Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: a systematic review of systematic reviews. The SENATOR project ONTOP series

Kirsty A Kilpatrick, Pamela Paton, Selvarani Subbarayan, Carrie Stewart, Iosief Abraha, Alfonso J. Cruz-Jentoft, Denis O’Mahony, Antonio Cherubini, Roy L Soiza* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group.
Objective: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons.
Methods: A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane by June 2018. Primary trials with a population mean age ≥65years were identified with subsequent data extraction and risk of bias assessment. Qualitative analysis and meta-analysis, when possible, were undertaken followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons.
Results: Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95%CI 0.69-1.45) and 0.74 (95%CI 0.42-1.06) episodes per day respectively, evidence grade ‘moderate’). Evidence for other interventions was limited and of insufficient quality.
Conclusions: There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
Original languageEnglish
JournalMaturitas
Early online date23 Dec 2019
DOIs
Publication statusE-pub ahead of print - 23 Dec 2019

Fingerprint

Urinary Incontinence
Acupuncture
Exercise Therapy
Caffeine
Group Psychotherapy
Meta-Analysis
Therapeutics
Electric Stimulation Therapy
Transcutaneous Electric Nerve Stimulation
Tibial Nerve
Habits
Software
Outcome Assessment (Health Care)
Databases
Population

Keywords

  • aging
  • incontinence
  • meta-analysis
  • stress incontinence
  • urge incontinence

Cite this

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons : a systematic review of systematic reviews. The SENATOR project ONTOP series. / Kilpatrick, Kirsty A; Paton, Pamela; Subbarayan, Selvarani; Stewart, Carrie; Abraha, Iosief; Cruz-Jentoft, Alfonso J. ; O’Mahony, Denis ; Cherubini, Antonio; Soiza, Roy L (Corresponding Author).

In: Maturitas, 23.12.2019.

Research output: Contribution to journalArticle

Kilpatrick, Kirsty A ; Paton, Pamela ; Subbarayan, Selvarani ; Stewart, Carrie ; Abraha, Iosief ; Cruz-Jentoft, Alfonso J. ; O’Mahony, Denis ; Cherubini, Antonio ; Soiza, Roy L. / Non-pharmacological, non-surgical interventions for urinary incontinence in older persons : a systematic review of systematic reviews. The SENATOR project ONTOP series. In: Maturitas. 2019.
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abstract = "Background: Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. Objective: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. Methods: A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane by June 2018. Primary trials with a population mean age ≥65years were identified with subsequent data extraction and risk of bias assessment. Qualitative analysis and meta-analysis, when possible, were undertaken followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. Results: Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95{\%}CI 0.69-1.45) and 0.74 (95{\%}CI 0.42-1.06) episodes per day respectively, evidence grade ‘moderate’). Evidence for other interventions was limited and of insufficient quality. Conclusions: There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.",
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author = "Kilpatrick, {Kirsty A} and Pamela Paton and Selvarani Subbarayan and Carrie Stewart and Iosief Abraha and Cruz-Jentoft, {Alfonso J.} and Denis O’Mahony and Antonio Cherubini and Soiza, {Roy L}",
note = "This work was supported by the European Union Seventh Framework program (FP7/2007–2013) under grant agreement n° 305930",
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T1 - Non-pharmacological, non-surgical interventions for urinary incontinence in older persons

T2 - a systematic review of systematic reviews. The SENATOR project ONTOP series

AU - Kilpatrick, Kirsty A

AU - Paton, Pamela

AU - Subbarayan, Selvarani

AU - Stewart, Carrie

AU - Abraha, Iosief

AU - Cruz-Jentoft, Alfonso J.

AU - O’Mahony, Denis

AU - Cherubini, Antonio

AU - Soiza, Roy L

N1 - This work was supported by the European Union Seventh Framework program (FP7/2007–2013) under grant agreement n° 305930

PY - 2019/12/23

Y1 - 2019/12/23

N2 - Background: Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. Objective: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. Methods: A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane by June 2018. Primary trials with a population mean age ≥65years were identified with subsequent data extraction and risk of bias assessment. Qualitative analysis and meta-analysis, when possible, were undertaken followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. Results: Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95%CI 0.69-1.45) and 0.74 (95%CI 0.42-1.06) episodes per day respectively, evidence grade ‘moderate’). Evidence for other interventions was limited and of insufficient quality. Conclusions: There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.

AB - Background: Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. Objective: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. Methods: A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane by June 2018. Primary trials with a population mean age ≥65years were identified with subsequent data extraction and risk of bias assessment. Qualitative analysis and meta-analysis, when possible, were undertaken followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. Results: Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95%CI 0.69-1.45) and 0.74 (95%CI 0.42-1.06) episodes per day respectively, evidence grade ‘moderate’). Evidence for other interventions was limited and of insufficient quality. Conclusions: There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.

KW - aging

KW - incontinence

KW - meta-analysis

KW - stress incontinence

KW - urge incontinence

U2 - 10.1016/j.maturitas.2019.12.010

DO - 10.1016/j.maturitas.2019.12.010

M3 - Article

JO - Maturitas

JF - Maturitas

SN - 0378-5122

ER -