Abstract
BackgroundUrinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents’ dignity and quality of life. CHs predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe and low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in CHs is not known. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences.MethodsThis is a pragmatic, multicentre, placebo-controlled, randomised parallel-group trial comparing the effectiveness of TPTNS (target n = 250) with sham stimulation (target n = 250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff-reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-h Pad Weight Tests, post void residual urine (bladder scans), Patient Perception of Bladder Condition, Minnesota Toileting Skills Questionnaire and Dementia Quality of Life. Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors, and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers.DiscussionTPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication.Trial registrationClinicalTrials.gov, NCT03248362. Registered on 14 August 2017.ISRCTN, ISRCTN98415244. Registered on 25 April 2018. https://www.isrctn.com/.
Highlights
The highest prevalence of urinary incontinence (UI), defined by the International Continence Society as ‘any involuntary loss of urine’ [1], is found in residential or nursing care homes (CHs)
The ELECTRIC trial will: 1. Establish whether Transcutaneous posterior tibial nerve stimulation (TPTNS) is more effective than sham stimulation for reducing the volume of Urinary incontinence (UI) at 6, 12 and 18 weeks, in CH residents
The primary outcome, measured at 6 weeks post randomisation, will be analysed using linear multivariable regression correcting for baseline 24- h Pad Weight Test (PWT), the stratification design variables and other prognostic variables; all models will include a random effect for CH
Summary
Background and rationale The highest prevalence of urinary incontinence (UI), defined by the International Continence Society as ‘any involuntary loss of urine’ [1], is found in residential or nursing care homes (CHs). UI is distressing for older adults and profoundly impacts on dignity and quality of life [2]. It is associated with impaired physical functioning [3], cognitive impairment [3, 4], sleep disturbance [2], falls [5, 6], fractures [7], urinary tract infection (UTI) [8] and hygiene and tissue viability problems [9]. Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CHs) and profoundly impacts on residents’ dignity and quality of life. The ELECTRIC trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in CH residents and investigate the associated costs and consequences
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
