Effects Of Cognitive Behavioural Intervention On Patients With Overactive Bladder:a Randomized Controlled Trial

Objective:1. To develop cognitive behavioural intervention strategy for overactive bladder (OAB) patients on the basis of Health Belief Model (HBM).2. To explore the effects of cognitive behavioural intervention on OAB symptoms, bother and quality of life by conducting an empirical study.Methods:It was an randomized controlled study (RCT). After the cognitive behavioural intervention strategy for OAB patients was developed on the basis of Health Belief Model,104 OAB patients were enrolled from two hospitals in Ji’nan and then randomly divided into an intervention group (51 cases) and a control group (53 cases). The intervention group were treated with cognitive behavioural intervention for six weeks combined with an manual, while patients in the control group were given the manual only. The outcome measures of Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), Overactive Bladder Questionnaire Short Form (OAB-q SF), MOS 12-item Short Form Health Survey (SF-12), Toileting Behavior Scale (TB) and Treatment Benefit Scale (TBS) were evaluated before the intervention (To), at the end of a six-week intervention (T1), three month after intervention (T2) and six month after intervention (T3). The general information were described by using percentage, frequency, mean and standard deviation. Repeated measures analysis of variance and t-test were used to analyze the effects of intervention. P<0.05 was considered statistically significant.Results:1.The baseline results showed that:(1) The mean (SD) score of OABSS, increased daytime frequency, nocturia, urgency, urgency incontinence, PPBC, OAB-q SF symptom-bother scale, OAB-q SF HR-QOL scale, SF-12 physical function score (PCS), SF-12 mental function score (MCS) were 8.13(2.45),0.45(0.57),2.28(0.85),3.19(1.05),2.20(1.32),3.13(1.30), 39.39 (26.56),71.66(21.24),40.30(8.92),50.04(8.83) respectively, while the number of mild OAB, moderate OAB, severe OAB were 17,76,11, respectively.(2) The mean (SD) score of place preference for voiding domain, premature voiding domain, delay voiding domain, straining voiding domain were 2.17(1.21), 2.96(0.88),1.96(0.70),1.77(1.09), respectively, and the mean (SD) score of position preference for voiding domain was 1.97(0.79) for female OAB patients.(3) No significantly difference was found in the comparison between the intervention group and the control group (P>0.05)2.Patients’participation in this study:(1) At the end of six-week intervention,47 in the control group and 46 in the intervention group with an retention of 89.4%, at the end of the second follow-up,42 for each group with an retention of 80.8%.(2) No significantly difference was found in the comparison between the lost follow-up and these objects who completed the study.(3) The attendance of intervention was high, with 84.3% of the patients in the intervention group attended at least 5 times.3.The treatment results showed that:(1) The treatment benefit was high, with 44(95.7%) patients thought their urinary problem had improved or greatly improved,2(4.3%) patients thought not changed and none worsened during intervention.(2) Repeated measure analysis of variance showed that the main intervention effect and time effect on OABSS, urgency, urgency incontinence, PPBC, OAB-q SF, place preference for voiding domain, premature voiding domain, and delay voiding domain was significant (P<0.05); the main intervention effect on straining voiding domain, position preference, nocturia, SF-12 physical function score (PCS) and SF-12 mental function score (MCS) was not significant, while the main intervention effect and time effect on increased daytime frequency were both not significant (P>0.05); there was significant interaction between intervention and time on all the outcome measures and interaction diagrams showed that the increase or decrease degree of outcome measures was different between two groups.(3) The results of t-test comparing the outcome measures at different times in both groups indicated that there was no significant difference on delay voiding domain, position preference for voiding domain, straining voiding domain, increased daytime frequency, nocturia, SF-12 physical function score (PCS), and SF-12 mental function score (MCS) at T1 (P>0.05), the scores of other outcome measures were significantly different between two groups at T1 (P<0.05); there was no significant difference on straining voiding domain and SF-12 mental function score (MCS) at T2, and there was no significant difference on nocturia and SF-12 mental function score (MCS) at T3 (P>0.05), other outcome measures were significantly different between the two groups at T2 and T3 (P<0.05).(4) The comparison of the scores of the outcome measures in intervention group at T0、T1、T2、T3 showed that there was no significant difference in OABSS in T2、T3; no significant difference in increased daytime frequency, nocturia in T、T2, T2、T3,T1、T3, no significant difference in urgency incontinence in T2、T3; no significant difference in OAB-q SF symptom-bother scale and OAB-q SF HR-QOL scale in T2、T3; no significant difference in SF-12 physical function score (PCS) in T1、T2、T2、3, T1、T3, no significant difference in SF-12 mental function score (MCS) in T1、 T3, T2、T3;no significant difference in place preference for voiding domain in T0、T1,T1、T2,T2、T3; no significant difference in premature voiding domain in T1、 T2, T2、T3,T1、T3; no significant difference in delay voiding domain in T2、T3, no significant difference in straining voiding domain in T1、T2, T2、T3,T1、T3, no significant difference in position preference for voiding domain in T0、T1, T1、T2, T2、 T3,T1、T3(P>0.05).Conclusion:1.There were many problems existing in OAB patient’ toileting behavior, premature voiding was the biggest problem; among OAB symptoms, urgency was the most severe symptom, followed by nocturia and urgency incontinence; OAB patients had symptom bother and their quality of life was affected.2. The cognitive behavioural intervention based on HBM caused significant decrease in patients’ unhealthy toileting behavior, especially in place preference for voiding domain, premature voiding domain and delay voiding domain, but not for the straining voiding domain and position preference for voiding domain.3. The cognitive behavioural intervention based on HBM caused significant decrease in patients’OABSS, especially in urgency and urgency incontinence; and caused decrease in patients’PPBC, and at last caused increase in patients’quality of life, proving that the cognitive behavioural intervention is simple, effective, and can be accepted by OAB patients.