Enhancing Non-Pharmacologic Therapy for Incontinence

加强失禁的非药物治疗

• 批准号: 6925355
• 负责人: NEIL M. RESNICK
• 金额: $ 33.41万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6925355
• 关键词: alternative medicine; behavioral /social science research tag; biofeedback; clinical chemistry; clinical research; clinical trials; data collection methodology /evaluation; exercise; female; human old age (65+); human subject; human therapy evaluation; muscle contraction; operant conditionings; proprioception /kinesthesia; quality of life; stimulus /response; urinary incontinence; urinary tract motility /pressure; women' s health

DESCRIPTION (provided by applicant): Urinary incontinence (UI) is prevalent and morbid in the elderly, and its associated costs exceed $26 billion annually. Although effective therapy exists, it is underutilized. This is particularly true for non-pharmacologic therapies, which are at least as effective as drugs but safer, and recommended as the initial approach by every national panel. If therapies such as biofeedback (which targets pelvic muscles and detrusor suppression) are to become more widely used, they will require simplification, fewer and briefer sessions, less expensive equipment, and less sophisticated therapists. Unfortunately, such protocols cannot yet be devised because it is unknown which components are essential. We postulate that the mechanisms mediating effectiveness can be identified and that such knowledge will make it possible to enhance efficacy and to formulate more feasible and cost-effective protocols. Since reduction in UI correlates weakly with improved quality of life, however, it is important that biofeedback's impact on life quality be assessed concomitantly to ensure that formulation of such streamlined methods does not eliminate components essential for improved quality of life, even if they have no physiological correlates. We will address these issues by treating 175 elderly subjects with urge UI in an 8-week course of biofeedback. We will collect clinical and quality of life data and perform extensive physiologic testing on each subject at baseline and 8 weeks later. Improvement will be correlated with change in physiologic and quality of life parameters to identify the parameters that likely mediated it. Knowledge from this study should identify predictors and mechanisms mediating success of biofeedback; suggest ways that it could be further improved; facilitate development of less expensive, quicker, and more feasible protocols to deliver it (potentially permitting application to less motivated and cognitively intact patients); and shed insight into mechanisms that may even improve efficacy of other interventions.

描述（由申请人提供）：尿失禁（UI）在老年人中普遍存在且病态，其相关费用每年超过260亿美元。虽然存在有效的治疗方法，但未得到充分利用。对于非药物治疗尤其如此，这些治疗至少与药物一样有效，但更安全，并被每个国家小组推荐为初始方法。如果生物反馈（针对盆腔肌肉和逼尿肌抑制）等疗法要得到更广泛的应用，它们将需要简化、更少和更简短的疗程、更便宜的设备和更简单的治疗师。不幸的是，这样的协议还不能设计，因为它是未知的，哪些组件是必不可少的。我们假设，调解的有效性的机制，可以确定，这种知识将有可能提高疗效，并制定更可行的和具有成本效益的协议。然而，由于UI的减少与生活质量的改善相关性较弱，因此必须同时评估生物反馈对生活质量的影响，以确保此类简化方法的制定不会消除对改善生活质量至关重要的成分，即使它们没有生理相关性。我们将通过治疗175名老年受试者在8周的生物反馈过程中的敦促UI来解决这些问题。我们将收集临床和生活质量数据，并在基线和8周后对每例受试者进行广泛的生理测试。改善将与生理和生活质量参数的变化相关，以确定可能介导的参数。本研究的知识应确定生物反馈成功的预测因素和介导机制;建议进一步改善的方法;促进开发更便宜、更快、更可行的协议来交付它（可能允许应用于动机较低和认知完整的患者）;并深入了解甚至可能提高其他干预措施疗效的机制。