Outcome reporting in randomized controlled trials (RCTs) on the pharmacological management of idiopathic overactive bladder (OAB) in women; a systematic review for the development of core outcome sets (COS)

The effect of conservative non-pharmacological interventions on the management of urinary incontinence in older adults living with frailty: Systematic review and meta-analysis

BACKGROUND

Urinary incontinence (UI) is highly prevalent among older adults with frailty, impacting function, quality of life and risk of long-term care admission.

OBJECTIVE

To systematically review and synthesise the results of randomised controlled trials (RCTs) investigating the effect of conservative non-pharmacological interventions on the management of UI in older adults aged ≥ 65 years living with frailty.

METHODS

Five databases (Cochrane Library, Medline (EBSCO), CINAHL (EBSCO), Embase (OVID), PsycINFO (EBSCO)) were searched from inception to April 2024 for RCTs that evaluated conservative non-pharmacological interventions for UI in older adults living with frailty. Two independent reviewers screened records, assessed methodological quality using the Cochrane Risk of Bias (RoB 2.0) Tool and Level of Evidence was summarised using GRADE guidelines. A meta-analysis using a random-effects model or narrative synthesis were performed as appropriate.

RESULTS

Twelve RCTs, including 1,580 participants, with medium to high risk of bias were included. Conservative non-pharmacological interventions (categorised as single component or multicomponent interventions) resulted in a non-statistically significant reduction of objective measures of UI (6 RCTs, g = -0.39, p = 0.090; pooled effect size, with CI = -0.39 [-0.832, 0.060], I2 = 85.26%, with very low certainty of evidence). Improvements in functional ability were not found to be statistically significant (5 RCTs, g = 0.20, p = 0.39, pooled effect size, with CI = 0.20 [- 0.251, 0.642], I2 = 85.87%, and very low certainty of evidence). The interventions did not result in adverse events. Studies did not evaluate caregiver quality of life.

CONCLUSIONS

Very low-quality evidence found that conservative non-pharmacological interventions had beneficial but not statistically significant effects on objective UI and functional ability. Due to the high incidence of intervening illnesses and mortality in older adults living with frailty, it is recommended that future studies assess the effect of implementing tailored interventions addressing modifiable risk factors using more appropriate study design and outcome measures.

REGISTRATION

This review was prospectively registered on the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022316287; https://www.crd.york.ac.uk/prospero/).

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade after Approval: A Single-Blind Study to Evaluate the Reduction in Pain in OnabotulinumtoxinA Detrusor Injection Using Different Injection Needles

Overactive bladder (OAB) has a significant impact on the quality of life; thus, it requires treatment that can be adhered to over a long period without undue side effects. The current treatment which uses an anticholinergic or β-3 agonist may fail to improve symptoms and has side effects, leading to high discontinuation rates. OnabotulinumtoxinA (OnabotA) detrusor injection has been approved for idiopathic OAB as a second-line treatment with good effectiveness and tolerability. This study used a visual analog scale (VAS) to assess the impact of the type of needle used for OnabotA detrusor injections under local anesthesia on the pain levels after each injection. This study included 68 female patients. We used three different needles with thicknesses ranging from 22 to 27 gauge, lengths between 4 and 5 mm, and different cuts. The sensation of pain was rated at each standardized injection location. Regardless of the needle used, the patients' perceptions of pain at the beginning of the procedure were rated as being less than the subsequent injections. Most pain sensations were rated as low to moderate. The mean pain sensation on the VAS was 2.5 ± 0.3 overall, i.e., for all patients and needles used. Statistically significant differences in pain sensation were rated only at some locations of the bladder (on the back wall and the right side of the bladder). The single needles averaged the following pain scores: 2.8 ± 0.3 for needle A (20 G, 4 mm), 2.1 ± 0.3 for needle B (27 G, 5 mm), and 2.6 ± 0.4 for needle C (20 G, 4 mm, sharp cut 15°). The 27-gauge needle caused significantly less pain, and it had no negative impact due to its length, which was 1 mm longer than the other needles. Thus, the needle thickness was a decisive factor in the patients' perceptions of pain.

Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes

BACKGROUND

Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia.

METHODS

We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted.

RESULTS

Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92%) reported outcomes within the 'blood and lymphatic system' domain, followed by "adverse event" (77%) and "need for further resources" (77%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33%) of six prospective studies were registered prospectively of which one (17%) showed no signs of selective outcome reporting.

CONCLUSION

This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020214247.