Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms

Study Overview
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Brief Summary
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This three-site randomized controlled trial compares the effectiveness and cost-effectiveness of a group-administered behavioral treatment program to no treatment. Women with stress, urgency, or mixed urinary incontinence will be recruited and screened centrally, evaluated clinically at each of three study sites, and random assigned to one of two treatment arms: 1. Group behavioral treatment or 2. No treatment. Group treatment modalities have the potential to reach a larger population of older women with urinary incontinence, not only in the traditional medical settings, but also in community settings. The investigators hypothesize that group behavioral treatment will be more effective than no treatment. The investigators hypothesize that the group treatment will be cost-effective compared to no treatment.

Official Title
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Group Learning Achieves Decreased Incidents of Lower Urinary Symptoms

Conditions
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Urinary Incontinence, Stress, Urinary Incontinence, Urge

Intervention / Treatment
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* Behavioral: Group Behavioral Treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female Aged 55 years or older Ability to understand, read and write English Stress, urgency, or mixed urgency and stress urinary incontinence (UI) (by self report) On the International Consultation on Incontinence Modular Questionnaire - Short Form (ICIQ UI-SF), frequency of leakage at least a 1 (about once a week or less often) on item #1 and volume of urine loss at least a 2 (a small amount) on item #2. Symptoms of three months duration or longer (on history) Passing score (i.e., categorized as probably not demented) on the MiniCog Test Timed Up and Go Test (TUG) score of 20 seconds or less Willing to undergo vaginal/pelvic examination Signed informed consent form Exclusion Criteria: History of renal, bladder, uterine, ovarian, urethral, anal or rectal cancer, radiation therapy to the pelvis for any cancer/malignancy, or any active cancer/malignancy (except skin cancer) Non-ambulatory (participant confined to bed or wheelchair) Persistent pelvic pain (defined as daily pelvic pain > 3 months) History of neurologic or end-stage diseases (e.g. cerebral vascular accident (CVA), Parkinson's disease, multiple sclerosis, epilepsy, spinal cord tumor or trauma, spina bifida, symptomatic herniated disc) Previous treatment or current participation in a research study for UI, including surgery or formal behavioral treatment (pelvic floor muscle training, biofeedback, pelvic floor electrical stimulation, percutaneous tibial nerve stimulation, sacral neuromodulation, botox or other periurethral injection) Currently taking urinary incontinence or overactive bladder medications History of other urinary conditions or procedures that may affect continence status (e.g. urethral diverticula, previous augmentation cystoplasty or artificial urinary sphincter; implanted nerve stimulators for urinary symptoms) Participation in any drug/device research study. Pelvic organ prolapse protruding past the introitus (at rest or persisting after strain) Evidence of urinary tract infection (UTI) by urine dipstick (leukocytes +1 or greater, nitrites +1 or greater, leukocytes alone (w/o nitrites) +2 or greater, or presence of hematuria > +1). Participants may be re-screened after treatment with antibiotics or if hematuria work-up is negative. History of 2 or more recurrent UTI's within the past year; more than one UTI within past 6 months Post void residual urine volume 150 cc or more. Unstable medical condition (as determined by site PI) -

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group Behavioral Treatment<br>Participants will attend a group behavioral treatment class and follow-up visits. | Behavioral: Group Behavioral Treatment<br>* Group Behavioral Treatment class is a two hour class taught by certified interventionist covering urinary system anatomy, bladder health and self management strategies, pelvic floor training, pelvic floor muscle contracting techniques, and bladder training. Slides and handouts supplement the content of the class.<br>|
| No Intervention: No Treatment<br>Subjects will not attend group behavioral treatment class. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Group Behavioral Treatment Effectiveness as Shown by Changes From Baseline to 3 Months in Urinary Incontinence Severity. | The primary outcome is the self-reported urinary incontinence severity as measured by the International Consultation on Incontinence questionnaire-short form (ICI-Q). This short and simple questionnaire is used to screen for incontinence (urine leakage) to obtain a brief yet comprehensive summary of the level, impact and perceived cause of symptoms of incontinence. The ICI-Q consists of four questions and numeric scales: 1. How much do you leak urine? (0-5); never - all the time, 2. How much urine do you usually leak? (0-6); none - large amount, 3. Overall, how much does leaking urine interfere with your everyday life? (0-10); not at all - a great deal, 4. When does urine leak? Multiple choices. The ICI-Q score is the sum of questions 1-3 and ranges from 0-21. The higher the score, the greater severity of incontinence. Baseline data is compared to the 3 month data for the primary outcome. | Baseline and 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Group Behavioral Treatment Cost-effectiveness | Measure resource use and utilities and compare the difference in incontinence management costs and utilities between treatment and control group. | 12 months |