A Cochrane review [Abstract] 1 included 18 studies which included a complex or educational intervention for nocturnal enuresis, with a total of 1 174 subjects. A complex intervention [such as dry bed training (DBT) or full spectrum home training (FSHT)] including an alarm was better than no-treatment control groups (eg RR for failure or relapse after stopping DBT 0.25; 95% CI 0.16 to 0.39) but there was not enough evidence about the effects of complex interventions alone if an alarm was not used. A complex intervention on its own was not as good as an alarm on its own or the intervention supplemented by an alarm (e.g. RR for failure or relapse after DBT alone versus DBT plus alarm 2.81; 95% CI 1.80 to 4.38). On the other hand, a complex intervention supplemented by a bed alarm might reduce the relapse rate compared with the alarm on its own (e.g. RR for failure or relapse after DBT plus alarm versus alarm alone 0.5; 95% CI 0.31 to 0.80). There was some evidence that direct contact between families and therapists enhanced the effect of a complex intervention.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and inadequate follow up) and by imprecise results (limited study size for each comparison).
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