title: Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial.
abstract: OBJECTIVE
  We examined whether an intervention combining pelvic floor muscle exercise and symptom self-management would improve urinary continence and quality of life in patients with prostate cancer.
  
  
  METHODS
  In a randomized, controlled, longitudinal clinical trial 279 patients with prostate cancer with persistent urinary incontinence were randomized to 1 of 3 groups, including biofeedback pelvic floor muscle exercise plus a support group, the biofeedback exercise plus telephone contact and usual care without intervention. The biofeedback plus support and plus telephone groups received 1 session of biofeedback assisted exercise and 6 biweekly sessions of problem solving therapy. This delivered symptom management skills through a peer support group or telephone contacts for 3 months. All subjects were assessed in blinded fashion at baseline, and 3 and 6 months for urinary leakage frequency, leakage amount and disease specific quality of life.
  
  
  RESULTS
  A total of 244 subjects completed the study. The biofeedback plus support and biofeedback plus telephone groups had a lower frequency of daily urinary leakage than the group with usual care without intervention at 3 months (p=0.019 and p≤0.001, respectively) but not at 6 months. The biofeedback plus support group but not the biofeedback plus telephone group had 13.3 gm lower leakage at 6 months than the usual care group (p=0.003). Overall the biofeedback plus support and plus telephone groups reported less symptom severity (p≤0.001) and fewer incontinence problems (p≤0.01) than the usual care group at 6 months.
  
  
  CONCLUSIONS
  Study findings show that pelvic floor muscle exercise practice plus symptom self-management in a peer support setting can significantly improve urinary continence and quality of life in patients with prostate cancer.
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, Ohio. Electronic address: Amy.Zhang@case.edu.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Department of Urology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; Urology Clinic, Cleveland, Ohio.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Bodner
authors.affiliation: Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, D.C.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.affiliation: Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Gunzler
authors.affiliation: Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Klein
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Denise
authors.initials: D
authors.lastname: Kresevic
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Shirley
authors.initials: S
authors.lastname: Moore
authors.affiliation: Department of Urology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Lee
authors.initials: L
authors.lastname: Ponsky
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Purdum
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Gerald
authors.initials: G
authors.lastname: Strauss
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio; Urology Clinic, Cleveland, Ohio.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
mesh_terms: D000368:Aged; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D059952:Pelvic Floor Disorders / Q000628:therapy*; D011340:Problem Solving; D011471:Prostatic Neoplasms / Q000628:therapy*; D011613:Psychotherapy; D011788:Quality of Life; D012017:Referral and Consultation; D012648:Self Care; D012657:Self-Help Groups; D013689:Telephone; D014549:Urinary Incontinence / Q000628:therapy*
keywords: exercise; pelvic floor; prostatic neoplasms; quality of life; urinary incontinence