1. 行為治療於尿失禁婦女之應用 Dissertation topic : Longitudinal Continence Outcomes for Rural Older Women Presented by Shu-Yuan Lin 林淑媛 Oct 15, 2005

2. 護理人是行動家？ 是藝術家？ 或兩者皆是？

3. 3 Major Results 研究目的：瞭解不同層次的行為治療、目標設定、目標 成就和治療強度在改善尿失禁的成效。 研究發現： –(1) 接受較高層次的行為治療婦女可顯著降低其在短期和長期的 漏尿次數和漏尿量； –(2) 接受較高層次的行為治療婦女在短期的目標成就上有顯著增 加； –(3) 目標成就最高組的婦女在追蹤期的第六個月和第十二個月的 漏尿次數和漏尿量有顯著降低； –(4) 接受較高治療強度的婦女在短期和追蹤期的第六個月和第十 二個月的漏尿次數和漏尿量有顯著降低； –(5) 接受較高治療強度的婦女在短期的目標成就表現較佳，且治 療強度最高組的婦女在追蹤期的第六、十二、十八和二十四個 月的目標成就表現進步最多。

4. Are you convinced of my work?

5. 研究簡介 這個二次分析研究是利用 Dougherty 等人的原始 研究資料來進行，原始研究共有 218 位婦女參加， 主要變項的資料收集發生在措施終止及每六個月 的追蹤期（持續兩年），在實驗組內，有 42 位婦 女接受過一個階段的治療， 51 位婦女接受過兩個 階段的治療， 16 位婦女接受過三個階段的治療； 控制組則有 99 位婦女她們並無接受過任何治療。 資料分析採描述性及推論性統計，結果報告以 Repeated-measures MANOVA 統計為主。

6. Research Questions and Conceptual Relationships Tested 5 research questions 5 proposed relationships –Levels of interventions → UI episodes, Grams of urine loss –Levels of interventions → goal achievement in the short term –Levels of goal achievement → UI episodes, Grams of urine loss in the long term –Levels of therapeutic intensity → UI episodes, Grams of urine loss –Levels of therapeutic intensity → Levels of goal achievement

7. Methods: Intervention protocol Primary study (Dougherty et al., 1998; 2002) –Home-based behavioral management for continence (BMC): 20-24 weeks Self-monitoring (2-4 weeks) Bladder training (6-8 weeks) PFME with biofeedback (12 weeks) Secondary study –Levels of interventions: 0(control), 1-3(BMC)

8. Methods: Measurements Time span: baseline, 6m, 12m, 18m, 24m Instruments Continence outcomes- bladder diary & pad test Quality of life- IIQ Perceived health & severity of UI- Cantril ladder scale Goal setting & goal achievement- Cantril ladder scale Therapeutic intensity- worksheet

9. Results:RQ1 Do women experiencing varied of levels of interventions (no intervention, a single phase, two or more phases of interventions) differ in terms of demographics, clinical characteristics, self- reported health, severity of UI and goal-setting at baseline? No significant differences (except for prior treatment)

10. Results:RQ2 Do women experiencing varied levels of interventions (1-3 phases) differ in their immediate continence outcomes and at 6-, 12-, 18- and 24-month follow ups? Short term- Reduction in UI episodes and grams of urine loss (greatest improvement in the 3-phase group). Significant differences in UI episodes at 6, 12, 18 and 24 months 1. UI episodes- 2 or more phase group improved the greatest at 6 and 12 months; one phase group improved the greatest at 18 and 24 months. Significant differences in grams of urine loss at 6 and 12 months 2. Grams of urine loss- 2 or more phase group improved the greatest at 6, 12, 18 and 24 months; control and one phase group worse.

11. Results: RQ3 Do levels of interventions have different effects on goal achievement immediately after treatment? –Significant increase in goal achievement (three-phase group gained the most) Do levels of goal achievement have different effects on continence outcomes at 6-, 12-, 18- and 24-month follow ups? Significant differences in UI episodes at 6, 12, 18 and 24 months 1. Reduction in UI episodes- high goal achievement group improved the greatest at 6 and 12 months (least at 18 and 24 months); low and moderate goal achievement groups improved the greatest at 18 and 24 months, respectively. Significant differences in grams of urine loss at 6, 12, 18 and 24 months 2. Decrease in grams of urine loss- high goal achievement group improved the greatest at 6 and 12 months; moderate goal achievement group improved the greatest at 18 and 24 months.

12. Results:RQ4 Do the levels of therapeutic intensity affect differently short term continence outcomes and at 6-, 12-, 18- and 24-month follow ups? –Short term- No significant differences Do levels of goal achievement have different effects on continence outcomes at 6-, 12-, 18- and 24-month follow ups? Significant differences in UI episodes at 6, 12, 18 and 24 months 1. Reduction in UI episodes- high therapeutic intensity group improved the greatest at 6 and 12 months; low therapeutic intensity group improved the greatest at 18 and 24 months. Significant differences in grams of urine loss at 6, 12, 18 and 24 months 2. Decrease in grams of urine loss- high therapeutic intensity group improved the greatest at 6 and 12 months; moderate therapeutic intensity group improved the greatest at 18 and 24 months.

13. Discussion Significance of UI research –Prevalence, risk factors, consequences, behavioral treatment What we still don’t know? –The effect of sequenced behavioral intervention on incontinence improvements –The effect of incorporate goal-setting to behavioral intervention on incontinence improvements –The effect of therapeutic intensity on incontinence improvements

14. Limitations Difficulty of sample retention Disproportion of minority participants No reliability test No rationale for cut-off criteria Limited scope of therapeutic intensity Potential bias of the control group

15. Suggestions: Future studies Control group Subjective and objective measures Rationale sufficiency of intervention Sample recruitment Facilitator: motivation, client-nurse interaction

16. Questions? Comments? Thanks for your attention!