So Aeyoung, De Gagne Jennie C, Park Sunah
Aeyoung So, PhD, MPH, RN, Department of Nursing, Gangneung-Wonju National University, Wonju, South Korea. Jennie C. De Gagne, PhD, DNP, RN-BC, CNE, ANEF, FAAN, Duke University School of Nursing, Durham, North Carolina. Sunah Park, PhD, RN, Department of Nursing, Gangneung-Wonju National University, Wonju, South Korea.
J Wound Ostomy Continence Nurs. 2019 Jan/Feb;46(1):55-61. doi: 10.1097/WON.0000000000000498.
The purpose of the study was to examine the long-term effects of a urinary incontinence (UI) self-management program for older women on the severity, knowledge, and attitudes regarding UI.
This was a quasi-experimental design (nonrandomized trial) with intervention and comparison groups.
Participants were recruited from a primary health care facility in rural Korea. Forty-four older women with UI were assigned to either the intervention or the control group. Of 44 participants, 26 (17 experimental and 9 control) completed the study: 7 participants did not meet inclusion criteria (eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation), and 6 dropped out of the intervention group because of admission to hospital, hearing problems, difficulty traveling to meetings, and disinterest in the program. Five subjects in the comparison group were lost to follow-up.
The intervention group (n = 17) underwent a 5-session UI self-management educational program held once weekly. Its contents included a lecture, instruction on pelvic muscle exercises, and assignments related to action plans (exercises and a daily bladder diary). The study's main outcome measures were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, along with knowledge and attitudes toward UI measured by the UI knowledge scale (UIKS) and UI attitude scale (UIAS). Data were collected at baseline, immediately following the intervention, and at the 1-year follow-up. Repeated-measures analysis of variance was used to analyze changes in ICIQ-SF, UIKS, and UIAS scores over time.
A significant improvement in UI severity was found in the intervention group, who showed a gradually decreasing ICIQ-SF score from at pretest to 5 weeks and 12 months, while it increased over the 12-month period in the control group (main effect of group, F = 17.31, P < .001; main effect of time, F = 8.45, P = .001; interaction effect, F = 22.54, P < .001). There was no significant improvement in UIKS scores over time. Scores on the UIAS changed significantly over time in the experimental group (χ = 6.76, P = .034), but the mean score at 1-year follow-up (mean ± standard deviation: 2.61 ± 0.56) was lower than the mean score at baseline (2.64 ± 0.19).
Study findings suggest that the UI self-management educational program is effective for improving UI and related lower urinary tract symptoms and feasible to conduct as a long-term intervention program for older women living in communities. However, strategies for a systematic follow-up management are needed for long-term retention of improved UI knowledge and attitudes toward incontinence.
本研究旨在探讨一项针对老年女性的尿失禁自我管理项目对尿失禁严重程度、相关知识及态度的长期影响。
这是一项采用干预组和对照组的准实验设计（非随机试验）。
参与者来自韩国农村的一家初级卫生保健机构。44名患有尿失禁的老年女性被分配至干预组或对照组。44名参与者中，26名（17名干预组和9名对照组）完成了研究：7名参与者不符合纳入标准（ eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation），6名干预组参与者因住院、听力问题以及参加会议出行困难和对该项目不感兴趣而退出。对照组有5名受试者失访。
干预组（n = 17）参加了为期5节、每周一次的尿失禁自我管理教育项目。其内容包括讲座、盆底肌锻炼指导以及与行动计划相关的作业（锻炼和每日膀胱日记）。本研究的主要结局指标为国际尿失禁咨询委员会简表（ICIQ - SF）评分，以及通过尿失禁知识量表（UIKS）和尿失禁态度量表（UIAS）测量的对尿失禁的知识和态度。在基线、干预结束后即刻以及1年随访时收集数据。采用重复测量方差分析来分析ICIQ - SF、UIKS和UIAS评分随时间的变化。
干预组尿失禁严重程度有显著改善，从预测试到5周及12个月时ICIQ - SF评分逐渐降低，而对照组在12个月期间评分升高（组间主效应，F = 17.31，P <.001；时间主效应，F = 8.45, P =.001；交互效应，F = 22.54，P <.001）。UIKS评分随时间无显著改善。实验组UIAS评分随时间有显著变化（χ = 6.76，P =.034），但1年随访时的平均评分（均值±标准差：2.61±0.56）低于基线时的平均评分（2.64±0.19）。
研究结果表明，尿失禁自我管理教育项目对于改善尿失禁及相关下尿路症状有效，并且作为针对社区老年女性的长期干预项目是可行的。然而，需要制定系统的随访管理策略，以长期保持改善后的尿失禁知识和对尿失禁的态度。
