Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up.
OBJECTIVE
To compare the efficacy and labour costs of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence.


METHODS
Single centre randomised controlled trial of patients with mild or moderate leakage.


METHODS
Tertiary urogynaecology unit.


METHODS
One hundred and forty-five consecutive patients with stress and/or urge incontinence.


METHODS
Standardised conservative therapy regimens, provided by nurse continence advisors and urogynaecologists.


METHODS
One-hour pad test, frequency volume charts, a 20-point incontinence score and two quality of life tests, staff treatment times and costs.


RESULTS
Of 110 women who completed 12-week treatments, 64% of the women in the nurse continence advisor group (n = 58) and 52% of women treated by urogynaecologists (n = 52) were asymptomatic (dry pad test; OR 1.63, 95% CI 0.71-3.75). There was no significant difference between clinician groups for change in pad test result (P = 0.71), voids/day (0.43), incontinence score (P = 0.57) or quality of life scores (urogenital distress inventory, P = 0.27; Incontinence Impact Questionnaire, P = 0.41). Despite the expected longer consultation times for the advisor group (median 160 min, interquartile range [IQR] 130-210) versus the urogynaecologist group (median 90 min, IQR 60-120), the per capita labour cost for advisor treatment (median AU$59.20, IQR 48.10-77.70) was lower than for treatment given by urogynaecologists (median cost AU$ 189.70, IQR 120.60-250.70, Mann-Whitney U test, P < 0.0001). At 2.5 years, 23/58 patients (40%) treated by advisor and 27/52 patients (52%) treated by urogynaecologist group, who had been cured and discharged, were available for contact. Of these, 29% of women in the nurse continence advisor group and 41% of those treated by urogynaecologists remained continent (on 20-point score). Quality of life improvement persisted equally in both groups. These data should be interpreted cautiously due to a 24% dropout rate.


CONCLUSIONS
The reduction in urine leakage and improvement in quality of life observed in patients treated by nurse continence advisors and urogynaecologists were similar at 12 weeks and 2 years, but lower costs arose from treatment provided by nurse advisors. We suggest that conservative treatment by the nurse continence advisor could be used more widely in mild to moderate incontinence.
Moore
K H
KH
Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, New South Wales 2217, Australia.
O'Sullivan
R J
RJ
Simons
A
A
Prashar
S
S
Anderson
P
P
Louey
M
M
D000368:Aged; D000553:Ambulatory Care; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal; D014549:Urinary Incontinence / Q000191:economics / Q000451:nursing* / Q000503:physiopathology; D014554:Urination / Q000502:physiology; D014932:Women's Health Services