Streamlining biofeedback for urge incontinence.

The aim of this study was to determine the important elements of biofeedback-assisted pelvic floor muscle exercises to treat urge incontinence. Urge suppression and pelvic floor muscle exercises were most beneficial. Responders can be identified early in treatment, allowing for fewer sessions.

What predicts and what mediates the response of urge urinary incontinence to biofeedback?

AIMS: To better target a behavioral approach for urge urinary incontinence (UUI) and enhance its efficacy by (1) identifying predictors of response to biofeedback-assisted pelvic muscle training (BFB), and (2) determining factors that mediate response. METHODS: BFB (four biweekly visits) was administered to 183 women > 60 years (mean = 73.6). Before and after intervention, all underwent comprehensive evaluation and videourodynamic testing. Postulated predictors and mediators from four urodynamic domains, specified a priori, were correlated with reduction in UUI frequency. RESULTS: Median UUI frequency decreased from 3.2/day to 1/day (P =0.0001). UUI improved by ≥50% in 55% of subjects and by 100% in 13% of subjects. Frequent UUI predicted poor response (P < 0.01). Of the urodynamic parameters, only high amplitude and briskness of detrusor overactivity (DO) predicted decreased response (P < 0.05 and P < 0.01) and these could be measured only in the 43% of subjects with elicitable DO. Decreased DO elicitability was the only urodynamic variable that changed in concert with improvement and thus was a candidate mediator. Response was neither predicted nor mediated by proprioception/warning, cystometric capacity, detrusor contractility, sphincter strength, or baseline DO elicitability. CONCLUSIONS: Severe DO predicts poor response to BFB. Good response is mediated by reduction in DO elicitability. Other than baseline UUI frequency, there are no other clinically or urodynamically important predictors or mediators of BFB response in this population. BFB may be best for patients with less severe DO. Future research to enhance its efficacy might better focus on the brain than on the lower urinary tract.

Optimizing Medication Adherence in Older Patients: A Systematic Review.

OBJECTIVE: To review the literature on strategies to optimize medication adherence in community-dwelling older adults and to make recommendations for clinical practice. METHODS: A systematic literature search was conducted using the MEDLINE, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and EMBASE databases for randomized controlled trials examining strategies to optimize medication adherence in patients aged 65 or older prescribed long-term medication regimens. Additional studies were found by examining the reference lists of systematic reviews and selected papers. 34 papers reporting on 33 studies met the eligibility criteria and were included in this review. RESULTS: Improvement in adherence was mixed across the studies examining educational interventions, with only 12 of the 28 studies showing improvement in adherence; most were delivered by pharmacists. Effect sizes for the statistically significant educational interventions ranged from Cohen's d = 0.14 to 4.93. Four of the 5 interventions using memory aids and cues, some in conjunction with newer technologies, improved adherence. Effect sizes for the statistically significant interventions using memory aids and cues ranged from Cohen's d = 0.26 to 2.72. CONCLUSION: The evidence from this review does not clearly support one single intervention to optimize medication adherence in older patients. Future studies should explore suggestive strategies, such as tailored interventions involving ongoing contact, and should endeavor to correct methodologic weaknesses found in the literature.