Incondition

Plain English summary of protocol

Background and study aims
Urinary incontinence (UI) is one of the major problems in older adults with a high impact on quality of life, especially among older women in long-term care facilities. Although conservative treatment for UI, such as pelvic floor muscle training (PFMT) and bladder training (BT), have been proven effective in independent older adults, current practice for women in homes for the elderly focuses on managing the consequences by providing incontinence pads and toileting assistance instead of treating underlying conditions or causes of UI such as reduced mobility. Strategies such as prompted voiding (participants urinate according to a schedule) and individual physical training have been shown to have a positive effect on frail nursing home residents. These interventions significantly reduce the frequency of incontinence episodes and improve mobility endurance even in people with mental and physical impairments. The main disadvantages of these interventions are the increased workload for nursing staff and high costs which could obstruct large-scale implementation. For these reasons it would be worthwhile to develop a strategy that targets the main causes and risk factors of UI without increasing the workload for nursing staff in long-term care facilities. To evaluate such a strategy, we developed a group-based physical exercise program to be delivered by physical therapists. It consists of exercises that target the functional causes of UI both directly by strengthening of the pelvic floor muscles and bladder training, and indirectly by improving physical performance relevant to continence behavior. The aim of this study was to evaluate the effectiveness of this group-based program by improving functional performance in older women living in homes for the elderly.

Who can participate?
Older women with or without UI and physically and mentally capable of participating in the exercise program.

What does the study involve?
The Incondition program consisted of weekly, 1-hour training sessions for groups of 6–10 women over a period of 22 weeks. Each session consisted of behavioral instructions and physical exercises. The behavioral element aimed to improve the control of micturition (urination) by improving knowledge about continence, improving toilet behavior (position, relaxation etc.), BT, and PFMT including relaxation and breathing. The aim of the physical exercises was to increase the functional ability to use the toilet independently and in time. Exercises were kept functional and pleasant, and used materials to enhance compliance. The 30-minute exercise session included warming up, exercises to improve the mobility of the upper extremities, hand function, standing up and sitting down on a chair or bed, walking, and cooling down. Participants received a written leaflet containing guidelines on good toilet behavior and micturition. After each session, homework exercises were given, if possible on an individual basis, and evaluated at the start of the following session. The intervention was delivered by physical therapists specialized in PFMT and experienced in group training and affinity with older adults. The physical therapists received special training to carry out the intervention correctly. Taking part in this program for 1 year was compared with receiving care as usual (in most cases prescribing incontinence pads). Ten homes carried out the new program, ten provided care as usual.

What are the possible benefits and risks of participating?
Benefits included better physical performance to use the toilet independently and reduction of UI. Possible risks were minimal as the program was adapted to the current physical level of participants. In order to avoid the taboo surrounding UI in homes both women with and without UI could participate so it was not publicly known who had UI. If successful the program will be implemented in other homes.

Where is the study run from?
Twenty homes for the elderly will be contacted to join in this study. The Netherlands organization for applied sciences (TNO) will carry out the development and evaluation.

When is study starting and how long is it expected to run for?
The study started in February 2002 and recruitment started in 2003. The program ran for 6 months.

Who is funding the study?
It was funded by the Netherlands Health Research and Development Council, The Hague, The Netherlands.

Who is the main contact?
Erwin Tak
erwin.tak@tno.nl

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• Netherlands

Study participating centre

Sponsor information

Netherlands Health Research and Development Council (Netherlands)
Government

Laan van Nieuw Oost-Indië 334
The Hague
2593 CE
Netherlands

Phone	+31 (0) 70 349 51 11
Email	info@zonmw.nl
Website	http://www.zonmw.nl
"ROR"	https://ror.org/01yaj9a77

Funders

Funder type

Government

Results and Publications

Study outputs