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Objectives: The primary objective of this cluster randomised controlled
trial was to compare the effectiveness of the three experimental
continence promotion interventions against a control intervention on
urinary symptom improvement in older women with untreated incontinence
recruited from community organisations. Setting: 71 community
organisations across the United Kingdom Participants: 259 women aged 60
years and older with untreated incontinence entered the trial; 88%
completed the 3-month follow-up. Interventions: The three active
interventions consisted of a single 60-minute group workshop on 1)
continence education (20 clusters, 64 women); 2) evidence-based
self-management (17 clusters, 70 women); or 3) combined education and
self-management (17 clusters, 61 women). The control intervention was a
single 60-minute educational group workshop on memory loss, polypharmacy
and osteoporosis (17 clusters, 64 women). Primary and secondary outcome
measures: The primary outcome was self-reported improvement in
incontinence 3 months post-intervention at the level of the individual.
The secondary outcome was change in the International Consultation on
Incontinence Questionnaire (ICIQ). Changes in incontinence-related
knowledge and behaviours were also assessed. Results: The highest rate of
urinary symptom improvement occurred in the combined intervention group
(66% vs 11% of the control group, prevalence difference 55%, 95% CI
43%-67%, intracluster correlation 0). Thirty percent versus 6% of
participants reported significant improvement respectively (prevalence
difference 23%, 95% CI 10%-36%, intracluster correlation 0). The
number-needed-to-treat was 2 to achieve any improvement in incontinence
symptoms, and 5 to attain significant improvement. Compared to controls,
the combined group reported an adjusted mean 2.05 point (95% CI 0.87-3.24)
greater improvement on the ICIQ. Changes in knowledge and self-reported
risk-reduction behaviours paralleled rates of improvement in all
intervention arms. Conclusion: Continence education combined with
evidence-based self-management improves symptoms of incontinence among
untreated older women. Community organisations represent an untapped
vector for delivering effective continence promotion interventions.
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