Effectiveness of a nurse-led hybrid self-management program for community-dwelling older people with urinary incontinence: A randomized controlled trial.

BACKGROUND

Evidence-based guidelines recommend multicomponent interventions including behavior interventions and lifestyle interventions to optimize effects on the urinary incontinence in older people. However, few studies have trialed these interventions led by nurses in primary care setting using hybrid (offline and online) self-management strategies for community-dwelling older people with urinary incontinence.

OBJECTIVES

To evaluate the effectiveness of a nurse-led hybrid self-management program on self-efficacy, severity of urinary incontinence, urinary incontinence related knowledge and attitude, quality of life, adherence to pelvic floor muscle training and anxiety and depression among community-dwelling older people with urinary incontinence, compared to the existing usual nursing care.

DESIGN

A single-blind, two-arm parallel randomized controlled trial with a repeated measures design.

SETTINGS AND

PARTICIPANTS

We recruited community-dwelling older people with mild or moderate severity of urinary incontinence.

METHODS

Eligible participants were randomly assigned (1:1) to either the intervention group (a nurse-led hybrid self-management program) or usual care group (usual nursing care) in the primary care. Outcomes were measured at baseline (T0), 3 months (T1) and 6-months (T2) post-baseline.

RESULTS

Sixty-six participants were recruited and randomly assigned to the intervention group (N = 33) or the usual care group (N = 33). Of those, 95.5 % completed the 3-month follow-up after the completion of intervention. The intervention group demonstrated a statistically significant higher score of self-efficacy (Mean Difference (MD) = 45.3, 95 % CI: 38.9, 51.8, p < 0.001), urinary incontinence related knowledge (MD = 10.5, 95 % CI: 8.8, 12.2, p < 0.001), attitude (MD = 4.1, 95 % CI: 3.0, 5.1, p < 0.001), quality of life (MD = 19.3, 95 % CI: 15.4, 23.2, p < 0.001) and lower score of severity of urinary incontinence (MD = 4.1, 95 % CI: 2.8, 5.4, p < 0.001) than the usual care group at T2. The proportion with high adherence to pelvic floor muscle training was statistically significant larger in the intervention group than in the usual care group (33.3 % vs. 12.1 %, Risk Difference (RD) = 0.21, 95 % CI: 1.0, 12.9; χ2 = 4.23, p = 0.040) at T2. However, no statistically significant differences were observed in anxiety (MD = 0.3, 95 % CI: -1.6. 0.9, p = 0.600) and depression (p > 0.05) at T2.

CONCLUSION

The nurse-led hybrid self-management program demonstrated positive effects on the self-efficacy, severity of urinary incontinence, urinary incontinence related knowledge and attitude, adherence to pelvic floor muscle training and quality of life for community-dwelling older people with urinary incontinence.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR220005828, Registered 04/04/2022, first recruitment 04/10/2022, https://www.chictr.org.cn/showprojEN.html?proj=164661).