All patients self-manage their pelvic health to some extent or the other. The problem is that some commonly used self-management techniques are at best ineffective, and at worst, potentially harmful. Empowering patients to self-manage in an evidence-based fashion is an important goal for all pelvic health specialists.
At ICS 2016, Drs Tannenbaum, Brown, Wilde and Agnew will review the theory and evidence behind efficient and cost-effective self-management practices for a variety of pelvic floor disorders, and will share personal tips and tricks from their own clinical experience and their research for how to identify patients most likely to succeed at self-management. The Round Table is entitled Self-Management Evidence and Practice Round Table Discussion and will take place, Thursday 15th September from 08:35-09:35.
Dr. Tannenbaum is a geriatrician and women’s health specialist who has led several research studies on the self-management of urinary incontinence among older women. “When I promote the self-management of lower urinary tract symptoms, I only use proven, evidence-based risk factor modification strategies.” She believes that use of the bladder diary is an essential component of self-monitoring. She also speaks enthusiastically about the importance of building and measuring self-efficacy in her patients, “Self-efficacy is the confidence an individual has in their ability to perform a task. Self-efficacy is measured on a scale of 0 (no way in the world I can do that!) to 10 (absolutely, I am 100% certain that I can complete that task). Our research has shown that a change in 5-points on the Geriatric Self-Efficacy for Urinary Incontinence Scale is associated with mild improvement in incontinent symptoms, and a 14-point change is predictive of significant improvement.” Findings from her clinical trials suggest that self-management strategies can be synergistic when combined with other continence promotion techniques in older, community-dwelling women.
Dr. Brown is a urogynecologist in the United States (US) whose focus is improving access to effective strategies to improve bowel continence. Using Dr. Tannenbaum’s urinary continence promotion programme as a springboard, Dr. Brown’s team has adapted a continence promotion programme for US women to include information and self-management strategies to improve both bowel and bladder continence. Many of the strategies for self-management of bladder and bowel dysfunction are similar, such as normalising fluid intake, preventing constipation, coordinating and strengthening the pelvic floor muscles, avoiding triggers, and addressing medications that may be exacerbating symptoms. In addition, helping women identify ways to achieve their recommended daily fibre intake to improve stool consistency is a key component of self-management of bowel dysfunction. Guided by Dr. Tannenbaum’s self-efficacy framework, women are encouraged to identify personal goals based on their individual symptoms, set concrete plans for how they will meet and maintain those goals, evaluate the success of those plans, and redirect if necessary. Dr. Brown is currently pilot-testing an adapted version of Dr. Tannenbaum’s “Dare to Age Well” workshop entitled “Mind Over Matter; Healthy Bowels, Healthy Bladder,” and will share lessons learned from that process thus far.
Dr Rona Agnew is a Registered General Nurse and Service Manager in Scotland, UK. Faced with growing cost pressures on the caring services, with containment costs and the older population increasing, the team used evidence from a previous cluster, randomised controlled trial as the basis for a pilot. This pilot delivered behavioural interventions and modification educational groups to all eligible women with bladder symptoms referred to a continence service. Pre and post outcome measures, along with service indicators such as waiting times, attendance rates, reduced containment costs and patient satisfaction, were assessed. This resulted in a service redesign and refocused the service efforts on exploring more treatment options thus reducing the need for containment. This treatment approach to continence care has shown improved patient clinical outcomes, reducing the need for containment use and thus has reduced the deficit spend in this area of care. Waiting times have fallen to 4-6 weeks, having been in excess of 18 weeks, ‘did not attend’ rates have fallen from 77 per cent to less than 25 per cent with a positive impact on uptake to the behavioural intervention groups, demonstrated by a 99 per cent satisfaction score in the patient satisfaction survey.
Mary Wilde, PhD, RN, is a professor from the University of Rochester, USA. An RCT in 202 adults with long-term indwelling urinary catheters is described. The self-management intervention involved four contacts with a study nurse, including 3 home visits, over a 4 month period. The experimental group participants were taught to increase awareness and self-monitoring of their own patterns of urine flow and to modify self-management behaviour as needed. Main group differences were tested through GEE for repeated measures. Catheter blockage decreased significantly in the first six months of the study but not over the 12 months. CAUTI did not differ by group. However, rates showed that both groups improved significantly in decreased CAUTI and catheter blockage. Data collection functioned as an unintended self-monitoring intervention by using a calendar to improve recall in bimonthly phone call interviews. Blockage decreases in the experimental group in the first 6 months indicate that the intervention effect could extend with more coaching and support. Testing the model through SEM suggested that increased confidence (self-efficacy) about fluids can increase self-management about fluids and decrease the frequency of catheter blockage, but not whether blockage occurred or not. CAUTI was not affected by self-efficacy or self-management of fluid intake. More research focusing on people with frequent blockages is indicated.
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