Enhancing Non-Pharmacologic Therapy for Incontinence

描述(申请人提供)：尿失禁(UI)在老年人中很普遍和病态，每年相关成本超过260亿美元。虽然存在有效的治疗方法，但它没有得到充分利用。对于非药物疗法尤其如此，这种疗法至少与药物一样有效，但更安全，并被每个国家小组推荐为最初的方法。如果生物反馈(针对骨盆肌肉和逼尿肌抑制)等疗法要得到更广泛的应用，它们将需要简化、更少和更短的疗程、更便宜的设备和不那么老练的治疗师。不幸的是，目前还不能设计出这样的协议，因为还不知道哪些组件是必不可少的。我们假定，调停效力的机制是可以确定的，而且这种知识将使提高效力和制定更可行和更具成本效益的议定书成为可能。然而，由于UI的减少与生活质量的改善相关性较弱，因此重要的是同时评估生物反馈对生活质量的影响，以确保这种简化方法的制定不会消除提高生活质量所必需的组成部分，即使它们没有生理相关性。我们将通过对175名老年受试者进行为期8周的生物反馈治疗来解决这些问题。我们将收集临床和生活质量数据，并在基线和8周后对每个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联，以确定可能调节它的参数。这项研究的知识应该确定生物反馈成功的预测因素和机制；提出可以进一步改进的方法；促进开发更便宜、更快和更可行的方案来提供生物反馈(潜在地允许应用于动机较差和认知功能完整的患者)；并洞察甚至可能提高其他干预措施有效性的机制。

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.