Comparing Mindfulness-Based Stress Reduction With the Health Enhancement Program in the Treatment of Urinary Urge Incontinence in Older Adult Women: A Pilot Feasibility and Randomized Controlled Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Urinary Incontinence, Urge
- Sponsor
- University of Utah
- Enrollment
- 25
- Locations
- 1
- Primary Endpoint
- number of participants who completed each week's homework practice
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of this study is to examine the feasibility of conducting a pilot randomized controlled trial comparing mindfulness-based stress reduction with the health enhancement program on symptoms of urinary urge incontinence in older adult women, and to establish preliminary efficacy of these two approaches on symptoms of urinary urge incontinence.
Detailed Description
The overarching goal of this research is to evaluate potential treatment options for older women with symptoms of urinary urge incontinence, with a specific focus on Mindfulness-Based Stress Reduction, a promising therapeutic approach in preliminary studies and one increasingly used to treat symptoms associated with brain-visceral interactions. Feasibility and preliminary efficacy will be tested in two randomized study arms: a Mindfulness-Based Stress Reduction intervention group and a Health Enhancement Program intervention comparison group. This research study will explore the feasibility and preliminary efficacy of treating urinary urge incontinence in older adult women with mindfulness-based stress reduction in comparison to the health enhancement program through a randomized controlled pilot study. Feasibility determinants will include both research feasibility (recruitment, retention, treatment fidelity) and intervention feasibility (acceptability, tolerability, treatment adherence). Clinical outcomes to evaluate preliminary intervention efficacy will include severity of urinary urge incontinence symptoms, bother of urinary urge incontinence symptoms, perceived stress, and perceived level of self-efficacy of self-management of urinary urge incontinence symptoms. Preliminary efficacy of the intervention will also be evaluated with the Patient Global Impression of Improvement, a process measure that rates the patient's "response of a condition to a therapy" (Ryan, n.d., p. 1). This combined pilot feasibility study and randomized controlled trial will evaluate specific factors crucial to the success of a large trial to evaluate the effect of Mindfulness-Based Stress Reduction on urinary urge incontinence in older adult women. Moore (2011) recommended that the pilot study design parallel the future larger study, particularly when evaluating feasibility in the pilot study. The capacity for hypothesis testing, or establishing causal inference is limited in a pilot study due to insufficient power; however, the information from efficacy testing is vital in informing future larger scale clinical trials. This study will serve as a necessary step for the development of effectiveness trials of Mindfulness-Based Stress Reduction in treatment of urinary urge incontinence in older adult women by informing and guiding evaluation, implementation, and dissemination.
Investigators
Katarina Felsted
Assistant Professor
University of Utah
Eligibility Criteria
Inclusion Criteria
- •The following eligibility criteria must be met for the potential participant to be considered for enrollment.
- •The study is enrolling older adult women, with urinary urge incontinence.
- •They cannot be currently treating their urinary urge incontinence with medication as this will confound results.
- •Women who have attempted more extreme treatments and are still experiencing urinary urge incontinence will not be considered as potential participants, as it is unlikely that mindfulness-based stress reduction would treat urinary urge incontinence that is refractory to that degree.
- •Participants must be English speaking, as the interventions and homework will be delivered in English.
- •postmenopausal women
- •Urge predominant urinary incontinence, defined as score of ≥ 3 (moderate to severe urinary incontinence) on the Incontinence Severity Index
- •Urge predominant urinary incontinence as determined by question 3 on the 3 Incontinence Questions. The 3 Incontinence Questions has been shown to be a quick and accurate way of diagnosing stress, urge or mixed incontinence in most cases
- •Has experienced urinary urge incontinence symptoms for at least three months
- •Committed to attend 8 weekly sessions and one half day retreat between weeks 6 and 7
Exclusion Criteria
- •The following exclusions are applied, as they could seriously limit participation or confound participant response to the intervention:
- •Predominantly stress, mixed, or other type of incontinence as determined by question 3 on the 3 Incontinence Questions
- •Currently taking medications for Alzheimer's disease or other dementias; these medications could interfere with their participation
- •Known neurologic disease acknowledged to impact bladder function including Parkinson's disease, spinal cord injury, or stroke affecting urinary control; these diseases provide cause for urinary urge incontinence and as such the participant would be unlikely to benefit from the intervention
- •Current symptomatic urinary tract infection that has not resolved prior to the start of intervention
- •Current bladder infection that has not resolved prior to the start of intervention
- •Use of an assistive device for ambulation (such as a cane, walker, or wheelchair) and feels that difficulties with bladder management are related to the slowed time in visiting the restroom ("Was urinary urge incontinence a problem before you began using the assistive device?")
- •Functionally incontinent, in other words, having a mental or physical condition that prevents a person from visiting the restroom in time
- •Ever diagnosed with interstitial cystitis
- •Self-report of vaginal bulge protruding outside of the vagina
Outcomes
Primary Outcomes
number of participants who completed each week's homework practice
Time Frame: 8 weeks
participants mark on homework practice log and submit weekly
consent rate
Time Frame: 10 weeks
number of participants who are willing to sign consent document at enrollment interview; number who pass the Montreal Cognitive Assessment and are willing to sign consent document
number of dropouts due to stated distress from or dislike of either intervention experience (as opposed to someone needing to withdraw due to a family emergency or illness)
Time Frame: 8 weeks
participant self-report of what made the intervention challenging - why they were unable or unwilling to complete the course
positive or negative coded responses to the question "How did it go today?"
Time Frame: 8 weeks
data coded from two participants' responses after each class in each arm
number of potential participants who are eligible to enroll
Time Frame: 10 weeks
number of people who passed the screening process via calls or emails
Number of potential participants contacted
Time Frame: 10 weeks
number of people who contacted PI during recruitment process, including the place they heard about the study
number of enrolled participants completing the study
Time Frame: 12 weeks
number of participants who attended at least five of nine classes number of excused absences number of unexcused absences
percentage of course content delivered during intervention
Time Frame: 44 weeks
weekly interventionist report on what was taught participants perception of course content delivered measured by a checklist of concepts covered in the weekly interventions at study completion
number of participants recruited for enrollment
Time Frame: 10 weeks
potential participants who were interested in the study
number of participants enrolled
Time Frame: 10 weeks
number of people who enrolled into the study
- number of minutes of homework practice each week
Time Frame: 8 weeks
totaled from daily numbers reported by participant
Secondary Outcomes
- change in perceived self-efficacy(16 weeks, 6 months)
- self report of rate and trajectory of change in participant impression of improvement(16 weeks, 6 months)
- change in symptom severity(16 weeks, 6 months)
- change in symptom bother(16 weeks, 6 months)
- change in perceived stress(16 weeks, 6 months)