title: A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care.
abstract: OBJECTIVE
  To assess preliminary effects of a program of transcutaneous posterior tibial nerve stimulation (TPTNS) on lower urinary tract symptoms and number of episodes of urinary and fecal incontinence in older adults in residential care homes and the feasibility of a full-scale randomized trial.
  
  
  METHODS
  Pilot randomized single-blind, placebo-controlled trial.
  
  
  METHODS
  Seven residential care homes and 3 sheltered accommodation complexes in the United Kingdom.
  
  
  METHODS
  Thirty care home residents aged 65 and older with urinary or bowel symptoms and/or incontinence.
  
  
  METHODS
  Twelve 30-minute sessions of TPTNS or sham stimulation (placebo).
  
  
  METHODS
  Lower urinary tract symptoms using American Urological Society Symptom Index, urinary incontinence using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), postvoid residual urine volumes using portable bladder scanning, bowel symptoms and fecal incontinence using selected ICIQ questions.
  
  
  RESULTS
  Total American Urological Society Symptom Index scores improved, showing a median reduction of 7 (interquartile range [IQR] -8 to -3) in the TPTNS group and a median increase in the sham stimulation (placebo) group of 1 (IQR -1 to 4) (Mann-Whitney U 16.5000, Z -3.742, P < .001). Total ICIQ-SF scores improved by a median of 2 (IQR -6 to 0) in the TPTNS group and 0 points (IQR -3 to 3) in the sham stimulation group (Mann-Whitney U 65.000, Z -1.508, P = .132). Significant reduction was found in postvoid residual urine of 55 mL in the TPTNS group (t = -2.215, df 11.338, P = .048). Bowel urgency improved in 27% of the TPTNS group compared with 8% of the sham group (χ(2) 2.395, df 2, P > .302), fecal leakage improved in 47% of the TPTNS group compared with 23% of the sham group (χ(2) 4.480, df 2, P > .106); however, these differences were not significant. No adverse effects were reported by older adults or care staff.
  
  
  CONCLUSIONS
  TPTNS is safe and acceptable with evidence of potential benefit for bladder and bowel dysfunction in older male and female residents of care homes. Data support the feasibility of a substantive trial of TPTNS in this population.
authors.affiliation: Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, Scotland. jo.booth@gcu.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: Booth
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hagen
authors.forename: Doreen
authors.initials: D
authors.lastname: McClurg
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
authors.forename: Carolyn
authors.initials: C
authors.lastname: MacInnes
authors.forename: Brigitte
authors.initials: B
authors.lastname: Collins
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.forename: Debbie
authors.initials: D
authors.lastname: Tolson
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005240:Feasibility Studies; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D017060:Patient Satisfaction; D010865:Pilot Projects; D011788:Quality of Life; D016037:Single-Blind Method; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom