontinence in stroke survivors in the community Design a feasibility randomised controlled trial of the intervention Develop a bid for submission to NIHR in April 2019 Review 1) Update quantitative evidence for combined behavioural interventions for UI Aim Primary objective: to assess the effects of combined behavioural interventions for urge, stress, or mixed urinary incontinence in adults on the number of participants regaining
continence and the number of incontinent episodes Secondary objective: to assess the effects of combined behavioural interventions on physical measures of the severity of urinary incontinence, quality of life and adverse events Design Quantitative review with meta-analysis Review 2) Update qualitative evidence of barriers and facilitators to successful implementation of behavioural interventions for UI Aim to evaluate factors influencing uptake and delivery of behavioural interventions for urinary incontinence from the perspective of clients and clinical staff
Design Qualitative evidence synthesis Review 3) Critical review of continence programmes Aim to produce a detailed descriptive account of behavioural interventions used in continence programmes for treating urinary incontinence in adults using Michie et al.s (2011) behaviour change wheel, to classify the intervention functions studies use (for example training), and which essential conditions of behaviour change (capability, opportunity and motivation) these address
Design matrix analysis identify which combinations of intervention components, participants, deliverer (e.g. patient, carer, clinical staff), delivery (e.g. intensity, duration), and context (e.g. setting, mode of delivery) appear to influence outcomes The intervention might comprise introduce pelvic floor muscle training (PFMT) at home alongside bladder training once patients are discharged, perhaps giving patients training while they are in hospital continuing at home with bladder training only use an app for PFMT Eva Samuelsson has developed one, there is also the NHS Squeezy app
https://www.bladderandbowel.org/news/squeezy-the-nhs-physiotherapy-app-for-pe lvic-floor-muscle-exercises / Thank you! Any questions? [email protected] +44(0)1772 893643 Funding acknowledgement: ICONS II is funded by the NIHR HTA Programme (16/111/31). Department of Health disclaimer: The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health
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