[Managing urinary incontinence in stroke rehabilitation--a review].
BACKGROUND
Urinary incontinence following stroke is an extensive problem for the patients and their relatives that influences the well-being and care in the future. There are a lot of therapeutic interventions available, their effectiveness, however, is not known in detail. For rehabilitation practice the ongoing question is how Urinary Incontinence (UI) can best be treated in a way that the patients daily life is not compromised.


METHODS
The search for clinical trials was carried out in PubMed, CINAHL, and Cochrane Library, restricted to German and English papers published between 1989 and April 2005. Medical, nursing and physiotherapeutic interventions for treating UI after stroke were described and analysed.


RESULTS
The clinical trials were divided into process-oriented trials and those looking at individual interventions. The process trials could be divided into three different groups with an overall success of 82-95 %, 50-56 % and 23-36 % respectively. Behavioral methods (caregiver-induced, patient-active and other interventions) and medical interventions are available. The studies of the most successful group include staff education and application of interventions based on an assessment procedure and a guideline. No clinical trial on individual interventions reached a result like the process-oriented studies.


CONCLUSIONS
For treating urinary incontinence a multimodal approach is necessary: special education of the nurses, applying and acting in a problem-solving process, for example in the Rehabilitation Cycle and delivering care based on an assessment procedure and guidelines. Development of a guideline for treating urinary incontinence after stroke can be recommended. Further research in the efficacy of individual interventions is needed.
Wilbert-Herr
I S
IS
Leistungszentrum für neurologische und muskuloskelettale Rehabilitation, Zürcher Höhenklinik Wald, 8639 Wald-Faltigberg, Switzerland. pflegeexpertin.id@zhw.ch
Hürlimann
U
U
Imhof
L
L
Wilbert
D M
DM
D015897:Comorbidity; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011788:Quality of Life; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000534:rehabilitation*