Predictors of response and adherence to enuresis alarm therapy-a confirmatory study.

Abstract

To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently. We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own. We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554). Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.