title: Behavioral therapy to treat urinary incontinence in Parkinson disease.
abstract: OBJECTIVE
  To assess the feasibility and efficacy of exercise-based behavioral therapy to treat urinary incontinence (UI) in older adults with Parkinson disease (PD).
  
  
  METHODS
  Participants with PD ≥50 years with ≥4 UI episodes on a 7-day bladder diary were recruited from movement disorders clinics. In 5 visits over 8 weeks, participants learned pelvic floor muscle exercises using computer-assisted EMG biofeedback, and bladder control strategies including urge suppression. Bladder diaries were used to reinforce techniques and monitor the primary outcome of UI frequency. Secondary outcomes included additional reporting of lower urinary tract symptoms, symptom bother, and quality of life (QOL) using the International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB).
  
  
  RESULTS
  Twenty participants were enrolled (90% male, age 66.5 ± 6.2 [mean ± SD], with PD for 6.9 ± 5.4 years) and 17 completed the study. The median (interquartile range) weekly frequency of baseline UI episodes was 9 (4-11) and following intervention was 1 (0-3), representing an 83.3% reduction (45.5-100.0, p = 0.0001). QOL scores on the ICIQ-OAB improved from 71.1 ± 23.9 to 54.7 ± 15.4 (p = 0.002).
  
  
  CONCLUSIONS
  In this uncontrolled pilot study of an exercise-based, biofeedback-assisted behavioral intervention, older participants with PD demonstrated statistically significant and clinically meaningful reductions in frequency of UI and improvement in QOL. Randomized controlled trials to assess behavioral therapies for UI in patients with PD are warranted.
  
  
  METHODS
  This study provides Class IV evidence that exercise-based, biofeedback-assisted behavioral intervention can reduce UI frequency in patients >50 years old with PD.
authors.affiliation: Atlanta VA Medical Center, Decatur, GA 30033, USA. camille.vaughan@emory.edu
authors.forename: C P
authors.initials: CP
authors.lastname: Vaughan
authors.forename: J L
authors.initials: JL
authors.lastname: Juncos
authors.forename: K L
authors.initials: KL
authors.lastname: Burgio
authors.forename: P S
authors.initials: PS
authors.lastname: Goode
authors.forename: R A
authors.initials: RA
authors.lastname: Wolf
authors.forename: T M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058765:Neurofeedback / Q000379:methods; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000150:complications; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*