Interventions for treating urinary incontinence after stroke in adults
Information
- DOI:
- https://doi.org/10.1002/14651858.CD004462.pub4Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 01 February 2019see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Incontinence Group
- Copyright:
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- Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Cited by:
Authors
Contributions of authors
LT: conceiving and designing the review, study screening, data extraction, assessment of risk of bias and writing of the review. LT acts as the guarantor of this review.
JC: study screening, data extraction, assessment of risk of bias and writing of the review.
LC: study screening, data extraction and assessment of risk of bias.
AT: translation of Chinese studies, interpretation of inclusion and exclusion criteria, data extraction and assessment of risk of bias.
CW: provided clinical input and contributed to constructing the review authors' conclusions.
Sources of support
Internal sources
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Faculty of Health and Wellbeing, University of Central Lancashire, UK.
External sources
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National Institute of Health Research (NIHR), UK.
This project was supported by the National Institute for Health Research, via Cochrane Incentive Scheme and Infrastructure funding to Cochrane Incontinence. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health. The NIHR is the largest single funder of Cochrane Incontinence.
Declarations of interest
LT: none known.
JC: none known.
LC: none known.
AT: none known.
CW: none known.
Acknowledgements
For the 2019 update of this review, we are grateful to David Bousfield, Fiona Campbell, Nicola Dean and Richard Lindley for valuable comments on drafts of this review. We would also like to acknowledge the help of Sheila Wallace (Cochrane Incontinence) and Joshua Cheyne (Cochrane Stroke) for kindly updating the searches of their Cochrane Specialised Registers, and to Susan Wieland (Cochrane Complementary Medicine) for finding papers for this version of the review. We would particularly like to thank Lindsey Elstub, Eugenie Johnson and Luke Vale for all their advice and guidance.
For previous versions of the review, we would like to thank the authors of the 2008 review for their contributions (Stephen Cross, James Barrett, Beverley French, Michael Leathley, Christopher J Sutton). We also wish to thank members of the editorial team in the Incontinence Review Group, in particular Sheila Wallace and Cathryn Glazener, and Hazel Fraser and Brenda Thomas from the Stroke Review Group. Our thanks also go to the Faculty of Health and Wellbeing of the University of Central Lancashire for supporting this review, to trial authors for kindly responding to our requests for information and to the members of the Stroke Incontinence Interest Group for their valuable comments. Thank you to Gui Li of the Shanghai Medical Military University and Luyan Fang of the University of Central Lancashire for kindly translating some of our included studies in the earlier version of this review
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Feb 01 | Interventions for treating urinary incontinence after stroke in adults | Review | Lois H Thomas, Jacqueline Coupe, Lucy D Cross, Aidan L Tan, Caroline L Watkins | |
| 2008 Jan 23 | Treatment of urinary incontinence after stroke in adults | Review | Lois H Thomas, Stephen Cross, James Barrett, Beverley French, Michael Leathley, Christopher J Sutton, Caroline Watkins | |
| 2005 Jul 20 | Prevention and treatment of urinary incontinence after stroke in adults | Review | Lois H Thomas, James Barrett, Stephen Cross, Beverley French, Michael Leathley, Chris Sutton, Caroline Watkins | |
| 2003 Oct 20 | Prevention and treatment of urinary incontinence after stroke in adults | Protocol | Lois H Thomas, James Barrett, Stephen Cross, Beverley French, Michael Leathley, Lynn Legg, Chris Sutton, Caroline Watkins | |
Differences between protocol and review
2019: This version of the review has been substantively modified to comply with current Cochrane recommendations, including full risk of bias assessment, the implementation of GRADE to assess the quality of the body of evidence and the development of 'Summary of findings' tables. The title of the review was updated to reflect current Cochrane standards. In addition, we made the following changes.
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The additional search of CINAHL was not updated, predominantly because both Specialised Register searches include CINAHL but also because this search did not yield additional studies for previous updates of the review.
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Additional searches of trials registries were not performed as the searches for both the Cochrane Stroke and Cochrane Incontinence Specialised Registers already cover a number of trials registries and platforms, including those specified in the Cochrane MECIR standards.
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Two previously included studies were excluded (Wikander 1998; Zhu 2003). Further inspection of these studies revealed participants were recruited within one month of stroke (acute phase), which is not covered by the scope of this review.
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Two secondary outcome measures originally listed in the protocol, economic outcomes and other outcomes, have now been removed.
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We have removed catheters and pads from the "physical aids" category of intervention; these are not designed to treat UI and catheters may be harmful.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Female; Humans; Male;
PICOs
PRISMA study flow diagram (2019 review update).
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Intervention versus no intervention/usual care, Outcome 1 Number of participants continent after treatment.
Comparison 1 Intervention versus no intervention/usual care, Outcome 2 Number of incontinent episodes in 24 hours (mean).
Comparison 1 Intervention versus no intervention/usual care, Outcome 3 Number of participants cured of all four urinary symptoms.
Comparison 1 Intervention versus no intervention/usual care, Outcome 4 Urinary symptoms – frequency (continuous variables).
Comparison 1 Intervention versus no intervention/usual care, Outcome 5 Urinary symptoms – frequency (dichotomous variables).
Comparison 1 Intervention versus no intervention/usual care, Outcome 6 Urinary symptoms – urgency.
Comparison 1 Intervention versus no intervention/usual care, Outcome 7 Urinary symptoms – nocturia (continuous variables).
Comparison 1 Intervention versus no intervention/usual care, Outcome 8 Urinary symptoms – nocturia (dichotomous variables).
Comparison 1 Intervention versus no intervention/usual care, Outcome 9 Physical measures: mean function of the pelvic floor muscle.
Comparison 1 Intervention versus no intervention/usual care, Outcome 10 Health status and quality of life – health status, mean total score 36‐Item Short Form.
Comparison 1 Intervention versus no intervention/usual care, Outcome 11 Health status and quality of life – quality of life.
Comparison 1 Intervention versus no intervention/usual care, Outcome 12 Functional ability – mean Barthel score (continuous variables).
Comparison 1 Intervention versus no intervention/usual care, Outcome 13 Participant satisfaction ‐ numbers who were dissatisfied.
Comparison 2 Intervention versus placebo, Outcome 1 Number of participants continent after treatment.
Comparison 2 Intervention versus placebo, Outcome 2 Number of incontinent episodes – mean per day.
Comparison 2 Intervention versus placebo, Outcome 3 Number of incontinent episodes – mean per week.
Comparison 2 Intervention versus placebo, Outcome 4 Health status and quality of life – quality of life.
Comparison 4 Combined intervention versus single intervention, Outcome 1 Number of participants continent after treatment.
Comparison 4 Combined intervention versus single intervention, Outcome 2 Number of incontinent episodes – mean.
Comparison 5 Specific intervention versus attention control, Outcome 1 Number of participants continent after treatment.
| Behavioural interventions compared with usual care or no treatment for treating urinary incontinence after stroke | ||||||
| Patient or population: people with stroke and urinary incontinence Settings: hospital, clinic or home Intervention: behavioural interventions Comparison: no treatment/usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Intervention | |||||
| Number of participants continent after treatment | Study population | — | — | — | Not reported | |
| — | — | |||||
| Number of incontinent episodes | The mean number of incontinent episodes in the control group was 1.2 | The mean number of incontinent episodes in the intervention group was 0.2 | MD –1.00 (–2.74 to 0.74) | 18 participants (1) | ⊕⊕⊝⊝ | Outcome reported descriptively for Tibaek 2017: the reported number of UI episodes per 24 hours was very small (intervention 0 at post‐test and 1 at follow‐up; control 0 at post‐test, 0 at follow‐up). |
| Perception of improvement or cure | — | — | — | — | — | Not reported |
| Health status and quality of life | The mean quality of life score ranged across control groups from 39.08 to 47 | The mean quality of life score in the intervention groups was | SMD –0.91 (–1.50 to –0.32) | 55 participants (2) | ⊕⊕⊝⊝ | — |
| Functional ability | — | — | — | — | — | Not reported |
| Adverse events | — | — | — | — | — | Not reported. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; SMD: standardised mean difference; UI: urinary incontinence. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded by one level for study design (allocation concealment unclear), and by one level for imprecision: fewer than 100 participants. bDowngraded by one level for study design (allocation concealment unclear in 2/2 trials in the meta‐analysis), and by one level for imprecision: fewer than 100 participants in both studies. | ||||||
| Specialised professional input interventions compared with usual care or no treatment for treating urinary incontinence after stroke | ||||||
| Patient or population: people with stroke and urinary incontinence Settings: hospital, clinic or home Intervention: specialised professional input Comparison: no treatment/usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Intervention | |||||
| Number of participants continent after treatment ‐ three months | 354 per 1000 | 453 per 1000 | RR 1.28 (0.81 to 2.02) | 121 participants (1) | ⊕⊕⊕⊝ | — |
| Number of incontinent episodes | — | — | — | — | — | Not reported |
| Perception of improvement or cure | — | — | — | — | — | Not reported |
| Health status and quality of life | — | — | — | — | — | Not reported |
| Functional ability | — | — | — | — | — | Not reported |
| Adverse events | — | — | — | — | — | Not reported. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded by one level for study design (allocation concealment unclear). | ||||||
| Complementary therapy interventions compared with usual care or no treatment for treating urinary incontinence after stroke | ||||||
| Patient or population: people with stroke and urinary incontinence Settings: hospital, clinic or home Intervention: complementary therapy Comparison: no treatment/usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Intervention | |||||
| Number of participants continent after treatment | Study population | RR 2.82 (1.57 to 5.07) | 524 participants (5) | ⊕⊕⊝⊝ | — | |
| 193 per 1000 | 544 per 1000 | |||||
| Number of incontinent episodes | — | — | — | — | — | Not reported |
| Perception of improvement or cure | — | — | — | — | — | Not reported |
| Health status and quality of life | — | — | — | — | — | Not reported |
| Functional ability | — | — | — | — | — | Not reported |
| Adverse events | — | — | — | — | See comment | Song 2013: 45/136 (33%) in the intervention group had bruises on arms and torso with full recovery; 17/136 (13%) had abdominal pain post‐acupuncture with resolution after warm compress; no other adverse effects noted. Chu 1997; Liu 2006; Zhang 2002; Zhou 1999: unclear |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for study design (random sequence generation unclear in 3/5 trials in the meta‐analysis; allocation concealment unclear in 5/5 trials), and by one level for imprecision: 3/5 studies fewer than 100 participants. | ||||||
| Physical therapy interventions compared with usual care or no treatment for treating urinary incontinence after stroke | ||||||
| Patient or population: people with stroke and urinary incontinence Settings: hospital, clinic or home Intervention: physical therapy Comparison: no treatment/usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Intervention | |||||
| Number of participants continent after treatment | — | — | — | — | — | Not reported |
| Number of incontinent episodes | The mean number of incontinent episodes ranged across control groups from 0.74 to 3.51 | The mean number of incontinent episodes in the intervention groups was 1.61 to 4.69 | MD –4.76 (–8.10 to –1.41) | 142 participants (2 studies (1 3‐arm study)) | ⊕⊕⊝⊝ | — |
| Perception of improvement or cure | — | — | — | — | — | Not reported |
| Health status and quality of life | — | — | — | — | — | Not reported |
| Functional ability: mean Barthel score (continuous variables) | The mean Barthel score was 52.5 in the control groups | The mean Barthel score in the intervention groups was 57.9 to 65.8 | MD 8.97 (1.27 to 16.68) | 81 participants (1 × 3‐arm study) | ⊕⊕⊕⊝ | — |
| Adverse events | — | — | — | — | — | Not reported |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for study design (random sequence generation unclear in 1/2 trials in the meta‐analysis; allocation concealment unclear in 1/2 trials), and one level for imprecision: 2/2 studies fewer than 100 participants. bDowngraded one level for imprecision: fewer than 100 participants. | ||||||
| Study IDs | Continent prior to stroke | Diagnostic criteria for assessment of incontinence as reported by study authors | Description of participant incontinence by study authors |
| Yes | Not reported | At least once weekly | |
| Unclear | Yes (structured 1‐hour assessment by continence nurse practitioner) | Self‐reported clinical symptoms of leakage several times per month or more, frequency every ≥ 30 minutes, nocturia, urgency | |
| Unclear | Not reported | Not reported | |
| Yes | Yes (according to "neurological disease syndrome") | According to "neurological disease syndrome" neurogenic bladder with incontinence | |
| Unclear | Not reported | Normal urodynamic studies with incontinence | |
| Unclear | Not reported | Bladder hyper‐reflexia | |
| Yes | Yes (OABSS) | Post‐stroke urinary incontinence | |
| Unclear | Not reported | Mild or severe incontinence | |
| Unclear | Not reported | Post‐stroke urge urinary incontinence | |
| Yes | Yes (Barthel Index – continence item) | Completely incontinent, partially incontinent and self‐controlling | |
| Yes | Yes (urodynamic assessment) | Post‐stroke detrusor overactivity | |
| Yes | Yes (OABSS) | Post‐stroke urinary incontinence | |
| Yes | Yes (OABSS) | Post‐stroke urinary incontinence | |
| Yes | Yes (Barthel Index – Bladder item) | Post‐stroke neurogenic overactive bladder | |
| Yes | Yes (Bristol Female Urinary Symptoms Questionnaire) | Post‐stroke stress urinary incontinence | |
| Yes | Not reported | Post‐stroke urinary incontinence | |
| Yes | Yes (ICS definition) | Post‐stroke urinary incontinence | |
| Yes | Yes (ICS definition) | Lower urinary tract symptoms | |
| Unclear | Not reported | Post‐stroke urinary incontinence | |
| Unclear | Not reported | Post‐stroke urinary incontinence | |
| Unclear | Not reported | Post‐stroke urinary incontinence | |
| ICS: International Continence Society; OABSS: Overactive Bladder Symptom Score. | |||
| Study IDs | Stroke history of participants (any previous stroke) | Stroke diagnostic information provided by study authors | Stroke description of study participants |
| Not reported | According to WHO 1989 criteria | Ischaemic (87.8%) Haemorrhagic (10.2%) Other (2%) | |
| Not reported | Postal screening questionnaire – self‐report | Not reported | |
| Not reported | Not reported | Multi‐focal cerebral infarction | |
| First or repeated episode of stroke | According to the Fourth National Conference on Cerebrovascular Disease | Ischaemic (73%) Haemorrhagic (27%) | |
| Not reported | Not reported | Unilateral stroke | |
| Not reported | Not reported | Unilateral stroke | |
| Not reported | Not reported | Ischaemic (77%) Haemorrhagic (23%) | |
| Not reported | Not reported | Cerebrovascular accidents | |
| Not reported | Not reported | Ischaemic (78.2%) Haemorrhagic (21.8%) | |
| Not reported | Not reported | Ischaemic (80%) Haemorrhagic (20%) | |
| Not reported | Confirmation by CT or MRI scan | Ischaemic (45.5%) Haemorrhagic (54.5%) | |
| Not reported | Not reported | Ischaemic (72.8%) Haemorrhagic (27.2%) | |
| Not reported | Not reported | Ischaemic (72.8%) Haemorrhagic (27.2%) | |
| Not reported | Clinical and neuroimaging evaluation according to established criteria of Brazilian Cerebrovascular Disease Society | Ischaemic (100%) | |
| Not reported | Not reported | Not reported | |
| Not reported | According 1995 National Meeting on Cerebrovascular Accidents | Ischaemic (49.5%) Haemorrhagic (50.5%) | |
| First ever stroke | According to WHO 1989 criteria | Ischaemic (100%) | |
| 16.7% had 1 previous stroke | According to WHO 1989 criteria | Not reported | |
| Not reported | Confirmation by CT or MRI scan | Ischaemic and Haemorrhagic, figures not reported. | |
| Not reported | Not reported | Ischaemic (100%) | |
| Not reported | According to criteria from Chinese Diagnostic Guidelines | Ischaemic (66.3%) Haemorrhagic (33.7%) | |
| CT: computed tomography; MRI: magnetic resonance imaging. | |||
| Study IDs | Primary outcome(s) | Measured by | Secondary outcome(s) | Measured by |
| Number of incontinent episodes | ICIQ‐UI‐SF | Severity | ICIQ‐UI‐SF | |
| Urinary symptoms | AUASI* | |||
| Urgency perception scores | Bladder diary | |||
| Postvoid residual volume | Bladder scan | |||
| Quality of life | EQ‐5D‐5L ICIQLUTSqol | |||
| Adverse events | Participant reports | |||
| ADL | Barthel Index | |||
| Number of people incontinent | Nurse assessment and self‐report | Urinary symptoms Satisfaction with service | Nurse assessment and self‐report | |
| Number regaining continence | Not reported | None reported | — | |
| Number of people incontinent | Urinary Continence Status Grading (4 categories) | Severity | Urinary Continence Status Grading (4 categories) Participant reports | |
| Urinary symptoms | Clinical aggregate score | |||
| Adverse events | Not reported | |||
| Number of incontinent episodes per day for each month of treatment for 1 year | Not reported | None reported | — | |
| Number of incontinent episodes per day for each month of treatment for 1 year | Not reported | None reported | — | |
| Primary outcome not stated | — | Urinary symptoms | OABSS | |
| ADL | Barthel Index | |||
| Number of incontinent episodes per week | Not reported | None reported | — | |
| Number of incontinent episodes | Not reported | — | — | |
| Number of incontinent episodes daytime and night‐time, urinary symptoms | Barthel Index – continence item | — | — | |
| Maximum cystometric capacity, bladder compliance, detrusor leak point pressure. Number of incontinence episodes per day, urinary symptoms | Urodynamic assessment according to AUA/SUFU guidelines | None reported | — | |
| Primary outcome not stated | — | Number of incontinent episodes, urodynamic assessment, voiding diary | OABSS | |
| ADL | Barthel Index | |||
| Primary outcome not stated | — | Number of incontinent episodes, urodynamic assessment, voiding diary | OABSS | |
| ADL | Barthel Index | |||
| Primary outcome not stated | — | Urinary symptoms | Barthel Index (Bladder item) | |
| Primary outcome not stated | — | Contractility and muscle activity of the pelvic floor muscle | Perineometer and pelvic floor electromyography | |
| Urinary symptoms | Bristol Female Lower Urinary Tract Symptoms Questionnaire | |||
| Primary outcome not stated | — | Urinary symptoms | Scoring of urinary symptoms control score (0 = totally controlled, 1 = partial control, 2 = fully no control) | |
| Postvoid residual urine | Bladder scan | |||
| Number of incontinent episodes, number of pads used, frequency 24‐hour home pad test | 3‐day voiding diary | Vaginal palpation of PFM | Physical examination | |
| Urinary symptoms, frequency and severity | DAN‐PSS‐1 questionnaire | Digital anal palpation of PFM | Physical examination | |
| Frequency, number of incontinence episodes, number of pads used | 3‐day voiding diary | Health status | SF‐36 | |
| 24‐hour pad test | Pad test | |||
| Number of people with urinary incontinence | Not reported | — | — | |
| Number of people with urinary incontinence | Not reported | — | — | |
| Number of people with urinary incontinence | Not reported | — | — | |
| ADL: activities of daily living; AUASI: American Urological Association Symptom Index; AUA/SUFU: American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines; DAN‐PSS‐1: Danish Prostatic Symptom Score; EQ‐5D‐5L: EuroQol Five‐Dimensional Questionnaire; ICIQLUTSqol: International Consultation on Incontinence Questionnaire ‐ Lower Urinary Tract Symptoms Quality of Life; ICIQ‐UI‐SF: International Consultation on Incontinence Questionnaire‐Urinary Incontinence‐Short Form; OABSS: Overactive Bladder Symptom Score; PFM: pelvic floor muscle; SF‐36: 36‐Item Short Form Survey. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants continent after treatment Show forest plot | 6 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1 Professional input interventions | 1 | 121 | Risk Ratio (M‐H, Random, 95% CI) | 1.28 [0.81, 2.02] |
| 1.2 Complementary therapy interventions | 5 | 524 | Risk Ratio (M‐H, Random, 95% CI) | 2.82 [1.57, 5.07] |
| 2 Number of incontinent episodes in 24 hours (mean) Show forest plot | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2.1 Behavioural interventions | 1 | 18 | Mean Difference (IV, Random, 95% CI) | ‐1.0 [‐2.74, 0.74] |
| 2.2 Physical therapy interventions | 3 | 142 | Mean Difference (IV, Random, 95% CI) | ‐4.76 [‐8.10, ‐1.41] |
| 3 Number of participants cured of all four urinary symptoms Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.1 Specialised professional input interventions | 1 | 143 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.55 [0.97, 2.48] |
| 4 Urinary symptoms – frequency (continuous variables) Show forest plot | 6 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 4.1 Behavioural interventions | 2 | 48 | Mean Difference (IV, Random, 95% CI) | ‐1.71 [‐3.02, ‐0.40] |
| 4.2 Complementary therapy interventions | 1 | 62 | Mean Difference (IV, Random, 95% CI) | ‐5.57 [‐7.00, ‐4.14] |
| 4.3 Physical therapy interventions | 3 | 142 | Mean Difference (IV, Random, 95% CI) | ‐2.83 [‐5.75, 0.09] |
| 5 Urinary symptoms – frequency (dichotomous variables) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1 Specialised professional input interventions | 1 | 187 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.93 [0.82, 1.05] |
| 6 Urinary symptoms – urgency Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.1 Specialised professional input interventions | 1 | 188 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.89, 1.24] |
| 7 Urinary symptoms – nocturia (continuous variables) Show forest plot | 5 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 7.1 Behavioural interventions | 2 | 48 | Mean Difference (IV, Random, 95% CI) | ‐0.38 [‐1.06, 0.29] |
| 7.2 Complementary therapy interventions | 2 | 256 | Mean Difference (IV, Random, 95% CI) | ‐1.76 [‐4.49, 0.96] |
| 7.3 Physical therapy interventions | 1 | 61 | Mean Difference (IV, Random, 95% CI) | ‐1.52 [‐1.73, ‐1.31] |
| 8 Urinary symptoms – nocturia (dichotomous variables) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1 Specialised professional input interventions | 1 | 186 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.86, 1.07] |
| 9 Physical measures: mean function of the pelvic floor muscle Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 9.1 Behavioural interventions | 1 | 23 | Mean Difference (IV, Fixed, 95% CI) | 0.10 [‐0.48, 0.68] |
| 10 Health status and quality of life – health status, mean total score 36‐Item Short Form Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 10.1 Behavioural interventions | 1 | 24 | Mean Difference (IV, Fixed, 95% CI) | ‐28.0 [‐169.66, 113.66] |
| 11 Health status and quality of life – quality of life Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 11.1 Behavioural interventions | 2 | 55 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.99 [‐2.83, 0.86] |
| 12 Functional ability – mean Barthel score (continuous variables) Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 12.1 Physical therapy interventions | 2 | 81 | Mean Difference (IV, Random, 95% CI) | 8.97 [1.27, 16.68] |
| 13 Participant satisfaction ‐ numbers who were dissatisfied Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 13.1 Specialised professional input interventions | 1 | 154 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.17, 0.59] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants continent after treatment Show forest plot | 1 | 54 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.75 [0.19, 3.04] |
| 2 Number of incontinent episodes – mean per day Show forest plot | 1 | 39 | Mean Difference (IV, Fixed, 95% CI) | ‐1.10 [‐3.99, 1.79] |
| 3 Number of incontinent episodes – mean per week Show forest plot | 1 | Paired samples mean (Random, 95% CI) | ‐3.88 [‐8.47, 0.70] | |
| 3.1 Oestrogen vs placebo (mild incontinence) | 1 | Paired samples mean (Random, 95% CI) | ‐1.71 [‐3.51, 0.09] | |
| 3.2 Oestrogen vs placebo (severe incontinence) | 1 | Paired samples mean (Random, 95% CI) | ‐6.4 [‐9.47, ‐3.33] | |
| 4 Health status and quality of life – quality of life Show forest plot | 1 | 30 | Mean Difference (IV, Fixed, 95% CI) | 3.90 [‐4.25, 12.05] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants continent after treatment Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 Sensory‐motor biofeedback device + timed voiding vs timed voiding alone | 1 | 23 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.55 [0.06, 5.21] |
| 2 Number of incontinent episodes – mean Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.1 Sensory‐motor biofeedback device + timed voiding vs timed voiding alone | 1 | 23 | Mean Difference (IV, Fixed, 95% CI) | 2.2 [0.12, 4.28] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of participants continent after treatment Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 TPTNS versus stretching exercises | 1 | 24 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.38, 4.72] |
