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  • 1.
    Franzén, Karin
    Örebro University, School of Health and Medical Sciences.
    Interventions for urinary incontinence in women: survey and effects on population and patient level2011Doctoral 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.

    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
    Show others...
    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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  • 2.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Johansson, Jan Erik
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Jan
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Validation of the Swedish version of the Incontinence Impact Questionnaire, IIQ-7 and the Urogenital Distress Inventory, UDI-6.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.

  • 3.
    Franzén, Karin
    et al.
    Department of Clinical Medicine and Section of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Department of Clinical Medicine and Section of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Andersson, Gunnel
    Department of Clinical Medicine and Section of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Nilsson, Kerstin
    Department of Clinical Medicine and Section of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Urinary incontinence: evaluation of an information campaign directed towards the general public2008In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 42, no 6, p. 534-538Article in journal (Refereed)
    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. 

  • 4.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences. 2 Obstetrics and Gynaecology, Örebro County Council, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences. Urology, Örebro University Hospital, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences. Urology, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Nicklas
    Department of Statistics, Stockholm University, Stockholm, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Obstetrics and Gynaecology,Örebro County Council, Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
    Urinary incontinence in women is not exclusively a medical problem: a population-based study on urinary incontinence and general living conditions2009In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, no 3, p. 226-232Article in journal (Refereed)
    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.

  • 5.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Karlsson, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, p. 555-561Article in journal (Refereed)
    Abstract [en]

    Objective. To validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Design and setting. Prospective study, university hospital. Population and method. We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with urinary incontinence. Main outcome measures. Construct and criterion validity, reliability via test-retest and internal consistency. Responsiveness via calculation of effect size. 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 six months was moderate in the Stress Urinary Incontinence group and small in the Urge Urinary Incontinence + Mixed Urinary Incontinence group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at six, 12, and 24 months for both groups. Conclusion. The UDI-6 scale did not produce the same solid result in the psychometric analysis as the IIQ-7 scale, but these newly translated Swedish forms of UDI-6 and IIQ-7 show good responsiveness and are easy to administer and to fill out.

  • 6.
    Franzén, Karin
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden; Ctr Assessment Med Technol, Örebro Cty Council, Örebro, Sweden.
    Lauridsen, Inger
    Dept Urol, Torsby Hosp, Torsby, Sweden.
    Canelid, Jill
    Dept Obstet & Gynaecol, Karlstad Hosp, Karlstad, Sweden.
    Heiwall, Bengt
    Dept Obstet & Gynaecol, Karlstad Hosp, Karlstad, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden; Ctr Assessment Med Technol, Örebro Cty Council, Örebro, Sweden.
    Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women: a randomized controlled trial2010In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 21, no 12, p. 1517-1524Article in journal (Refereed)
    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.

  • 7.
    Franzén, Karin M
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Odeberg, Jenny
    Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden.
    Midlöv, Patrik
    Center for Primary Health Care Research, Lund University, Malmö, Sweden.
    Samuelsson, Eva
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Stenzelius, Karin
    Department of Care Science, Malmö University, Malmö, Sweden.
    Hammarström, Margareta
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Surgery for urinary incontinence in women 65 years and older: a systematic review2015In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 26, no 8, p. 1095-1102Article in journal (Refereed)
    Abstract [en]

    Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.

    Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.

    The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.

    Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.

    Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.

  • 8.
    Jansson, Markus
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Development and validation of a protocol for documentation of obstetric perineal lacerations2019In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 30, no 12, p. 2069-2076Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.

    METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.

    RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.

    CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.

  • 9.
    Samuelsson, Eva
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Odeberg, Jenny
    Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden .
    Stenzelius, Karin
    Department of Care Science, Malmö University, Malmö, Sweden.
    Molander, Ulla
    Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hammarström, Margareta
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden .
    Franzén, Karin M
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Midlöv, Patrik
    Center for Primary Health Care Research, Lund University, Malmö, Sweden .
    The effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review2015In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 15, no 5, p. 521-534Article in journal (Refereed)
    Abstract [en]

    Aim: The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits ofpharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review theefficacy of pharmacological treatment for UI in the elderly and frail elderly.

    Methods: We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 toidentify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged ≥65 years.Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of lifeand adverse events.

    Results: We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderatequality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in thefrail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trialsevaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased(standard mean difference: −0.24, 95% confidence interval −0.32–0.15), corresponding to a reduction of half a leakageper 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluationof the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. Noeligible studies on mirabegron and estrogen were found.

    Conclusions: Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI.Treatment with drugs for UUI in the frail elderly is not evidence based.

  • 10.
    Stenzelius, Karin
    et al.
    Faculty of Health and Society, Malmö University, Skåne University Hospital, Malmö, Sweden.
    Molander, Ulla
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Odeberg, Jenny
    SBU-The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Hammarström, Margareta
    Department of Gynecology and Obstetrics, Childrens and Youth Hospital of Queen Silvia, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Franzen, Karin M.
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Gynecology and Obstetrics, Örebro University Hospital, Örebro, Sweden.
    Midlöv, Patrik
    Clinical Research Centre (CRC), Skåne University Hospital, Malmö, Sweden.
    Samuelsson, Eva
    Family Medicine, Department of Public Health and Clinical medicine, Umeå University, Umeå, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 5, p. 736-744Article in journal (Refereed)
    Abstract [en]

    Background: urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment.

    Objective: the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons.

    Methods: a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis.

    Results: documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited.

    Conclusions: this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.

  • 11.
    Wadensten, T.
    et al.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden.
    Nyström, E.
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Umeå University, Sweden.
    Franzén, Karin
    Örebro University, School of Medical Sciences.
    Stenzelius, K.
    Department of Care Sciences, Malmö University, Malmö, Sweden; Skåne University Hospital, Malmö/Lund, Sweden.
    Lindam, A.
    Unit of Research, Education, and Development, Östersund Hospital, Östersund, Sweden.
    Samuelsson, E.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden.
    A smartphone app for self-management of urgency and mixed urinary incontinence: a randomized controlled trial2019In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 38, no S3, p. S361-S363Article in journal (Other academic)
  • 12.
    Wadensten, T.
    et al.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Nyström, E.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Women’s Clinic, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Stenzelius, K.
    Department of Care Sciences, Malmö University, Malmö, Sweden; Skåne University Hospital, Malmö/Lund, Sweden.
    Malmberg, L.
    Skåne University Hospital, Malmö/Lund, Sweden.
    Samuelsson, E.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    DEVELOPMENT AND USE OF AN ALGORITHM FOR IDENTIFYING WOMEN WITH URGENCY OR MIXED URINARY INCONTINENCE SUITABLE FOR E-HEALTH TREATMENT2018In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 37, no Suppl. 5, p. S72-S74Article in journal (Other academic)
  • 13.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease2016In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed)
    Abstract [en]

    Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

    Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

    Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

    Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

  • 14.
    Wijk, Lena
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden; Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Surg.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, p. 749-756Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

    Design: Observational study.

    Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

    Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

    Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

    Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

    Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

    Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

  • 15.
    Hammarström, Margareta (Creator)
    Södersjukhuset, Stockholm, Sweden.
    Andersson, Gunnel (Creator)
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro universitetssjukhus, Örebro, Sweden.
    Anttila, Sten (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Davidsson, Thomas (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Franzén, Karin (Creator)
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro universitetssjukhus, Örebro, Sweden.
    Gustafsson, Elisabeth (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Gyllensvärd, Harald (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Malmberg, Lars (Creator)
    Skånes universitetssjukhus, Malmö/Lund, Sweden.
    Midlöv, Patrik (Creator)
    Lunds universitet, Lund, Sweden.
    Molander, Ulla (Creator)
    Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Odeberg, Jenny (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Olofsson, Hanna (Creator)
    Statens beredning för medicinsk utvärdering (SBU), Stockholm, Sweden.
    Sahlin, Nils-Eric (Creator)
    Lunds universitet, Lund, Sweden.
    Samuelsson, Eva (Creator)
    Umeå universitet, Umeå, Sweden.
    Stenzelius, Karin (Creator)
    Skånes universitetssjukhus, Malmö, Sweden; Malmö högskola, Malmö, Sweden.
    Behandling av urininkontinens hos äldre och sköra äldre: en systematisk litteraturöversikt2013Report (Refereed)
1 - 15 of 15
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