A Cochrane review [Abstract] 1 included two studies with a total of 298 subjects. In both trials, the fixed schedule of toileting was combined with other interventions and its independent effect cannot be determined. One trial combined timed voiding with continence products, placement of a bedside commode for each participant, education to staff on transfer techniques, feedback and encouragement to staff and to participants, and administration of oxybutynin in small doses. The mean percentage of incontinent persons when checked daily was 20% in the intervention group compared with 80% in the control group receiving usual care. The other trial combined timed voiding with individualised medical management. Reduction of incontinence in the intervention group was statistically significant only for night-time wetting.
Another Cochrane review [Abstract] 2 included 4 studies with a total of 378 subjects. 3 studies compared habit retraining plus other treatment with usual care. Most of the 337 participants were care-dependent elderly women with concurrent cognitive and/or physical impairment. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers' perceptions of their level of stress. The fourth trial compared habit retraining alone with habit retraining plus an electronic monitoring device, aiming to identify episodes of incontinence more reliably. The 41 participants (25 women and 16 men; mean age 83 years) were from acute care rehabilitation wards. The data are too limited to provide reliable treatment after estimates. However, there is some evidence of less severe incontinence in the monitoring group.
A third Cochrane review [Abstract] 3 included 9 studies with a total of 674 elderly subjects. The limited evidence suggested that prompted voiding increased self-initiated voiding and decreased incontinence episodes in the short term. There was no evidence of long-term effects.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals), by limitations in study quality and by inconsistency (heterogeneity in interventions and outcomes).
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