Schnelle J F, Traughber B, Sowell V A, Newman D R, Petrilli C O, Ory M
Middle Tennessee State University, Murfreesboro 37132.
J Am Geriatr Soc. 1989 Nov;37(11):1051-7. doi: 10.1111/j.1532-5415.1989.tb06919.x.
This study evaluated a treatment procedure in which 126 incontinent nursing home patients were checked on an hourly basis, asked if they needed toileting assistance (prompted), and socially reinforced for appropriate toileting. Urodynamic analysis (including cystometrogram), provocative stress test, and behavioral assessment revealed that the nursing home patients were severely debilitated, with 65% demonstrating bladder abnormalities, 87% incapable of independent toileting, and 25% failing to score on the Mini-Mental Status Exam (average score, 8.0). The treatment procedures were evaluated with a multiple baseline design in which subjects were randomly divided into immediate or delayed treatment groups after a baseline observation period. During treatment, the frequency of incontinence per 12 hours changed from a baseline average of 3.85 to a treatment average of 1.91. Three behavioral measures that can be easily collected by nursing staff significantly predicted continence levels during treatment (multiple R, 0.79) and change in incontinence during treatment (multiple R, 0.64). These prognostic criteria offer nursing staff a cost-effective method for selecting the most responsive patients for prompted-voiding treatment.
本研究评估了一种治疗程序，该程序对126名失禁的疗养院患者每小时进行一次检查，询问他们是否需要如厕协助（提示），并对适当的如厕行为给予社交强化。尿动力学分析（包括膀胱测压）、激发应激试验和行为评估显示，这些疗养院患者严重虚弱，65%表现出膀胱异常，87%无法独立如厕，25%在简易精神状态检查表上得分不及格（平均得分8.0）。采用多基线设计对治疗程序进行评估，在基线观察期后，将受试者随机分为立即治疗组或延迟治疗组。在治疗期间，每12小时的失禁频率从基线平均3.85次变为治疗平均1.91次。护理人员可以轻松收集的三项行为指标显著预测了治疗期间的控尿水平（复相关系数，0.79）和治疗期间失禁情况的变化（复相关系数，0.64）。这些预后标准为护理人员提供了一种经济有效的方法，用于选择对提示排尿治疗反应最灵敏的患者。
