McDowell B J, Engberg S, Sereika S, Donovan N, Jubeck M E, Weber E, Engberg R
University of Pittsburgh School of Nursing, Pennsylvania 15261, USA.
J Am Geriatr Soc. 1999 Mar;47(3):309-18. doi: 10.1111/j.1532-5415.1999.tb02994.x.
To examine the (1) short-term effectiveness of behavioral therapies in homebound older adults and (2) characteristics of responders and nonresponders to the therapies.
Prospective, controlled clinical trial with cross-over design.
Adults aged 60 and older with urinary incontinence and who met Health Care Financing Administration criteria for being homebound were referred to the study by homecare nurses from two large Medicare-approved home health agencies in a large metropolitan county in southwestern Pennsylvania.
Structured continence and medical history, OARS Physical and Instrumental Activities of Daily Living scales, Folstein Mini-Mental State Examination Score, Clock Drawing Test, Geriatric Depression Scale, Performance-Based Toileting Assessment, bladder diaries, and physical examination.
One hundred five subjects were randomized to biofeedback-assisted pelvic floor muscle training (53 to the treatment group and 52 to the control groups). Control subjects with complete pre- and post-control data (n = 45) experienced a median 6.4% reduction in urinary accidents in contrast to a median 75.0% reduction in subjects with complete pre- and post-treatment data (n = 48, P < .001). Following the control phase, subjects crossed over to the treatment protocol. Eighty-five subjects completed treatment, achieving a median 73.9% reduction in UI. Exercise adherence was the most consistent predictor of responsiveness to the behavioral therapy.
Clinically significant reductions in urinary incontinence are achievable with behavioral therapies in many cognitively intact homebound older adults despite high levels of co-morbidity and functional impairment.
探讨（1）行为疗法对居家老年人的短期疗效，以及（2）治疗反应者和无反应者的特征。
采用交叉设计的前瞻性对照临床试验。
宾夕法尼亚州西南部一个大都市县的两家大型医疗保险批准的家庭健康机构的家庭护理护士，将年龄在60岁及以上、患有尿失禁且符合医疗保健财务管理局居家标准的成年人转介到该研究。
结构化的尿失禁及病史、OARS身体和日常生活工具性活动量表、Folstein简易精神状态检查评分、画钟试验、老年抑郁量表、基于表现的如厕评估、膀胱日记和体格检查。
105名受试者被随机分为生物反馈辅助盆底肌肉训练组（53人进入治疗组，52人进入对照组）。有完整对照前后数据的对照组受试者（n = 45）尿失禁事故中位数减少6.4%，而有完整治疗前后数据的受试者（n = 48）尿失禁事故中位数减少75.0%（P < .001）。在对照阶段之后，受试者交叉进入治疗方案。85名受试者完成治疗，尿失禁中位数减少73.9%。运动依从性是行为疗法反应性最一致的预测指标。
尽管存在高度的共病和功能障碍，但行为疗法可使许多认知功能完好的居家老年人的尿失禁得到临床上显著的减轻。
