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Patricia S Goode - One of the best experts on this subject based on the ideXlab platform.
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correlates and predictors of patient satisfaction with drug therapy and combined drug therapy and Behavioral Training for urgency urinary incontinence in women
International Urogynecology Journal, 2011Co-Authors: Kathryn L Burgio, Patricia S Goode, Stephen R Kraus, Kimberly Kenton, Heather J Litman, Holly E RichterAbstract:The goal was to identify correlates of patient satisfaction with drug and Behavioral treatments for urge-predominant incontinence, which may help tailor treatments to improve satisfaction. Planned secondary analysis of a multi-center, clinical trial randomizing 307 women to 10 weeks of tolterodine alone or combined with Behavioral Training. Satisfaction was measured using the Patient Satisfaction Question (PSQ). Potential correlates included baseline demographics, incontinence characteristics and prior treatments, history and physical parameters, expectations of treatment success, and outcome variables including the Global Perception of Improvement (GPI) and Urogenital Distress Inventory (UDI). After multivariable analysis, every 10-point increase in UDI change score increased odds of satisfaction by 11% (OR 1.11; 1.04–1.19). Odds of satisfaction increased among women reporting “much better” on the GPI (OR 13.8; 4.94–38.60). Treatment satisfaction for women with urge-predominant incontinence was associated with patient-related outcomes reflecting impression of improvement and bother from incontinence-related symptoms.
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combined Behavioral and individualized drug therapy versus individualized drug therapy alone for urge urinary incontinence in women
The Journal of Urology, 2010Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Alayne D Markland, Theodore M Johnson, David T ReddenAbstract:Purpose: We tested whether individualized drug therapy enhanced with Behavioral Training would result in better outcomes than individualized drug therapy alone.Materials and Methods: Participants were community dwelling women with urge predominant incontinence. Using a randomized clinical trial design women were randomized to 8 weeks (4 visits) of drug therapy alone (32) or drug therapy plus Behavioral Training (32). Drug therapy was individually titrated, extended release oxybutynin with proactive management of side effects. Behavioral Training included pelvic floor muscle Training and urge suppression techniques. The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks (with followup at 6 and 12 months). Secondary outcomes included patient satisfaction, global perception of improvement, Urogenital Distress Inventory and Incontinence Impact Questionnaire.Results: In intent to treat analysis frequency of incontinence was reduced a mean of 88.5% in the dru...
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preoperative biofeedback assisted Behavioral Training to decrease post prostatectomy incontinence a randomized controlled trial
The Journal of Urology, 2006Co-Authors: Kathryn L Burgio, Patricia S Goode, David T Redden, Donald A Urban, Mary Grace Umlauf, Julie L Locher, Anton J BueschenAbstract:Purpose: We tested the effectiveness of preoperative biofeedback assisted Behavioral Training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy.Materials and Methods: We performed a prospective, randomized, controlled trial comparing preoperative Behavioral Training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted Behavioral Training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological di...
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effects of Behavioral and drug therapy on nocturia in older incontinent women
Journal of the American Geriatrics Society, 2005Co-Authors: Theodore M Johnson, Kathryn L Burgio, David T Redden, Kate Clark Wright, Patricia S GoodeAbstract:Objectives: To examine changes in nocturia from a multicomponent Behavioral Training program or drug therapy in older women with urge or mixed (urge-predominant) urinary incontinence. Design: A secondary analysis of data from a prospective, randomized clinical trial. Setting: Parent trial was an outpatient research protocol in Alabama. Participants: One hundred ninety-seven women (aged 55–92) with incontinence and urodynamic evidence of bladder dysfunction. At baseline, 131 women (66% of participants) had nocturia. Intervention: In the parent study, participants received Behavioral Training, including four sessions of biofeedback-assisted pelvic floor muscle exercises, drug treatment (oxybutynin IR titrated from 2.5 mg per day to 5.0 mg three times a day), or placebo. Measurements: Participant-completed bladder diaries were used to calculate changes in nocturia. Results: Behavioral Training reduced nocturia by a median 0.50 episodes per night and was significantly more effective than drug treatment (median reduction=0.30 episodes; P=.02) and placebo (median reduction=0.00 episodes; P<.001). Also, drug treatment was more effective than control (P=.007). Conclusion: Both Behavioral Training and drug treatment reduced nocturia more than placebo, but Behavioral Training was the most effective.
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effect of Behavioral Training with or without pelvic floor electrical stimulation on stress incontinence in women a randomized controlled trial
JAMA, 2003Co-Authors: Patricia S Goode, Kathryn L Burgio, Holly E Richter, Mary Grace Umlauf, Julie L Locher, David L Roth, Edward R Varner, Keith L LloydAbstract:ContextPelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent Behavioral Training program has not been defined.ObjectiveTo determine if PFES increases efficacy of Behavioral Training for community-dwelling women with stress incontinence.Design and SettingProspective randomized controlled trial conducted from October 1, 1995, through May 1, 2001, at a university-based outpatient continence clinic in the United States.PatientsVolunteer sample of 200 ambulatory, nondemented, community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern; stratified by race, type of incontinence (stress only vs mixed), and severity (frequency of episodes).InterventionsPatients were randomly assigned to 8 weeks (4 visits) of Behavioral Training, 8 weeks (4 visits) of the Behavioral Training plus home PFES, or 8 weeks of self-administered Behavioral treatment using a self-help booklet (control condition).Main Outcome MeasuresPrimary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life.ResultsIntention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with Behavioral Training, 71.9% with Behavioral Training plus PFES, and 52.5% with the self-help booklet (P = .005). In comparison with the self-help booklet, Behavioral Training (P = .02) and Behavioral Training plus PFES (P = .002) were significantly more effective, but they were not significantly different from each other (P = .60). The PFES group had significantly better patient self-perception of outcome (P<.001) and satisfaction with progress (P = .02). Significant improvements were seen across all 3 groups on the Incontinence Impact Questionnaire but with no between-group differences.ConclusionsTreatment with PFES did not increase effectiveness of a comprehensive Behavioral program for women with stress incontinence. A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs.
Kathryn L Burgio - One of the best experts on this subject based on the ideXlab platform.
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correlates and predictors of patient satisfaction with drug therapy and combined drug therapy and Behavioral Training for urgency urinary incontinence in women
International Urogynecology Journal, 2011Co-Authors: Kathryn L Burgio, Patricia S Goode, Stephen R Kraus, Kimberly Kenton, Heather J Litman, Holly E RichterAbstract:The goal was to identify correlates of patient satisfaction with drug and Behavioral treatments for urge-predominant incontinence, which may help tailor treatments to improve satisfaction. Planned secondary analysis of a multi-center, clinical trial randomizing 307 women to 10 weeks of tolterodine alone or combined with Behavioral Training. Satisfaction was measured using the Patient Satisfaction Question (PSQ). Potential correlates included baseline demographics, incontinence characteristics and prior treatments, history and physical parameters, expectations of treatment success, and outcome variables including the Global Perception of Improvement (GPI) and Urogenital Distress Inventory (UDI). After multivariable analysis, every 10-point increase in UDI change score increased odds of satisfaction by 11% (OR 1.11; 1.04–1.19). Odds of satisfaction increased among women reporting “much better” on the GPI (OR 13.8; 4.94–38.60). Treatment satisfaction for women with urge-predominant incontinence was associated with patient-related outcomes reflecting impression of improvement and bother from incontinence-related symptoms.
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combined Behavioral and individualized drug therapy versus individualized drug therapy alone for urge urinary incontinence in women
The Journal of Urology, 2010Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Alayne D Markland, Theodore M Johnson, David T ReddenAbstract:Purpose: We tested whether individualized drug therapy enhanced with Behavioral Training would result in better outcomes than individualized drug therapy alone.Materials and Methods: Participants were community dwelling women with urge predominant incontinence. Using a randomized clinical trial design women were randomized to 8 weeks (4 visits) of drug therapy alone (32) or drug therapy plus Behavioral Training (32). Drug therapy was individually titrated, extended release oxybutynin with proactive management of side effects. Behavioral Training included pelvic floor muscle Training and urge suppression techniques. The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks (with followup at 6 and 12 months). Secondary outcomes included patient satisfaction, global perception of improvement, Urogenital Distress Inventory and Incontinence Impact Questionnaire.Results: In intent to treat analysis frequency of incontinence was reduced a mean of 88.5% in the dru...
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Behavioral therapy to enable women with urge incontinence to discontinue drug treatment a randomized trial
Annals of Internal Medicine, 2008Co-Authors: Kathryn L Burgio, Stephen R Kraus, Shawn A Menefee, Diane Borellofrance, Marlene M Corton, Harry W Johnson, Veronica Mallett, Peggy Norton, Mary P Fitzgerald, Kimberly J DandreoAbstract:Background: Women with urge urinary incontinence are commonly treated with antimuscarinic medications, but many discontinue therapy. Objective: To determine whether combining antimuscarinic drug therapy with supervised Behavioral Training, compared with drug therapy alone, improves the ability of women with urge incontinence to achieve clinically important reductions in incontinence episodes and to sustain these improvements after discontinuing drug therapy. Design: 2-stage, multicenter, randomized clinical trial conducted from July 2004 to January 2006. Setting: 9 university-affiliated outpatient clinics. Patients: 307 women with urge-predominant incontinence. Intervention: 10 weeks of open-label, extended-release tolterodine alone (n = 153) or combined with Behavioral Training (n = 154), followed by discontinuation of therapy and follow-up at 8 months. Measurements: The primary outcome, measured at 8 months, was no receipt of drugs or other therapy for urge incontinence and a 70% or greater reduction in frequency of incontinence episodes. Secondary outcomes were reduction in incontinence, self-reported satisfaction and improvement, and scores on validated questionnaires measuring symptom distress and bother and health-related quality of life. Study staff who performed outcome evaluations, but not participants and interventionists, were blinded to group assignment. Results: 237 participants completed the trial. According to life-table estimates, the rate of successful discontinuation of therapy at 8 months was the same in the combination therapy and drug therapy alone groups (41% in both groups; difference, 0 percentage points [95% Cl, -12 to 12 percentage points]). A higher proportion of participants who received combination therapy than drug therapy alone achieved a 70% or greater reduction in incontinence at 10 weeks (69% vs. 58%; difference, 11 percentage points [Cl, -0.3 to 22.1 percentage points]). Combination therapy yielded better outcomes over time on the Urogenital Distress Inventory and the Overactive Bladder Questionnaire (both P <0.001) at both time points for patient satisfaction and perceived improvement but not health-related quality of life. Adverse events were uncommon (12 events in 6 participants [3 in each group]). Limitations: Behavioral therapy components (daily bladder diary and recommendations for fluid management) in the group receiving drug therapy alone may have attenuated between-group differences. Assigned treatment was completed by 68% of participants, whereas 8-month outcome status was assessed on 77%. Conclusion: The addition of Behavioral Training to drug therapy may reduce incontinence frequency during active treatment but does not improve the ability to discontinue drug therapy and maintain improvement in urinary incontinence. Combination therapy has a beneficial effect on patient satisfaction, perceived improvement, and reduction of other bladder symptoms.
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preoperative biofeedback assisted Behavioral Training to decrease post prostatectomy incontinence a randomized controlled trial
The Journal of Urology, 2006Co-Authors: Kathryn L Burgio, Patricia S Goode, David T Redden, Donald A Urban, Mary Grace Umlauf, Julie L Locher, Anton J BueschenAbstract:Purpose: We tested the effectiveness of preoperative biofeedback assisted Behavioral Training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy.Materials and Methods: We performed a prospective, randomized, controlled trial comparing preoperative Behavioral Training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted Behavioral Training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological di...
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effects of Behavioral and drug therapy on nocturia in older incontinent women
Journal of the American Geriatrics Society, 2005Co-Authors: Theodore M Johnson, Kathryn L Burgio, David T Redden, Kate Clark Wright, Patricia S GoodeAbstract:Objectives: To examine changes in nocturia from a multicomponent Behavioral Training program or drug therapy in older women with urge or mixed (urge-predominant) urinary incontinence. Design: A secondary analysis of data from a prospective, randomized clinical trial. Setting: Parent trial was an outpatient research protocol in Alabama. Participants: One hundred ninety-seven women (aged 55–92) with incontinence and urodynamic evidence of bladder dysfunction. At baseline, 131 women (66% of participants) had nocturia. Intervention: In the parent study, participants received Behavioral Training, including four sessions of biofeedback-assisted pelvic floor muscle exercises, drug treatment (oxybutynin IR titrated from 2.5 mg per day to 5.0 mg three times a day), or placebo. Measurements: Participant-completed bladder diaries were used to calculate changes in nocturia. Results: Behavioral Training reduced nocturia by a median 0.50 episodes per night and was significantly more effective than drug treatment (median reduction=0.30 episodes; P=.02) and placebo (median reduction=0.00 episodes; P<.001). Also, drug treatment was more effective than control (P=.007). Conclusion: Both Behavioral Training and drug treatment reduced nocturia more than placebo, but Behavioral Training was the most effective.
David T Redden - One of the best experts on this subject based on the ideXlab platform.
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combined Behavioral and individualized drug therapy versus individualized drug therapy alone for urge urinary incontinence in women
The Journal of Urology, 2010Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Alayne D Markland, Theodore M Johnson, David T ReddenAbstract:Purpose: We tested whether individualized drug therapy enhanced with Behavioral Training would result in better outcomes than individualized drug therapy alone.Materials and Methods: Participants were community dwelling women with urge predominant incontinence. Using a randomized clinical trial design women were randomized to 8 weeks (4 visits) of drug therapy alone (32) or drug therapy plus Behavioral Training (32). Drug therapy was individually titrated, extended release oxybutynin with proactive management of side effects. Behavioral Training included pelvic floor muscle Training and urge suppression techniques. The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks (with followup at 6 and 12 months). Secondary outcomes included patient satisfaction, global perception of improvement, Urogenital Distress Inventory and Incontinence Impact Questionnaire.Results: In intent to treat analysis frequency of incontinence was reduced a mean of 88.5% in the dru...
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preoperative biofeedback assisted Behavioral Training to decrease post prostatectomy incontinence a randomized controlled trial
The Journal of Urology, 2006Co-Authors: Kathryn L Burgio, Patricia S Goode, David T Redden, Donald A Urban, Mary Grace Umlauf, Julie L Locher, Anton J BueschenAbstract:Purpose: We tested the effectiveness of preoperative biofeedback assisted Behavioral Training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy.Materials and Methods: We performed a prospective, randomized, controlled trial comparing preoperative Behavioral Training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted Behavioral Training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological di...
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effects of Behavioral and drug therapy on nocturia in older incontinent women
Journal of the American Geriatrics Society, 2005Co-Authors: Theodore M Johnson, Kathryn L Burgio, David T Redden, Kate Clark Wright, Patricia S GoodeAbstract:Objectives: To examine changes in nocturia from a multicomponent Behavioral Training program or drug therapy in older women with urge or mixed (urge-predominant) urinary incontinence. Design: A secondary analysis of data from a prospective, randomized clinical trial. Setting: Parent trial was an outpatient research protocol in Alabama. Participants: One hundred ninety-seven women (aged 55–92) with incontinence and urodynamic evidence of bladder dysfunction. At baseline, 131 women (66% of participants) had nocturia. Intervention: In the parent study, participants received Behavioral Training, including four sessions of biofeedback-assisted pelvic floor muscle exercises, drug treatment (oxybutynin IR titrated from 2.5 mg per day to 5.0 mg three times a day), or placebo. Measurements: Participant-completed bladder diaries were used to calculate changes in nocturia. Results: Behavioral Training reduced nocturia by a median 0.50 episodes per night and was significantly more effective than drug treatment (median reduction=0.30 episodes; P=.02) and placebo (median reduction=0.00 episodes; P<.001). Also, drug treatment was more effective than control (P=.007). Conclusion: Both Behavioral Training and drug treatment reduced nocturia more than placebo, but Behavioral Training was the most effective.
Julie L Locher - One of the best experts on this subject based on the ideXlab platform.
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preoperative biofeedback assisted Behavioral Training to decrease post prostatectomy incontinence a randomized controlled trial
The Journal of Urology, 2006Co-Authors: Kathryn L Burgio, Patricia S Goode, David T Redden, Donald A Urban, Mary Grace Umlauf, Julie L Locher, Anton J BueschenAbstract:Purpose: We tested the effectiveness of preoperative biofeedback assisted Behavioral Training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy.Materials and Methods: We performed a prospective, randomized, controlled trial comparing preoperative Behavioral Training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted Behavioral Training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological di...
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effect of Behavioral Training with or without pelvic floor electrical stimulation on stress incontinence in women a randomized controlled trial
JAMA, 2003Co-Authors: Patricia S Goode, Kathryn L Burgio, Holly E Richter, Mary Grace Umlauf, Julie L Locher, David L Roth, Edward R Varner, Keith L LloydAbstract:ContextPelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent Behavioral Training program has not been defined.ObjectiveTo determine if PFES increases efficacy of Behavioral Training for community-dwelling women with stress incontinence.Design and SettingProspective randomized controlled trial conducted from October 1, 1995, through May 1, 2001, at a university-based outpatient continence clinic in the United States.PatientsVolunteer sample of 200 ambulatory, nondemented, community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern; stratified by race, type of incontinence (stress only vs mixed), and severity (frequency of episodes).InterventionsPatients were randomly assigned to 8 weeks (4 visits) of Behavioral Training, 8 weeks (4 visits) of the Behavioral Training plus home PFES, or 8 weeks of self-administered Behavioral treatment using a self-help booklet (control condition).Main Outcome MeasuresPrimary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life.ResultsIntention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with Behavioral Training, 71.9% with Behavioral Training plus PFES, and 52.5% with the self-help booklet (P = .005). In comparison with the self-help booklet, Behavioral Training (P = .02) and Behavioral Training plus PFES (P = .002) were significantly more effective, but they were not significantly different from each other (P = .60). The PFES group had significantly better patient self-perception of outcome (P<.001) and satisfaction with progress (P = .02). Significant improvements were seen across all 3 groups on the Incontinence Impact Questionnaire but with no between-group differences.ConclusionsTreatment with PFES did not increase effectiveness of a comprehensive Behavioral program for women with stress incontinence. A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs.
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Behavioral Training with and without biofeedback in the treatment of urge incontinence in older women a randomized controlled trial
JAMA, 2002Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Mary Grace Umlauf, Julie L Locher, David L Roth, Edward R Varner, Keith L LloydAbstract:ContextPrevious research on urge urinary incontinence has demonstrated that multicomponent Behavioral Training with biofeedback is safe and effective, yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy.ObjectiveTo examine the role of biofeedback in a multicomponent Behavioral Training program for urge incontinence in community-dwelling older women.DesignProspective, randomized controlled trial conducted from April 1, 1995, to March 30, 2001.SettingUniversity-based outpatient continence clinic in the United States.PatientsA volunteer sample of 222 ambulatory, nondemented, community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern. Patients were stratified by race, type of incontinence (urge only vs mixed), and severity (frequency of accidents).InterventionsPatients were randomly assigned to receive 8 weeks (4 visits) of biofeedback-assisted Behavioral Training (n = 73), 8 weeks (4 visits) of Behavioral Training without biofeedback (verbal feedback based on vaginal palpation; n = 74), or 8 weeks of self-administered Behavioral treatment using a self-help booklet (control condition; n = 75).Main Outcome MeasuresReduction in the number of incontinence episodes as documented in bladder diaries, patients' perceptions and satisfaction, and changes in quality of life.ResultsIntention-to-treat analysis showed that Behavioral Training with biofeedback yielded a mean 63.1% reduction (SD, 42.7%) in incontinence, verbal feedback a mean 69.4% reduction (SD, 32.7%), and the self-help booklet a mean 58.6% reduction (SD, 38.8%). The 3 groups were not significantly different from each other (P = .23). The groups differed significantly regarding patient satisfaction: 75.0% of the biofeedback group, 85.5% of the verbal feedback group, and 55.7% of the self-help booklet group reported being completely satisfied with treatment (P = .001). Significant improvements were seen across all 3 groups on 3 quality-of-life instruments, with no significant between-group differences.ConclusionsBiofeedback to teach pelvic floor muscle control, verbal feedback based on vaginal palpation, and a self-help booklet in a first-line Behavioral Training program all achieved comparable improvements in urge incontinence in community-dwelling older women. Patients' perceptions of treatment were significantly better for the 2 Behavioral Training interventions.
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urodynamic changes associated with Behavioral and drug treatment of urge incontinence in older women
Journal of the American Geriatrics Society, 2002Co-Authors: Patricia S Goode, Kathryn L Burgio, Mary Grace Umlauf, Julie L Locher, Keith L Lloyd, David L RothAbstract:OBJECTIVES: To describe changes in bladder function and voiding frequency associated with Behavioral and drug treatment for urge incontinence and to examine whether these variables mediate the positive effects of treatment on the frequency of incontinence. DESIGN: Randomized, double-blinded, placebo-controlled, clinical trial. Eligible patients were stratified according to type of incontinence (urge only vs mixed urge and stress) and severity of incontinence (frequency of accidents as documented in bladder diary). SETTING: University-based outpatient geriatric medicine clinic. PARTICIPANTS: One hundred five ambulatory, nondemented, community-dwelling women; mean age 67.0 (range 55–91); 98% white, 2% African American. INTERVENTION: Four sessions (over 8 weeks) of biofeedback-assisted Behavioral Training, drug treatment with individually-titrated oxybutynin chloride, or a placebo control condition. MEASUREMENTS: Two-channel cystometry was performed to determine threshold volumes for first desire to void (FDV), strong desire to void (SDV), bladder capacity, and the volume at which detrusor instability (DI) or leakage occurred, before randomization and after completion of treatment. Two-week bladder diaries were used before and after treatment to document episodes of incontinence and voiding frequency. RESULTS: Bladder capacity increased by 68.9 mL in the oxybutynin group (P < .001) and 17.3 mL in the behavior group and decreased 6.0 mL in the control group. SDV increased 69.9 mL in the oxybutynin group (P < .001), 40.5 in the behavior group (P < .05), and 7.8 mL in the control group. FDV increased by 44.4 mL in the oxybutynin group (P < .001), 18.8 mL in the behavior group, and 8.9 mL in the control group. One of seven patients who presented with DI (12.0%) resolved in the behavior group, seven of eight (87.5%) resolved in the oxybutynin group, and seven of 12 (58.3%) resolved in the control group. These differences were not statistically significant. Voiding frequency was significantly reduced after treatment in both the behavior and the oxybutynin group. Behavioral Training resulted in a mean 82.3% reduction in frequency of accidents, oxybutynin (final doses 2.5 mg daily to 5 mg three times a day) resulted in a mean 78.3% reduction, and the control condition resulted in a mean 51.5% reduction (P = .002). Although oxybutynin and Behavioral treatment were both effective, and oxybutynin increased SDV and bladder capacity, the structural equation modeling did not demonstrate that the clinical improvement was mediated through the effects of these treatments on urodynamic or voiding frequency measures. CONCLUSIONS: Studies using more-complex urodynamics and studies with larger sample sizes are needed to better characterize changes in bladder function and explore other urodynamic changes that may accompany treatment. In addition, other factors, both physiological and Behavioral, need to be explored as mechanisms by which conservative therapies improve urge incontinence.
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combined Behavioral and drug therapy for urge incontinence in older women
Journal of the American Geriatrics Society, 2000Co-Authors: Kathryn L Burgio, Julie L Locher, Patricia S GoodeAbstract:OBJECTIVE: The purpose of this study was to examine the effects of combining Behavioral treatment and drug treatment for urge incontinence in community-dwelling older women. DESIGN: Modified crossover design (extension of a randomized clinical trial). Eligible subjects were stratified according to type and severity of incontinence and randomized to Behavioral treatment, drug treatment, or a control condition (placebo). Subjects not totally continent or not satisfied after 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy. SETTING: A university-based outpatient geriatric medicine clinic. PARTICIPANTS: Subjects in the clinical trial were 197 ambulatory, nondemented, community-dwelling women (age 55 years or older) with persistent urge urinary incontinence. Thirty-five subjects participated in combined treatment. INTERVENTION: One group of subjects received four sessions (over 8 weeks) of biofeedback-assisted Behavioral Training followed by 8 weeks of Behavioral Training combined with drug therapy (oxybutynin chloride individually titrated from 2.5 mg to 15 mg daily). The second group received drug therapy first, followed by 8 weeks of drug therapy combined with Behavioral Training. MEASUREMENTS: Bladder diaries completed by subjects before and after each treatment phase were used to calculate change in the frequency of incontinent episodes. RESULTS: Eight subjects (12.7%) crossed from Behavioral treatment alone to combined Behavioral and drug therapy. Additional benefit was seen in improvement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy (P = .034). Twenty-seven subjects (41.5%) crossed from drug therapy alone to combined drug and Behavioral treatment. They also showed additional improvement, from a mean 72.7% reduction of incontinence with single therapy to a mean 84.3% reduction of incontinence with combined therapy (P = .001). CONCLUSIONS: This study shows that combining drug and Behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence. J Am Geriatr Soc 48: 370–374, 2000.
Holly E Richter - One of the best experts on this subject based on the ideXlab platform.
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correlates and predictors of patient satisfaction with drug therapy and combined drug therapy and Behavioral Training for urgency urinary incontinence in women
International Urogynecology Journal, 2011Co-Authors: Kathryn L Burgio, Patricia S Goode, Stephen R Kraus, Kimberly Kenton, Heather J Litman, Holly E RichterAbstract:The goal was to identify correlates of patient satisfaction with drug and Behavioral treatments for urge-predominant incontinence, which may help tailor treatments to improve satisfaction. Planned secondary analysis of a multi-center, clinical trial randomizing 307 women to 10 weeks of tolterodine alone or combined with Behavioral Training. Satisfaction was measured using the Patient Satisfaction Question (PSQ). Potential correlates included baseline demographics, incontinence characteristics and prior treatments, history and physical parameters, expectations of treatment success, and outcome variables including the Global Perception of Improvement (GPI) and Urogenital Distress Inventory (UDI). After multivariable analysis, every 10-point increase in UDI change score increased odds of satisfaction by 11% (OR 1.11; 1.04–1.19). Odds of satisfaction increased among women reporting “much better” on the GPI (OR 13.8; 4.94–38.60). Treatment satisfaction for women with urge-predominant incontinence was associated with patient-related outcomes reflecting impression of improvement and bother from incontinence-related symptoms.
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combined Behavioral and individualized drug therapy versus individualized drug therapy alone for urge urinary incontinence in women
The Journal of Urology, 2010Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Alayne D Markland, Theodore M Johnson, David T ReddenAbstract:Purpose: We tested whether individualized drug therapy enhanced with Behavioral Training would result in better outcomes than individualized drug therapy alone.Materials and Methods: Participants were community dwelling women with urge predominant incontinence. Using a randomized clinical trial design women were randomized to 8 weeks (4 visits) of drug therapy alone (32) or drug therapy plus Behavioral Training (32). Drug therapy was individually titrated, extended release oxybutynin with proactive management of side effects. Behavioral Training included pelvic floor muscle Training and urge suppression techniques. The primary outcome measure was reduction in frequency of incontinence episodes on bladder diary at 8 weeks (with followup at 6 and 12 months). Secondary outcomes included patient satisfaction, global perception of improvement, Urogenital Distress Inventory and Incontinence Impact Questionnaire.Results: In intent to treat analysis frequency of incontinence was reduced a mean of 88.5% in the dru...
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effect of Behavioral Training with or without pelvic floor electrical stimulation on stress incontinence in women a randomized controlled trial
JAMA, 2003Co-Authors: Patricia S Goode, Kathryn L Burgio, Holly E Richter, Mary Grace Umlauf, Julie L Locher, David L Roth, Edward R Varner, Keith L LloydAbstract:ContextPelvic floor electrical stimulation (PFES) has been shown to be effective for stress incontinence. However, its role in a multicomponent Behavioral Training program has not been defined.ObjectiveTo determine if PFES increases efficacy of Behavioral Training for community-dwelling women with stress incontinence.Design and SettingProspective randomized controlled trial conducted from October 1, 1995, through May 1, 2001, at a university-based outpatient continence clinic in the United States.PatientsVolunteer sample of 200 ambulatory, nondemented, community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern; stratified by race, type of incontinence (stress only vs mixed), and severity (frequency of episodes).InterventionsPatients were randomly assigned to 8 weeks (4 visits) of Behavioral Training, 8 weeks (4 visits) of the Behavioral Training plus home PFES, or 8 weeks of self-administered Behavioral treatment using a self-help booklet (control condition).Main Outcome MeasuresPrimary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries. Secondary outcomes were patient satisfaction and changes in quality of life.ResultsIntention-to-treat analysis showed that incontinence was reduced a mean of 68.6% with Behavioral Training, 71.9% with Behavioral Training plus PFES, and 52.5% with the self-help booklet (P = .005). In comparison with the self-help booklet, Behavioral Training (P = .02) and Behavioral Training plus PFES (P = .002) were significantly more effective, but they were not significantly different from each other (P = .60). The PFES group had significantly better patient self-perception of outcome (P<.001) and satisfaction with progress (P = .02). Significant improvements were seen across all 3 groups on the Incontinence Impact Questionnaire but with no between-group differences.ConclusionsTreatment with PFES did not increase effectiveness of a comprehensive Behavioral program for women with stress incontinence. A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs.
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Behavioral Training with and without biofeedback in the treatment of urge incontinence in older women a randomized controlled trial
JAMA, 2002Co-Authors: Kathryn L Burgio, Patricia S Goode, Holly E Richter, Mary Grace Umlauf, Julie L Locher, David L Roth, Edward R Varner, Keith L LloydAbstract:ContextPrevious research on urge urinary incontinence has demonstrated that multicomponent Behavioral Training with biofeedback is safe and effective, yet it has not been established whether biofeedback is an essential component that heightens therapeutic efficacy.ObjectiveTo examine the role of biofeedback in a multicomponent Behavioral Training program for urge incontinence in community-dwelling older women.DesignProspective, randomized controlled trial conducted from April 1, 1995, to March 30, 2001.SettingUniversity-based outpatient continence clinic in the United States.PatientsA volunteer sample of 222 ambulatory, nondemented, community-dwelling women aged 55 to 92 years with urge incontinence or mixed incontinence with urge as the predominant pattern. Patients were stratified by race, type of incontinence (urge only vs mixed), and severity (frequency of accidents).InterventionsPatients were randomly assigned to receive 8 weeks (4 visits) of biofeedback-assisted Behavioral Training (n = 73), 8 weeks (4 visits) of Behavioral Training without biofeedback (verbal feedback based on vaginal palpation; n = 74), or 8 weeks of self-administered Behavioral treatment using a self-help booklet (control condition; n = 75).Main Outcome MeasuresReduction in the number of incontinence episodes as documented in bladder diaries, patients' perceptions and satisfaction, and changes in quality of life.ResultsIntention-to-treat analysis showed that Behavioral Training with biofeedback yielded a mean 63.1% reduction (SD, 42.7%) in incontinence, verbal feedback a mean 69.4% reduction (SD, 32.7%), and the self-help booklet a mean 58.6% reduction (SD, 38.8%). The 3 groups were not significantly different from each other (P = .23). The groups differed significantly regarding patient satisfaction: 75.0% of the biofeedback group, 85.5% of the verbal feedback group, and 55.7% of the self-help booklet group reported being completely satisfied with treatment (P = .001). Significant improvements were seen across all 3 groups on 3 quality-of-life instruments, with no significant between-group differences.ConclusionsBiofeedback to teach pelvic floor muscle control, verbal feedback based on vaginal palpation, and a self-help booklet in a first-line Behavioral Training program all achieved comparable improvements in urge incontinence in community-dwelling older women. Patients' perceptions of treatment were significantly better for the 2 Behavioral Training interventions.