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Interventions for urinary incontinence in women: survey and effects on population and patient level
Örebro University, School of Health and Medical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Urinary Incontinence is a common health problem that can cause both severe medical and social problems, resulting in negative impact on different aspects of Quality of Life. In 2000, the Swedish Council on Health Technology Assessment (SBU) published a systematic review, “Treatment of Urinary Incontinence” where multiple knowledge gaps in the field of UI, all of considerable clinical importance, were pointed out.Several of these knowledge gaps have been the starting points for the projects in this thesis. The overall aim has been to study the impact of different interventions for urinary incontinence in women on the population level but also on the patient group level, for assessessing the significance of UI on general living conditions and to validate instruments to measure quality of life to be used as part of the evaluation of treatment effectiveness.

Paper I: A population-based study where UI amongst women was found to be commonly associated with different psychosocial problems and an expressed feeling of vulnerability.

Paper II: A population-based study where informative material on UI to the general public in order to increase knowledge and encourage self management was found promising for meeting increasing demands and optimizing healthcare resources.

Paper III: A randomized controlled trial where both electrical stimulation and drug therapy reduced the number of micturitions and improved QoL in women with urge or urge incontinence, but electrical stimulation was not found to be superior to drug therapy.

Paper IV: A prospective cohort study where the international questionnaires UDI-6 and IIQ-7 after translation and validation, showed good responsiveness and were easy to administer and to fill out. The UDI-6 scale did not accomplish the same solid result in the psychometrical analysis as the IIQ-7 scale but both scales showed good responsiveness and can thereby be recommended for clinical use.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2011. , p. 74
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 51
Keywords [en]
Urinary incontinence, female, general living conditions, self-management, electrical stimulation, quality of life questionnaire
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-12631ISBN: 978-91-7668-778-9 (print)OAI: oai:DiVA.org:oru-12631DiVA, id: diva2:373620
Public defence
2011-02-11, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-12-01 Created: 2010-12-01 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Urinary incontinence in women is not exclusively a medical problem: a population-based study on urinary incontinence and general living conditions
Open this publication in new window or tab >>Urinary incontinence in women is not exclusively a medical problem: a population-based study on urinary incontinence and general living conditions
Show others...
2009 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, no 3, p. 226-232Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the study was to analyse differences in general health and general living conditions between women with and without urinary incontinence (UI).

MATERIAL AND METHODS: This cross-sectional population-based study was conducted in Orebro County, Sweden. A public health questionnaire, "Life and Health", was sent to a randomly selected sample of the population. The questionnaire consisted of 87 questions on broad aspects of general and psychiatric health. An additional questionnaire was enclosed for those respondents who reported experiencing UI. The data were analysed using binary logistic regression. The final study population constituted 4609 women, 1332 of whom had completed both questionnaires. The remaining 3277 had completed only the Life and Health questionnaire. Effect measures were odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

RESULTS: Statistically significant associations were found between UI and the occurrence of musculoskeletal pain (OR 1.45, 95% CI 1.20-1.76), fatigue and sleeping disorders (OR 1.59, 95% CI 1.30-1.95), feelings of humiliation (OR 1.29, 95% CI 1.12-1.50), financial problems (OR 1.36, 95% CI 1.11-1.66), and reluctance to seek medical care (OR 1.43, 95% CI 1.21-1.68).

CONCLUSION: UI among women is commonly associated with a number of different psychosocial problems as well as an expressed feeling of vulnerability.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2009
Keywords
Female, general health, living conditions, urinary incontinence
National Category
Urology and Nephrology Obstetrics, Gynecology and Reproductive Medicine Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-11773 (URN)10.1080/00365590902808566 (DOI)19308808 (PubMedID)2-s2.0-67649114475 (Scopus ID)
Available from: 2010-09-08 Created: 2010-09-08 Last updated: 2017-10-18Bibliographically approved
2. Urinary incontinence: evaluation of an information campaign directed towards the general public
Open this publication in new window or tab >>Urinary incontinence: evaluation of an information campaign directed towards the general public
2008 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 42, no 6, p. 534-538Article in journal (Refereed) Published
Abstract [en]

Objective. To study and evaluate the effect of an information campaign in the form of a brochure on urinary incontinence (UI) directed towards the general public, concerning knowledge, individual health behaviour, self-reported healthcare utilization and how the information was perceived.

Material and methods. Within a community in central Sweden a random sample of the population, in age groups from 18 years upwards, was selected from the population registry, resulting in a total sample of 3658 people. The study group was sent the brochure "Treatment of urinary incontinence", produced by SBU (Swedish Council on Technology Assessment in Health Care) in March 2003 and a questionnaire 1–2 months after the brochure was received.

Results. The overall response rate was 47.5%. Eighty per cent of the responders stated UI as an important health problem in society and 66% that they had gained new knowledge on UI. Twenty-eight per cent of the responders reported a current or previous history of UI, of whom 49% felt that they had received useful information for self-treatment and 21% had begun self-treatment.

Conclusion. This population-based study found that the distribution of a brochure on UI to the general public was well received and can be an efficient method to spread knowledge and encourage self-management. 

Keywords
Intervention, population-based study, self-management, urinary incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine; Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-3679 (URN)10.1080/00365590802229962 (DOI)000261174600006 ()18615365 (PubMedID)2-s2.0-56749107217 (Scopus ID)
Note

Funding agency:

Swedish Council on Technology Assessment in Healthcare 

Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2017-10-18Bibliographically approved
3. Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women: a randomized controlled trial
Open this publication in new window or tab >>Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women: a randomized controlled trial
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2010 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 21, no 12, p. 1517-1524Article in journal (Refereed) Published
Abstract [en]

Introduction and hypothesis: Few randomized controlled trials have compared electrical stimulation treatment with drug therapy. Our hypothesis was that electrical stimulation treatment in women with urgency/urge incontinence would be more efficient compared to drug treatment.

Methods: Women ≥18 years of age with urgency/urge incontinence were randomized to receive either ten electrical stimulation treatments vaginally and transanally over a period of 5-7 weeks or tolterodine 4 mg orally once daily.

Results: Sixty-one women completed the study. There was no significant difference between the two treatment groups in micturition rate from baseline to 6 months, mean difference, -0.40 (95% confidence interval (CI), -1.61 to 0.82), but a clearly significant difference within each group for electrical stimulation, -2.8 (95% CI, -3.7 to -1.9), and for tolterodine, -3.2 (95% CI, -4.1 to -2.4).

Conclusions: Both treatments reduced the number of micturitions, but electrical stimulation was not found to be superior to tolterodine.

Place, publisher, year, edition, pages
Berlin, Germany: Springer, 2010
Keywords
Electrical stimulation, pharmacological treatment, urge incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-12774 (URN)10.1007/s00192-010-1213-2 (DOI)000285026400012 ()20585755 (PubMedID)2-s2.0-78649984938 (Scopus ID)
Available from: 2010-12-22 Created: 2010-12-22 Last updated: 2018-04-19Bibliographically approved
4. Validation of the Swedish version of the Incontinence Impact Questionnaire, IIQ-7 and the Urogenital Distress Inventory, UDI-6.
Open this publication in new window or tab >>Validation of the Swedish version of the Incontinence Impact Questionnaire, IIQ-7 and the Urogenital Distress Inventory, UDI-6.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction and hypothesis:

The purpose was to validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Methods: We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with UI. Result:Test-retest reliability ranged from moderate to almost perfect. Cronbach’s alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at 6 months was moderate in the SUI group and small in the UUI+MUI group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at 6, 12, and 24 months for both groups. ConclusionThe Swedish UDI-6 and IIQ-7 show good responsiveness and are easy to administer and fill out. UDI-6 did not produce the same solid psychometrical results as IIQ-7, but both scales can be of clinical importance and are recommended for clinical use.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-12776 (URN)
Available from: 2010-12-22 Created: 2010-12-22 Last updated: 2017-10-18Bibliographically approved

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