Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial

• Type of Material: Article
• Authors: Camille Vaughan, Emory University; Jorge Juncos, Emory University; Lisa Muirhead, Emory University; Theodore Johnson II, Emory University; Kathryn L. Burgio, Birmingham/Atlanta VA Geriatric Research Education and Clinical Center; Patricia S. Goode, Birmingham/Atlanta VA Geriatric Research Education and Clinical Center; Gerald McGwin, Birmingham/Atlanta VA Geriatric Research Education and Clinical Center; Alayne D. Markland, Birmingham/Atlanta VA Geriatric Research Education and Clinical Center
• Language: English
• Date: 2019-08-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/nau.24052
• Title of Journal or Parent Work: NEUROUROLOGY AND URODYNAMICS
• Volume: 38
• Issue: 6
• Start Page: 1737
• End Page: 1744
• Grant/Funding Information: Funding provide by a United States Department of Veterans Affairs Rehabilitation Research & Development career development award IK2 RX 000747–01 and the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000454.
• Keywords: Parkinson's disease; behavioral therapy; Urology & Nephrology; overactive bladder; MOCA; DRUG-TREATMENT; MEN; INCONTINENCE; FALLS; urinary incontinence; DETRUSOR OVERACTIVITY; Science & Technology; Life Sciences & Biomedicine; BLADDER
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

Aim: Determine the efficacy of behavioral therapy for urinary symptoms in Parkinson's disease. Methods: Randomized trial of behavioral therapy compared with control condition among adults (aged 54-85 years, 74% male, 10% Black/ 83% White) with Parkinson's and greater than or equal to 4 incontinence episodes weekly. Behavioral therapy included pelvic floor muscle exercises, bladder training, fluid and constipation management. Both groups completed bladder diary self-monitoring. Outcomes included diary-derived incontinence and ICIQ-overactive bladder (OAB) score (range, 0-16) with bother and quality of life questionnaires (higher scores = worse outcomes). Results: Fifty-three participants randomized and 47 reported 8-week outcomes including 26 behavioral therapy and 21 control. Behavioral vs control participants were similar with respect to age (71.0 ± 6.1 vs 69.7 ± 8.2 years), sex (70% vs 78% male), motor score, cognition, mean weekly incontinence episodes (13.9 ± 9.6 vs 15.1 ± 11.1) and OAB symptoms (8.9 ± 2.4 vs 8.3 ± 2.2). Weekly incontinence reduction was similar between behavioral (−6.2 ± 8.7) and control participants (−6.5 ± 13.8) (P = 0.89). After multiple imputation analysis, behavioral therapy participants reported statistically similar reduction in OAB symptoms compared to control (−3.1 ± 2.8 vs −1.9 ± 2.2, P = 0.19); however quality of life (−22.6 ± 19.1 vs −7.0 ± 18.4, P = 0.048) and bother (−12.6 ± 17.2 vs − 6.7 ± 8.8, P = 0.037) improved significantly more with behavioral therapy. Conclusion: Self-monitoring resulted in fewer urinary symptoms; however, only multicomponent behavioral therapy was associated with reduced bother and improved quality of life. Providers should consider behavioral therapy as initial treatment for urinary symptoms in Parkinson's disease.