The ISQ-P tool: measuring stress associated with incontinence

Technology-assisted toilets: Improving independence and hygiene in stroke rehabilitation

Background and Purpose

Dependence on assistance for toileting is a widespread problem for persons receiving healthcare. Technology-assisted toilets, which hygienically wash and dry the perineal region, are devices that could improve toileting independence in a variety of patients. The objective was to investigate whether technology-assisted toilets improve toileting independence, quality of life, and whether technology-assisted toilets can provide sufficient toileting hygiene in stroke rehabilitation.

Methods

This pilot study was carried out in a stroke rehabilitation unit. Thirty participants were recruited. Participants had a bowel movement and cleaned themselves using the technology-assisted toilet on one to three occasions. Participants rated their toileting before using the technology-assisted toilet and after each technology-assisted toilet use with the Psychosocial Impact of Assistive Devices Scale (PIADS). After each session, participants were rated for cleanliness.

Results

PIADS scores were analyzed from eight individual participants, five of whom completed the full protocol. PIADS scores were significantly higher with the technology-assisted toilet than with the participants’ regular toileting routine (p < 0.05). Technology-assisted toilets cleaned effectively in 73% of cases (16/22, p < 0.05).

Conclusion

Technology-assisted toilets improved stroke patients’ psychosocial outcomes compared to standard toileting and completely cleaned participants in the majority of cases. A larger study should confirm technology-assisted toilet’s benefit in stroke rehabilitation through improved independence and hygiene.

Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients

PURPOSE

This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability.

METHOD

This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIM^Ⓡ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables.

RESULT

The multiple logistic regression analysis showed that the FIM^Ⓡ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points.

CONCLUSION

Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.

Approaches for improving the toileting problems of hemiplegic stroke patients with poor standing balance

[Purpose] Our objective was to evaluate the residual dynamic and static functionality in the sitting position of hemiplegic stroke patients who require help to pull their lower garments up and down during toileting. [Subjects and Methods] The subjects were 11 hemiplegic patients. We gathered data on the patients’ motor paralysis, sensory capacity, lower extremity muscle strength, trunk control, ability to roll and sit up from a lying position, sitting balance, and ability to pull the lower garments up and down. We then compared 2 groups: those able to pull the lower garments up and down independently while standing (the “independent group”), and those who were unable to do so (the “non-independent group”). [Results] Though the non-independent group had severely and significantly reduced trunk control and abilities as a whole, there was no significant difference from the independent group in static and dynamic sitting balance. [Conclusion] We conclude that, to enable hemiplegic patients with poor standing balance to pull their lower garments up and down, it is necessary to do these maneuvers in a sitting, rather than a standing, position, or to develop garments that are easier to put on and take off.

Improved underpants to reduce toileting problems in patients with poor standing balance

[Purpose] We developed and assessed improved underpants allowing patients to easily and completely open the crotch by pulling upward a string on the back of the underpants while seated. [Subjects and Methods] Healthy subjects tested commercial open-crotch underpants for disabled people and our improved open-crotch underpants by opening the crotch while seated. Measurement parameters included the percentage of crotch opening and the degree of genital or anal exposure before and after opening the crotch, as well as fit. The percentage of crotch opening and the degree of genital or anal exposure were recorded with a digital camera, and fit was determined with a visual analog scale. The measurements for both types of underpants were then compared. [Results] The commercial underpants for disabled people allowed opening of the crotch while seated, but the exposure of the genital and anal areas was insufficient to allow waste elimination. The improved underpants allowed sufficient opening of the crotch while seated and adequately exposed the genital and anal areas. The fit score of the improved underpants was significantly better than that of the commercial underpants. [Conclusion] The improved open-crotch underpants may allow for more effective opening of the crotch while seated than commercial open-crotch underpants for disabled people.

A review of quality-of-life questionnaires for urinary incontinence and overactive bladder: which ones to use and why?

Overactive bladder (OAB) and stress urinary incontinence have a profound impact on patients' health-related quality of life (HRQL). The purpose of this article is to identify and describe condition-specific HRQL measures validated among patients with symptoms of OAB or stress urinary incontinence. A Medline literature search was performed to identify published articles or abstracts focusing on the development and psychometric validation of relevant instruments. Target populations and psychometric properties (reliability, validity, responsiveness to change) of 16 questionnaires are reviewed. A range of well-validated, condition-specific HRQL measures are available. Recommendations are provided regarding which measures to use in different situations. When choosing among instruments, psychometric evidence and the match of an instrument to the study population should be considered.

Urinary incontinence in women under 65: quality of life, stress related to incontinence and patterns of seeking health care

OBJECTIVE

We sought to describe quality of life, psychological stress and patterns of seeking health care (PSHC) among young and middle-aged women experiencing urinary stress incontinence (USI). Reasons and variables associated with delay in seeking care were also investigated.

METHODS

A sample of 131 patients, aged 22-65, filled out a questionnaire consisted of: SF-36, stress related to incontinence, patterns of seeking health care questionnaires and a 10 cm visual analogue scale (VAS) measuring perceived suffering from USI (0 indicating absence of suffering while 10 indicating most severe suffering).

RESULTS

Scores on eight domains of SF-36 were lower, compared to 405 Israeli healthy women (p < 0.001). Forty-one percent reported impairment in performing work and other activities. Mean scores on the VAS was 5.04 (SD: 2.59), 30% marked 7 cm and higher and 12.6% reported most severe suffering due to USI (scored 10 cm). Psychological stress related to incontinence was higher among the younger women and those with severe impairment to sexual activity. The majority of the sample (74%) delayed seeking help for at least a year, 46% delayed it for 3 years. Common reasons for delay were lack of time (36.3%), shame (15.7%) and fear of surgery (14.7%). Age, psychological stress, perceived suffering and social functioning (SF) were associated with patterns of seeking care.

CONCLUSIONS

USI causes suffering and impaired quality of life among young women. Reluctance to seek help highlights the need to promote women's knowledge of treatment options and cure prospects.

A review of condition-specific instruments to assess the impact of urinary incontinence on health-related quality of life

To date, severity of symptoms of urinary tract conditions, such as overactive bladder (OAB) and stress incontinence, have been the main indicators used to understand the burden on the patient. However, there is also an impact on patients' health-related quality of life (HRQoL) that should also be assessed. A literature search was conducted and all HRQoL instruments published in peer-reviewed journals were evaluated. Ten instruments were identified: general use (five); urinary urge (OAB) incontinence (four); and stress incontinence (one). Several were identified as valid instruments for assessing HRQoL in urinary incontinence patients.

Managing urinary incontinence in the nursing home: residents' perspectives

The purpose of this study was to develop a substantive theory describing and explaining cognitive, psychosocial, and behavioural aspects of living with urinary incontinence in a nursing home. Using grounded theory methodology, data were obtained from interviews, participant observation, and minutes from meetings of resident advisory councils, and analysed concurrently using the constant comparative method. Three nursing homes located in the metropolitan area of a major American city served as sites for the study. Ethical approval was obtained from the administrator of each facility and institutional review board of a major university. Ten residents served as primary participants, consenting to provide one audiotaped formal interview, subsequent opportunities to observe and discuss their methods of bladder control, and access to their health care records. Another 33 residents from these facilities served as secondary participants, providing opportunities for observation and informal interview when their bladder control needs, issues, or methods were visible to the investigator and seemed relevant to the evolving theory. Data were collected over a period of 17 months. Findings suggest that nursing home residents with actual or potential urinary incontinence engage in a process called managing urinary incontinence. Managing urinary incontinence occurs in the context of believing that it is an inevitable part of ageing and seeking to protect physical, psychological, and social integrity. Managing urinary incontinence is a dynamic process with consequences that are influenced by the degree to which six specific strategies are used with satisfaction by the resident and supported by staff and significant others. Implications for nursing practice and research are discussed.

A health-promotion perspective of urinary continence

The purposes of this article are to discuss continence in older adults from a public health perspective, to expand a previously reported conceptual model of continence health promotion, and to provide a primary prevention focus to nursing research efforts regarding continence. The conceptual model shows that there has been a strong interest in secondary and tertiary prevention strategies, but little interest in primary prevention. Use of the matrix allows the nurse researcher identify primary, secondary, or tertiary prevention research questions and the target population for study. Historically, nurses have had a central role in the care and management of incontinent people. Nurses will continue to play a critical role in the evolution of research-based practice that includes identification of risks, health promotion, and preventive nursing strategies.