Group treatments for sensitive health care problems: a randomised controlled trial of group versus individual physiotherapy sessions for female urinary incontinence

Se Lamb,Md Clark,R Lall,Ec Jørstad-Stein,J Fereday-Smith,L Hill,J Pepper

doi:10.1186/1472-6874-9-26

Se Lamb, Md Clark + Show 5 more

Open Access

https://doi.org/10.1186/1472-6874-9-26

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Abstract

BackgroundThe aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment.MethodsA pragmatic, multi-centre randomised controlled trial in five British National Health Service physiotherapy departments. 174 women with stress and/or urge incontinence were randomised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions. Outcome were measured as Symptom Severity Index; Incontinence-related Quality of Life questionnaire; National Health Service costs, and out of pocket expenses.ResultsThe majority of women expressed no preference (55%) or preference for individual treatment (36%). Treatment attendance was good, with similar attendance with both service delivery models. Overall, there were no statistically significant differences in symptom severity or quality of life outcomes between the models. Over 85% of women reported a subjective benefit of treatment, with a slightly higher rating in the individual compared with the group setting. When all health care costs were considered, average cost per patient was lower for group sessions (Mean cost difference £52.91 95%, confidence interval (£25.82 - £80.00)).ConclusionIndications are that whilst some women may have an initial preference for individual treatment, there are no substantial differences in the symptom, quality of life outcomes or non-attendance. Because of the significant difference in mean cost, group treatment is recommended.Trial RegistrationTrial Registration number: ISRCTN 16772662

Highlights

The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment
A large randomised controlled trial (RCT) from the Netherlands showed no difference in the physical responses to treatment between individual and group sessions, but did not consider quality of life, acceptability or cost [10]
If effectiveness can be demonstrated across a range of physical and health related quality of life outcomes, the group approach is potentially more cost-effective, provided that other important components of resource use are not increased, and women are not deterred from attending treatment

Summary

Introduction

The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms, quality of life, and costs, and to investigate the effect of patient preference on uptake and outcome of treatment. Pelvic floor exercises delivered in an individual consultation with a physiotherapist are effective in the management of stress-related and urge female urinary incontinence [6,7,8]. If effectiveness can be demonstrated across a range of physical and health related quality of life outcomes, the group approach is potentially more cost-effective, provided that other important components of resource use are not increased, and women are not deterred from attending treatment. The aim of this study was to undertake an appraisal of the acceptability, clinical effectiveness and relative costs of group versus individual treatment sessions in the management of female urinary incontinence.

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