Prevalence and Consequences of Urinary Incontinence in People With Chronic Pulmonary Diseases Referred for Pulmonary Rehabilitation

Study Overview
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Brief Summary
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Urinary incontinence is a frequent chronic condition in general population. It is even more frequent in people with chronic respiratory disease due to several factors, including but not limited to frequent cough. Urinary incontinence may be more frequent during exercise so that it may contribute to the general deconditioning associated with chronic respiratory disease. Although pulmonary rehabilitation is a cornerstone in the management of people with chronic respiratory disease to break this spiral of worsening dyspnea, little is known about the prevalence of urinary incontinence among those people referred for pulmonary rehabilitation nor about its impact on the effects of the program.

Detailed Description
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Experimental design: People referred for pulmonary rehabilitation in two centres will be offer to participate in the study. Those people who will agree to participate and give their formal consent will be asked to answer two questionnaires about urinary incontinence symptoms (see outcomes) to assess the prevalence and the type of these symptoms. They will subsequently participate in their usual pulmonary rehabilitation program consisting in 90min sessions (including endurance training, muscle strengthening and self-management), 3x/week for 8weeks (centre 1) or 2x60min sessions (including the same components), 3x/week for 8weeks (centre 2). The effects of the pulmonary rehabilitation program on usual clinical outcomes (according to each centre routine practice; tests may differ between centres) will be compared between those people with or without urinary incontinence symptoms. As no prevalence data about urinary incontience was available at the time of study design, we planned to recruit the first 100 participants within the first year and to update the sample size calculation based on these preliminary data. Among the 70 people actually included, 21 (30%) experienced urinary incontinence. Therefore, assuming a true prevalence of 30% in this population and a total width for the 95% confidence interval of 10%, we planned to recruit a total 341 participants. The ethical approval to recruit this updated number of participants and to increase the duration of recruitment accordingly was obtained.

Official Title
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Prevalence and Consequences of Urinary Incontinence in People With Chronic Pulmonary Diseases Referred for Pulmonary Rehabilitation

Conditions
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Chronic Pulmonary Disease, Pulmonary Rehabilitation, Urinary Incontinence

Intervention / Treatment
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* Other: Pulmonary rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 ans ; Referred for pulmonary rehabilitation ; Non inclusion Criteria: History of pathology or prostate surgery ; Contra indication to pulmonary rehabilitation ; Exclusion Criteria: Pregnant woman or likely to be ; Patient under guardianship ; Patient withdrawal ; Did not complete at least 18 pulmonary rehabilitation sessions.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Prospective observational cohort<br>Every patient referred to pulmonary rehabilitation program will be eligible. They will will be asked to answer two questionnaires about urinary incontinence symptoms (see outcomes) to assess the prevalence and the type of these symptoms. They will subsequently participate in their usual pulmonary rehabilitation program consisting in 90min sessions (including endurance training, muscle strengthening and self-management), 3x/week for 8weeks (centre 1) or 2x60min sessions (including the same components), 3x/week for 8weeks (centre 2). | Other: Pulmonary rehabilitation<br>* Patients will be asked to answer two questionnaires about urinary incontinence symptoms (see outcomes) to assess the prevalence and the type of these symptoms. They will subsequently participate in their usual pulmonary rehabilitation program consisting in 90min sessions (including endurance training, muscle strengthening and self-management), 3x/week for 8weeks (centre 1) or 2x60min sessions (including the same components), 3x/week for 8weeks (centre 2).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of urinary incontinence symptoms | The prevalence of urinary incontinence symptoms will be assessed using the International Consultation on Incontinence Short Form | The questionnaire will be administered at baseline | 
| Prevalence of urinary incontinence symptoms | The prevalence of urinary incontinence symptoms will be assessed using the International Consultation on Incontinence Short Form | The questionnaire will be administered at the end of the program (8weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type of urinary incontinence symptoms | The type of urinary incontinence symptoms will be assessed using the Urinary Symptom Profile questionnaire. | The questionnaire will be administered at baseline | 
| Type of urinary incontinence symptoms | The type of urinary incontinence symptoms will be assessed using the Urinary Symptom Profile questionnaire. | The questionnaire will be administered at the end of the program (8weeks) | 
| Exercise capacity - Six-minute walk test (meters) | The six-minute walk test will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 25meters will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at baseline | 
| Exercise capacity - Six-minute walk test (meters) | The six-minute walk test will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 25meters will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at the end of the program (8weeks) | 
| Exercise capacity - Six-minute stepper test (steps) | The six-minute stepper test will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 20steps will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at baseline | 
| Exercise capacity - Six-minute stepper test (steps) | The six-minute stepper test will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 20steps will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at the end of the program (8weeks) | 
| Exercise capacity - Constant workload exercise testing | The constant workload exercise testing will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 101sec will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at baseline | 
| Exercise capacity - Constant workload exercise testing | The constant workload exercise testing will be performed before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 101sec will be compared between those people with or without urinary incontinence symptoms. | The test will be administered at the end of the program (8weeks) | 
| Quality of life - Saint Georges Respiratory Questionnaire (ranging from 0 to 100, higher score indicates worst quality of life) | The questionnaire will be administered before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 4points will be compared between those people with or without urinary incontinence symptoms. | The questionnaire will be administered at baseline | 
| Quality of life - Saint Georges Respiratory Questionnaire (ranging from 0 to 100, higher score indicates worst quality of life) | The questionnaire will be administered before and after the completion of the pulmonary rehabilitation program. In addition, the proportion of people who improve for more than 4points will be compared between those people with or without urinary incontinence symptoms. | The questionnaire will be administered at the end of the program (8weeks) | 
| Mood status - Anxiety | Anxiety will be assessed using the Hospital Anxiety and Depression Scale (ranging for 0 to 15, higher score indicates worst anxiety) | The questionnaire will be administered at baseline | 
| Mood status - Anxiety | Anxiety will be assessed using the Hospital Anxiety and Depression Scale (ranging for 0 to 15, higher score indicates worst anxiety) | The questionnaire will be administered at the end of the program (8weeks) | 
| Mood status - Depression | Depression will be assessed using the Hospital Anxiety and Depression Scale (ranging for 0 to 15, higher score indicates worst anxiety) | The questionnaire will be administered at baseline | 
| Mood status - Depression | Depression will be assessed using the Hospital Anxiety and Depression Scale (ranging for 0 to 15, higher score indicates worst anxiety) | The questionnaire will be administered at the end of the program (8weeks) |