title: Effectiveness of continence promotion for older women via community organisations: a cluster randomised trial.
abstract: OBJECTIVE
  The primary objective of this cluster randomised controlled trial was to compare the effectiveness of the three experimental continence promotion interventions against a control intervention on urinary symptom improvement in older women with untreated incontinence recruited from community organisations. A second objective was to determine whether changes in incontinence-related knowledge and new uptake of risk-modifying behaviours explain these improvements.
  
  
  METHODS
  71 community organisations across the UK.
  
  
  METHODS
  259 women aged 60 years and older with untreated incontinence entered the trial; 88% completed the 3-month follow-up.
  
  
  METHODS
  The three active interventions consisted of a single 60 min group workshop on (1) continence education (20 clusters, 64 women); (2) evidence-based self-management (17 clusters, 70 women); or (3) combined continence education and self-management (17 clusters, 61 women). The control intervention was a single 60 min educational group workshop on memory loss, polypharmacy and osteoporosis (17 clusters, 64 women).
  
  
  METHODS
  The primary outcome was self-reported improvement in incontinence 3 months postintervention at the level of the individual. The secondary outcome was change in the International Consultation on Incontinence Questionnaire (ICIQ) from baseline to 3-month follow-up. Changes in incontinence-related knowledge and behaviours were also assessed.
  
  
  RESULTS
  The highest rate of urinary symptom improvement occurred in the combined intervention group (66% vs 11% of the control group, prevalence difference 55%, 95% CI 43% to 67%, intracluster correlation 0). 30% versus 6% of participants reported significant improvement respectively (prevalence difference 23%, 95% CI 10% to 36%, intracluster correlation 0). The number-needed-to-treat was 2 to achieve any improvement in incontinence symptoms, and 5 to attain significant improvement. Compared to controls, participants in the combined intervention reported an adjusted mean 2.05 point (95% CI 0.87 to 3.24) greater improvement on the ICIQ from baseline to 3-month follow-up. Changes in knowledge and self-reported risk-reduction behaviours paralleled rates of improvement in all intervention arms.
  
  
  CONCLUSIONS
  Continence education combined with evidence-based self-management improves symptoms of incontinence among untreated older women. Community organisations represent an untapped vector for delivering effective continence promotion interventions.
  
  
  BACKGROUND
  ClinicalTrials.gov ID number NCT01239836.
authors: Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada.
authors: Cara
authors: C
authors: Tannenbaum
authors: Rona
authors: R
authors: Agnew
authors: Andrea
authors: A
authors: Benedetti
authors: Doneal
authors: D
authors: Thomas
authors: Eleanor
authors: E
authors: van den Heuvel