Urinary incontinence (UI) is prevalent and morbid in the elderly, and its associated costs exceed $26 billion annually. Although effective therapy exists, it is underutilized. This is particularly true for non-pharmacologic therapies, which are at least as effective as drugs but safer, and recommended as the initial approach by every national panel. If therapies such as biofeedback (which targets pelvic muscles and detrusor suppression) are to become more widely used, they will require simplification, fewer and briefer sessions, less expensive equipment, and less sophisticated therapists. Unfortunately, such protocols cannot yet be devised because it is unknown which components are essential. We postulate that the mechanisms mediating effectiveness can be identified and that such knowledge will make it possible to enhance efficacy and to formulate more feasible and cost-effective protocols. Since reduction in UI correlates weakly with improved quality of life, however, it is important that biofeedback's impact on life quality be assessed concomitantly to ensure that formulation of such streamlined methods does not eliminate components essential for improved quality of life, even if they have no physiological correlates. We will address these issues by treating 175 elderly subjects with urge UI in an 8-week course of biofeedback. We will collect clinical and quality of life data and perform extensive physiologic testing on each subject at baseline and 8 weeks later. Improvement will be correlated with change in physiologic and quality of life parameters to identify the parameters that likely mediated it. Knowledge from this study should identify predictors and mechanisms mediating success of biofeedback; suggest ways that it could be further improved; facilitate development of less expensive, quicker, and more feasible protocols to deliver it (potentially permitting application to less motivated and cognitively intact patients); and shed insight into mechanisms that may even improve efficacy of other interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG020629-04
Application #
7104173
Study Section
Special Emphasis Panel (ZRG1-GRM (01))
Program Officer
Yancik, Rosemary
Project Start
2003-09-30
Project End
2008-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
4
Fiscal Year
2006
Total Cost
$326,274
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Tyagi, Shachi; Perera, Subashan; Clarkson, Becky D et al. (2017) Nocturnal Polyuria in Older Women with Urge Urinary Incontinence: Role of Sleep Quality, Time in Bed and Medications Used. J Urol 197:753-758
Griffiths, Derek; Clarkson, Becky; Tadic, Stasa D et al. (2015) Brain Mechanisms Underlying Urge Incontinence and its Response to Pelvic Floor Muscle Training. J Urol 194:708-15
Riley, Mary Alyce; Organist, Linda (2014) Streamlining biofeedback for urge incontinence. Urol Nurs 34:19-26
Resnick, Neil M; Perera, Subashan; Tadic, Stasa et al. (2013) What predicts and what mediates the response of urge urinary incontinence to biofeedback? Neurourol Urodyn 32:408-15
Tadic, Stasa D; Tannenbaum, Cara; Resnick, Neil M et al. (2013) Brain responses to bladder filling in older women without urgency incontinence. Neurourol Urodyn 32:435-40
Tadic, Stasa D; Griffiths, Derek; Schaefer, Werner et al. (2012) Brain activity underlying impaired continence control in older women with overactive bladder. Neurourol Urodyn 31:652-8
Sorbero, Melony E; Saul, Melissa I; Liu, Hangsheng et al. (2012) Are geriatricians more efficient than other physicians at managing inpatient care for elderly patients? J Am Geriatr Soc 60:869-76
Griffiths, Derek J (2011) Use of functional imaging to monitor central control of voiding in humans. Handb Exp Pharmacol :81-97
Fowler, Clare J; Griffiths, Derek J (2010) A decade of functional brain imaging applied to bladder control. Neurourol Urodyn 29:49-55
Tadic, Stasa D; Griffiths, Derek; Schaefer, Werner et al. (2010) Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency urinary incontinence severity. J Urol 183:221-8

Showing the most recent 10 out of 22 publications